文章摘要
宋智慧,刘朋朋,高飞萌,王丽莉,王家伟.激素冲击治疗甲状腺相关性眼病的不良反应及预防用药分析[J].中国药事,2019,33(7):840-844
激素冲击治疗甲状腺相关性眼病的不良反应及预防用药分析
Analysis of Adverse Reactions and Preventive Medication for Thyroid-associated Ophthalmopathy Treated with Glucocorticoid Shock Therapy
投稿时间:2019-05-08  
DOI:10.16153/j.1002-7777.2019.07.019
中文关键词: 甲状腺相关性眼病  糖皮质激素  预防用药  不良反应
英文关键词: thyroid associated ophthalmopathy  glucocorticoid  preventive medication  adverse reactions
基金项目:
作者单位E-mail
宋智慧 首都医科大学附属北京同仁医院, 北京 100730  
刘朋朋 首都医科大学附属北京同仁医院, 北京 100730  
高飞萌 河北省眼科医院, 邢台 054001  
王丽莉 内蒙古锡林郭勒盟医院, 锡林郭勒 026000  
王家伟 首都医科大学附属北京同仁医院, 北京 100730 jwwang2017@126.com 
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中文摘要:
      目的:分析激素冲击治疗甲状腺相关性眼病的预防用药及不良反应发生情况,为保证甲状腺相关性眼病患者激素治疗的安全、有效、经济提供依据。方法:抽取某院2013年1月-2018年10月因甲状腺相关性眼病住院并应用糖皮质激素冲击治疗的病历97份,回顾性分析预防用药的使用及不良反应发生情况。结果:糖皮质激素冲击治疗的患者均使用预防消化道损伤的药物,其中单用H2受体拮抗剂及联合其他胃黏膜保护剂者53例,占比54.64%,单用质子泵抑制剂及联合其他胃黏膜保护剂预防的共44例,占比45.36%。应用H2受体拮抗剂与质子泵抑制剂两组实际消化道损伤发生率比较无统计学差异(P>0.05)。为预防糖皮质激素引起的骨质疏松,钙剂应用率最高(97/97,100.00%),其次是维生素D的补充(80/97,82.47%),双膦酸盐类药物的应用较少(17/97,17.53%)。预防用保肝药的患者很少(3/97,3.09%)。无其他预防用药。不良反应方面,糖皮质激素继发性糖尿病发生率最高(50/67,74.63%),其次是白细胞升高(11/69,15.94%),然后是眼压升高(8/71,11.27%)、睡眠障碍(10/97,10.31%)、低钾血症(9/96,9.38%)、肝功能损害(5/96,5.21%)。结论:使用激素冲击治疗甲状腺相关性眼病患者,应加强对糖皮质激素诱导骨质疏松的预防药物使用,预防消化道溃疡可首先考虑H2受体拮抗剂,谨慎应用质子泵抑制剂,无需预防使用保肝药、补钾药,以期进一步提升预防用药的合理性。
英文摘要:
      Objective:To analyze the preventive medication and adverse reactions in patients with thyroidassociated ophthalmopathy treated with glucocorticoid shock therapy and to lay a basis for the safety, efficiency and economy of TAO patients. Methods:A total of 97 medical records of TAO treated with GC shock therapy in a hospital from January, 2013 to October, 2018 were selected for the retrospective analysis of the use of preventive drugs and the occurrence of adverse reactions. Results:All patients treated with GC shock therapy were treated with drugs for preventing digestive tract injury. 53 patients were given H2 receptor antagonist (H2RA) alone and combined with other gastric mucosal protective agents, accounting for 54.64%. 44 patients were given proton pump inhibitor (PPI) alone and combined with other gastric mucosal protective agents, accounting for 45.36%. There was no significant difference in the actual incidence of adverse reactions between H2RA and PPI (P>0.05). In order to prevent osteoporosis caused by GC, application rate of calcium was the highest (97/97, 100.00%), followed by vitamin D supplementation (80/97, 82.47%), and bisphosphonates were less used (17/97, 17.53%). Few patients were given preventive hepatoprotective drugs (3/97, 3.09%). There were no other preventive medications. In terms of adverse reactions, the incidence of glucocorticoid-induced diabetes mellitus was the highest (50/67, 74.63%), followed by leukocytosis (11/69, 15.94%), elevated intraocular pressure (8/71, 11.27%), insomnia (10/97, 10.31%), hypokalemia (9/96, 9.38%) and liver function damage (5/96, 5.21%). Conclusion:For TAO patients treated with GC shock therapy, the use of preventive medication against osteoporosis should be strengthened. H2RA may be given priority to when preventing peptic ulcer. PPI should be used with caution. There is no need to use hepatoprotective drugs or potassium supplements for preventing liver damage or hypokalemia so as to further improve the rationality of preventive medication.
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