McDonough Allyson K, Curtis Jeffrey R, Saag Kenneth G
Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35213, USA.
Curr Opin Rheumatol. 2008 Mar;20(2):131-7. doi: 10.1097/BOR.0b013e3282f51031.
The introduction of glucocorticoid therapy by Dr Philip Hench in the 1950s revolutionized the treatment of rheumatic and inflammatory disease. These preparations remain an important component of therapy for a variety of diseases. As with any potent medication, however, they are not without side effects. Analysis of physician understanding and practice suggest that appreciation for the frequency and significant morbidity associated with glucocorticoids is poor. The purpose of this review is to provide an update on the most recent literature regarding glucocorticoid use and associated adverse events.
Recent studies suggest that adverse events such as weight gain, skin thinning, sleep disturbance and neuropsychiatric disorders may occur in patients taking glucocorticoids. Adverse events may occur even in low-dose therapy and appear to be dose and duration dependent. Glucocorticoid-induced osteoporosis is a potentially preventable complication but physician adherence to preventive guidelines is poor. New data reinforce the understanding that glucocorticoids significantly increase the risk of infection. There are strong data-driven concerns about the increased susceptibility of children and possibly even neonates to glucocorticoid-associated adverse events.
Glucocorticoid therapy, while important in the treatment of a variety of serious inflammatory diseases, causes significant morbidity among long term users.
20世纪50年代菲利普·亨奇医生引入糖皮质激素疗法，彻底改变了风湿性和炎性疾病的治疗方式。这些制剂仍然是多种疾病治疗的重要组成部分。然而，与任何强效药物一样，它们并非没有副作用。对医生的理解和实践进行分析表明，对糖皮质激素相关的频率和严重发病率的认识不足。本综述的目的是提供有关糖皮质激素使用及相关不良事件的最新文献的最新情况。
最近的研究表明，服用糖皮质激素的患者可能会出现体重增加、皮肤变薄、睡眠障碍和神经精神疾病等不良事件。即使在低剂量治疗中也可能发生不良事件，而且似乎与剂量和疗程有关。糖皮质激素诱导的骨质疏松症是一种潜在可预防的并发症，但医生对预防指南的依从性较差。新数据进一步强化了这样的认识，即糖皮质激素会显著增加感染风险。有强有力的数据表明，儿童甚至新生儿对糖皮质激素相关不良事件的易感性增加令人担忧。
糖皮质激素疗法虽然在治疗各种严重炎性疾病中很重要，但会给长期使用者带来显著的发病率。
