糖皮质激素诱导性肌病
- Author
- Marc L Miller, MD
Marc L Miller, MD
- Clinical Assistant Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- Deputy Editor
- Monica Ramirez Curtis, MD, MPH
Monica Ramirez Curtis, MD, MPH
- Deputy Editor — Rheumatology
- Instructor of Medicine, Part-time
- Harvard Medical School
- Translators
- 刘艺, 主治医师
刘艺, 主治医师
- 四川大学华西医院风湿免疫科
引言
自20世纪50年代糖皮质激素(皮质类固醇)开始作为一种治疗药物以来，已经公认肌病是这类药物的副作用[1]。肌病可见于任何糖皮质激素制剂的治疗中。对于年龄较大的患者和治疗开始前就有癌症或负氮平衡的患者，其风险可能增加[2]。类似症状也可见于库欣综合征患者。 (参见“库欣综合征的流行病学和临床表现”)
糖皮质激素诱导性肌病的主要内容将总结在此。与糖皮质激素治疗(包括口服和吸入)相关的其他副作用，将单独讨论。 (参见“全身性应用糖皮质激素的主要副作用”和“吸入性糖皮质激素的主要副作用”)
发病机制
糖皮质激素通过影响为糖异生作用提供氨基酸作为底物的中间代谢，从而对骨骼肌产生直接分解代谢作用。糖皮质激素受体激活似乎也参与其中[3,4]，因为糖皮质受体拮抗剂可预防肌病发生[3]。
一个实验模型的研究结果，提示了危重病情况下的另一种机制。在该模型中，糖皮质激素治疗干扰了胰岛素样生长因子-Ⅰ(insulin-like growth factor-Ⅰ, IGF-Ⅰ)的信号传递，从而增加了肌细胞的细胞凋亡[5]。 (参见下文‘糖皮质激素与神经肌肉阻断药’)
一种具有蛋白激酶活性的细胞内信号分子称为Akt1(Akt的主要亚型)[6]，其可能分别在肌肉对糖皮质激素的萎缩性反应，以及肌肉对IGF-Ⅰ肥大性反应中起着主要作用[7,8]。糖皮质激素诱导的Akt1抑制，最终可导致泛素连接酶atrogin-1(MAFbx)增加，这种酶可使目标肌肉蛋白降解[7,9]。相反，IGF-Ⅰ信号传递可增强Akt1的活性，而Akt1能抑制肌肉萎缩和诱导肌肉肥大[8]。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-02-19.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- BUNIM JJ, ZIFF M, McEWEN C. Evaluation of prolonged cortisone therapy in rheumatiod arthritis: a four-year study. Am J Med 1955; 18:27.
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