氟康唑治疗库欣综合征的临床运用初探

Primary reports about clinical application of fluconazole in Cushing's syndrome

目前我国用于治疗库欣综合征(Cushing's syndrome,CS)的药物很少,无日常可用的抑制肾上腺类固醇生成的药物,酮康唑由于肝毒性退市无法获得,氟康唑是否为临床上可行的皮质醇生成抑制剂?本文对氟康唑用于各类内源性CS的个案疗效、作用机制的基础实验和不良反应报告等研究进行综述,并重点与酮康唑进行比较,为氟康唑应用于CS的临床治疗提供指导。虽然氟康唑降低皮质醇效果不如酮康唑,但它通过抑制IIP-羟化酶和17a-羟化酶,对类固醇生成有抑制作用,可用于CS患者的短期治疗,它不良反应小、经济和普及性高。

At present,there are few available drugs for the treatment of Cushing’s syndrome(CS)in China.There is no medication for inhibiting steroidogenesis in daily practice here.Ketoconazole is unavailable because it was delisted from the market for its hepatotoxicity.Should fluconazole be a feasible alternative steroidogenesis inhibitor in the clinic?This article reviews the studies about fluconazole for the treatment of all kinds of endogenous CS including the basic experiments on mechanism of action,the research of idiographic cases,reports of side effects,etc.It focuses on comparing fluconazole with ketoconazole,in order to provide evidence for the clinical administration of fluconazole for CS.Fluconazole inhibits 11 p-hydroxylase and 17a-hydroxylase,and then reduces the production of adrenal steroids.Although it works less powerful than ketoconazole on reducing cortisol,it could be a short-term treatment option for CS.It has less side effect,low cost and easy accessibility.