成人肾上腺皮质功能不全的激素替代治疗进展

Advances in Hormone Replacement Therapy for Adult Adrenal Insufficiency

肾上腺皮质功能不全是一种以肾上腺皮质激素分泌不足为主要特征的疾病,其治疗方式为糖皮质激素替代治疗。传统的治疗药物可分为短效和长效药物,短效药物每日服用2~3次,患者单日内激素水平波动较大,长效药物的使用虽然可减少服药次数,但药物易导致激素替代过量,造成代谢方面的不良影响。目前已出现针对成人患者的新替代治疗方式,包括缓释型氢化可的松和氢化可的松皮下输注泵。本文将对这两种新疗法进行综述,并着重介绍其药效动力学和药物代谢动力学、对患者代谢的影响和药物安全性,以期对临床实践有所裨益。

Adrenal insufficiency is a disease characterized by insufficient secretion of adrenocortical hormones,usually treated with glucocorticoid replacement therapy.The routine drugs have two forms-short-acting and long-acting.The shorter one should be taken 2-3 times a day resulting hormone level of patients fluctuating greatly within a day.Although long-acting drugs reduce the frequency of administration,it is easy to lead to excessive replacement,resulting in adverse effects on metabolism.New alternative treatments for adult patients have emerged,including modified-release hydrocortisone and hydrocortisone subcutaneous infusion pumps.In this review,we briefly introduce these new therapies,emphasizing the pharmacodynamics and pharmacokinetics of the replacement,the effects on metabolism and drug safety,aiming at contributing to the future clinical practice.