Thorn G W
Harvard Medical School, Boston, USA.
N Engl J Med. 1966 Apr 7;274(14):775-81. doi: 10.1056/NEJM196604072741406.
Factors concerned with the institution of prolonged, nonspecific corticoid therapy are discussed in detail because of the seriousness of the complications that may occur and the magnitude of the clinical problem. Particular attention has been paid to the psychologic effects of ACTH and corticosteroid therapy with reference to the manner in which "habituation" to these agents may complicate the attempt to reduce or discontinue therapy at a later date. A plea is made to reassess regularly the possibility of effecting a reduction in dosage in all patients being maintained for prolonged periods on corticosteroids. Finally, a program is suggested that is based on physiologic concepts that may be employed when complete withdrawal of corticosteroid therapy is contemplated.
鉴于可能出现的并发症的严重性以及临床问题的规模,详细讨论了与长期非特异性皮质类固醇治疗的实施相关的因素。特别关注了促肾上腺皮质激素(ACTH)和皮质类固醇治疗的心理效应,涉及对这些药物的“习惯性”可能使日后减少或停止治疗的尝试变得复杂的方式。呼吁定期重新评估所有长期接受皮质类固醇治疗的患者减少剂量的可能性。最后,提出了一个基于生理学概念的方案,当考虑完全停用皮质类固醇治疗时可以采用。