Grbović Leposava, Radenković Miroslav
Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade.
Srp Arh Celok Lek. 2005 Oct;133 Suppl 1:67-73. doi: 10.2298/sarh05s1067g.
Pharmacotherapy of autoimmune thyroid disease (AITD) is complex. Apart from the replacement hormone therapy, antithyroid agents, beta adrenoceptor blockers and other drugs, in regard to the present symptoms, it also includes the administration of glucocorticoids and immunosuppressive agents. Physiological actions of glucocorticoids are significant in number, well known and described in details. The most prominent pharmacological properties of glucocorticoids, that are important fortheir clinical use, are antiinflammatory and immunosuppressive actions. In this article, the most notable clinical pharmacology aspects of glucocorticoids have been presented, including the basic principles of their therapeutic use, as well as the most important indications with the examples of dosing regiments (rheumatic disorders, renal diseases, allergic reactions, bronchial asthma, gastrointestinal inflammatory diseases, thrombocytopenia, organ transplantation, and Graves' ophthalmopathy). In addition, adverse and toxic effects of glucocorticoids as well as their interactions with other drugs have been described. Immunosuppressive agents have important role in treatment of immune disorders, including the reduction of immune response in autoimmune diseases and organ transplantation. Apart from glucocorticoids, immunosuppressive agents consist of calcineurin inhibitors (cyclosporine, tacrolimus), antiproliferative and antimetabolic agents (sirolimus, azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide), monoclonal antibodies: anti-CD3 antibody (muromonab-CD3), anti-CD25 antibody (daclizumab), anti-TNF-alpha antibody (infliximab). In this part, the most updated facts about mechanism of action, rational therapeutic use, as well as adverse and toxic effects of immunosuppressive agents have been reviewed.
自身免疫性甲状腺疾病（AITD）的药物治疗较为复杂。除了替代激素疗法、抗甲状腺药物、β肾上腺素能受体阻滞剂和其他药物外，针对当前症状，还包括糖皮质激素和免疫抑制剂的使用。糖皮质激素的生理作用众多，广为人知且有详细描述。糖皮质激素对其临床应用至关重要的最显著药理特性是抗炎和免疫抑制作用。本文介绍了糖皮质激素最值得注意的临床药理学方面，包括其治疗应用的基本原则，以及最重要的适应证和给药方案示例（风湿性疾病、肾脏疾病、过敏反应、支气管哮喘、胃肠道炎性疾病、血小板减少症、器官移植和格雷夫斯眼病）。此外，还描述了糖皮质激素的不良反应和毒性作用及其与其他药物的相互作用。免疫抑制剂在免疫紊乱的治疗中具有重要作用，包括降低自身免疫性疾病和器官移植中的免疫反应。除了糖皮质激素外，免疫抑制剂还包括钙调神经磷酸酶抑制剂（环孢素、他克莫司）、抗增殖和抗代谢药物（西罗莫司、硫唑嘌呤、霉酚酸酯、甲氨蝶呤、环磷酰胺）、单克隆抗体：抗CD3抗体（莫罗单抗-CD3）、抗CD25抗体（达利珠单抗）、抗TNF-α抗体（英夫利昔单抗）。在这部分内容中，对免疫抑制剂的作用机制、合理治疗应用以及不良反应和毒性作用的最新情况进行了综述。
