類固醇激素是一個很大的分類. 用於治療氣喘或過敏的類固醇. 通常是指皮質類固醇(Corticosteroids,CS). 除了皮質類固醇CS. 另一大類是性激素 (可參考維基百科-steroid hormone)
皮質類固醇CS用於氣喘的治療. 通常需要四小時才會出現效果, 口服類固醇(OCS)與靜脈注射類固醇效果差不多. 因此能吃藥的就不需要靜脈注射. 另外. 當發生急性全身性嚴重過敏反應 anaphylaxis 的時候, 類固醇不是最優先的藥物. 原因也是它的作用需要時間. 無法立即改善嚴重過敏的休克或呼吸道黏膜腫脹.
(參考資料 2014年Corticosteroids in the treatment of acute asthma)
Current guidelines recommend that patients with moderate exacerbation should receive three doses of inhaled or nebulized β2-agonist every 15-20 min in the 1st h.[22] Additional doses may be repeated in the next 2-3 h every 30-60 min. All those patients should be treated with systemic corticosteroids at a dose of 2 mg/kg or a maximum dose of 80 mg early in the course of management as it takes at least 4 h to start working.[23] Doses more than 80 mg will not confer any additional benefit. Systemic corticosteroids were found to speed resolution of symptoms, decrease the rate of admission and decrease the rate of relapse if administered for 3-5 days after the acute exacerbation. More detailed discussion about the use of systemic corticosteroids in the treatment of acute asthma can be found below.
Current guidelines recommend that patients with moderate exacerbation should receive three doses of inhaled or nebulized β2-agonist every 15-20 min in the 1st h.[22] Additional doses may be repeated in the next 2-3 h every 30-60 min. All those patients should be treated with systemic corticosteroids at a dose of 2 mg/kg or a maximum dose of 80 mg early in the course of management as it takes at least 4 h to start working.[23] Doses more than 80 mg will not confer any additional benefit. Systemic corticosteroids were found to speed resolution of symptoms, decrease the rate of admission and decrease the rate of relapse if administered for 3-5 days after the acute exacerbation. More detailed discussion about the use of systemic corticosteroids in the treatment of acute asthma can be found below.
類固醇的分類有很多種方式. 例如依照受體分類, 或依照碳原子數/化學式分類. 依照結構(開環)分類等等. 臨床醫師上最常接觸到的類固醇應該是皮質類固醇
依照功能簡單分成三類
1. 皮質類固醇
2. 性激素(性類固醇激素)
3. 其他: 包括神經甾類化合物，膽鹽，氨基甾類神經肌肉阻斷劑，類固醇抗雄性激素（合成的）, 類固醇生成抑制劑（外源性），膜固醇，毒素，維生素 D
** 膽固醇屬於膜固醇類.
皮質類固醇：由腎上腺皮質產生，這些激素調節壓力反應、電解質平衡和免疫功能。可根據抗發炎或鹽分水分滯留作用的強弱再分為葡萄糖皮質素及礦物鹽皮質素(我高中學習的名稱是礦物鹽皮質素, 還有很多其他翻譯, 例如鹽皮質素,礦物皮質固醇等等), 人工合成的類固醇通常具備上面兩種效果. 只是不同種類的類固醇在這兩方面的作用效果有差異. 例如高海拔疾病常用的dexamethasone對於鹽分水分滯留的效果較弱
Corticosteroids: Produced by the adrenal cortex, these hormones regulate stress responses, electrolyte balance, and immune function.Glucocorticoids: Involved in carbohydrate metabolism, anti-inflammatory actions, and immunosuppression.Cortisol, which increases blood glucose levels during stress and suppresses immune activity to prevent excessive inflammation.
Mineralocorticoids: Control salt and water balance to maintain blood pressure.Aldosterone, which promotes sodium reabsorption in the kidneys, thereby regulating extracellular fluid volume.
Sex steroids: Derived mainly from the gonads and adrenal glands, these influence sexual development, reproduction, and secondary sexual characteristics.Progestogens: Essential for preparing the reproductive system for pregnancy.Progesterone, which supports implantation and sustains early pregnancy by maintaining the uterine lining.
Androgens: Promote male reproductive development and maintenance.Testosterone, which drives spermatogenesis and the growth of male secondary sex characteristics such as muscle mass and facial hair.
Estrogens: Key to female reproductive cycles and skeletal health.Estradiol, which stimulates endometrial proliferation during the menstrual cycle and contributes to bone density.
Other steroids extend beyond hormonal roles and include compounds involved in neuroprotection, digestion, and neuromuscular activity:
依照功能簡單分成三類
1. 皮質類固醇
2. 性激素(性類固醇激素)
3. 其他: 包括神經甾類化合物，膽鹽，氨基甾類神經肌肉阻斷劑，類固醇抗雄性激素（合成的）, 類固醇生成抑制劑（外源性），膜固醇，毒素，維生素 D
** 膽固醇屬於膜固醇類.
皮質類固醇：由腎上腺皮質產生，這些激素調節壓力反應、電解質平衡和免疫功能。可根據抗發炎或鹽分水分滯留作用的強弱再分為葡萄糖皮質素及礦物鹽皮質素(我高中學習的名稱是礦物鹽皮質素, 還有很多其他翻譯, 例如鹽皮質素,礦物皮質固醇等等), 人工合成的類固醇通常具備上面兩種效果. 只是不同種類的類固醇在這兩方面的作用效果有差異. 例如高海拔疾病常用的dexamethasone對於鹽分水分滯留的效果較弱
** 若用於高海拔疾病治療, 水分滯留效果越弱越好
1. 葡萄糖皮質素：參與碳水化合物代謝、抗發炎作用和免疫抑制。
---- 舉例: 皮質醇會在壓力期間提高血糖水平，並抑制免疫活動以防止過度發炎。
2. 礦物鹽皮質素：控制鹽和水的平衡以維持血壓。
2. 礦物鹽皮質素：控制鹽和水的平衡以維持血壓。
---- 舉例: 醛固酮能促進腎臟對鈉的再吸收，進而調節細胞外液容量。
下圖來自維基百科: Glucocorticoids at the U.S. National Library of Medicine Medical Subject Headings (MeSH) 裡面將皮質類固醇GCS又分為天然及合成兩大類.
臨床醫師最常用到的類固醇是人工合成的皮質類固醇. 例如 Prednisolone. methylprednisolone. dexamethasome. 下面是不同皮質類固醇對於抗發炎或水分滯留的效果, 數字是與 hydrocortisone 做比較. dexamethasone 幾乎不會造成鹽分滯留(水腫).
| Name | Glucocorticoid potency | Mineralocorticoid potency | Terminal half-life (hours) |
|---|---|---|---|
| Cortisol (hydrocortisone) | 1 | 1 | 8 |
| Cortisone | 0.8 | 0.8 | 8 |
| Prednisone | 3.5–5 | 0.8 | 16–36 |
| Prednisolone | 4 | 0.8 | 16–36 |
| Methylprednisolone | 5–7.5 | 0.5 | 18–40 |
| Dexamethasone | 25–80 | 0 | 36–54 |
| Betamethasone | 25–30 | 0 | 36–54 |
| Triamcinolone | 5 | 0 | 12–36 |
| Deflazacort | 6.5 | – | 1.3 |
| Fludrocortisone acetate | 15 | 200 | 24 |
| Deoxycorticosterone acetate | 0 | 20 | – |
| Aldosterone | 0.3 | 200–1000 | – |
| Beclometasone | 8 sprays 4 times every day equivalent to orally 14 mg prednisone once a day | – | – |
人工合成的GCS
1. Cortisol-like and related (16-unsubstituted):
1. Cortisol-like and related (16-unsubstituted):
----例如Fluorometholone(眼藥水常用) Methylprednisolone Prednisolone
2. Methasones and related (16-substituted):
----例如 Betamethasone(藥膏常用) Clobetasol(藥膏常用) Dexamethason(兒科/高海拔疾病)Triamcinolone(注射型常用於治療蟹足腫,痘疤)
3. Cyclic ketals (16,17-cyclized):
----例如Budesonide(用於氣喘噴劑)
下面是參考資料
下面中文直接拷貝自維基百科Steroid Hormones
按功能
類固醇在多種生理過程中發揮作用，包括新陳代謝、發炎調節、免疫反應、生殖和細胞信號傳導。它們的作用主要透過與特定的細胞內受體結合而介導，進而影響基因轉錄和蛋白質合成。類固醇可根據其主要生物學功能進行大致分類，以下列出了主要的類固醇激素類別，以及一些重要成員及其功能實例。[ 51 ] [ 52 ]
其他類固醇的作用不僅限於荷爾蒙作用，還包括參與神經保護、消化和神經肌肉活動的化合物：
- 神經甾類化合物，如脫氫表雄酮（DHEA）和別孕烷醇酮，可以調節大腦中的神經傳導物質受體。
- 膽汁酸，例如牛磺膽酸，有助於腸道對脂質的消化和吸收。
- 氨基甾類神經肌肉阻斷劑（合成的），如泮庫溴銨，用於麻醉以誘導肌肉鬆弛。
- 類固醇抗雄性激素（合成的），例如醋酸環丙孕酮，在荷爾蒙治療中阻斷雄性激素受體。
- 類固醇生成抑制劑（外源性），如阿爾法二醇，可抑制類固醇合成以達到治療目的。
- 膜固醇，例如膽固醇（對細胞膜流動性至關重要）、麥角固醇（真菌膜成分）和各種植物固醇（具有降低膽固醇作用的植物來源固醇）。
- 毒素如甾體皂苷（植物防禦化合物）和強心配醣體/心臟糖苷（影響心臟功能）。
具有開環結構的類固醇，稱為開環類固醇，包括：
Corticosteroids: Produced by the adrenal cortex, these hormones regulate stress responses, electrolyte balance, and immune function.Glucocorticoids: Involved in carbohydrate metabolism, anti-inflammatory actions, and immunosuppression.Cortisol, which increases blood glucose levels during stress and suppresses immune activity to prevent excessive inflammation.
Mineralocorticoids: Control salt and water balance to maintain blood pressure.Aldosterone, which promotes sodium reabsorption in the kidneys, thereby regulating extracellular fluid volume.
Sex steroids: Derived mainly from the gonads and adrenal glands, these influence sexual development, reproduction, and secondary sexual characteristics.Progestogens: Essential for preparing the reproductive system for pregnancy.Progesterone, which supports implantation and sustains early pregnancy by maintaining the uterine lining.
Androgens: Promote male reproductive development and maintenance.Testosterone, which drives spermatogenesis and the growth of male secondary sex characteristics such as muscle mass and facial hair.
Estrogens: Key to female reproductive cycles and skeletal health.Estradiol, which stimulates endometrial proliferation during the menstrual cycle and contributes to bone density.
Other steroids extend beyond hormonal roles and include compounds involved in neuroprotection, digestion, and neuromuscular activity:
Neurosteroids such as dehydroepiandrosterone (DHEA) and allopregnanolone, which modulate neurotransmitter receptors in the brain.
Bile acids such as taurocholic acid, which aid in lipid digestion and absorption in the intestine.
Aminosteroid neuromuscular blocking agents (synthetic), such as pancuronium bromide, used in anesthesia to induce muscle relaxation.
Steroidal antiandrogens (synthetic), such as cyproterone acetate, which block androgen receptors in hormone therapy.
Steroidogenesis inhibitors (exogenous), such as alfatradiol, which suppress steroid synthesis for therapeutic purposes.
Membrane sterols such as cholesterol (essential for cell membrane fluidity), ergosterol (a fungal membrane component), and various phytosterols (plant-derived sterols with cholesterol-lowering effects).
Toxins such as steroidal saponins (plant defense compounds) and cardenolides/cardiac glycosides (which affect heart function).
Steroids with an open-ring structure, known as secosteroids, include:Vitamin D forms such as ergocalciferol (from plant sources), cholecalciferol (from animal sources and sunlight), and calcitriol (the active form that regulates calcium homeostasis).
Bile acids such as taurocholic acid, which aid in lipid digestion and absorption in the intestine.
Aminosteroid neuromuscular blocking agents (synthetic), such as pancuronium bromide, used in anesthesia to induce muscle relaxation.
Steroidal antiandrogens (synthetic), such as cyproterone acetate, which block androgen receptors in hormone therapy.
Steroidogenesis inhibitors (exogenous), such as alfatradiol, which suppress steroid synthesis for therapeutic purposes.
Membrane sterols such as cholesterol (essential for cell membrane fluidity), ergosterol (a fungal membrane component), and various phytosterols (plant-derived sterols with cholesterol-lowering effects).
Toxins such as steroidal saponins (plant defense compounds) and cardenolides/cardiac glycosides (which affect heart function).
Steroids with an open-ring structure, known as secosteroids, include:Vitamin D forms such as ergocalciferol (from plant sources), cholecalciferol (from animal sources and sunlight), and calcitriol (the active form that regulates calcium homeostasis).
沒有留言:
張貼留言