Immunosuppression is a well-documented risk factor for skin cancer, as exemplified by the 65- to 250-fold higher squamous cell carcinoma risk, 10-fold higher basal cell carcinoma risk, and 0 to 8-fold higher melanoma risk in solid organ transplant recipients (SOTRs) receiving potent, prolonged courses of immunosuppressive therapies.已显示许多免疫系统成分可以抑制或促进肿瘤的生长,并且免疫抑制药物可能对与免疫系统无关的增殖途径有其他影响。因此,皮肤科医生对特定方案的评估是评估每个患者皮肤癌风险的关键。在本手稿中,首次审查了皮肤癌发育和回归的免疫介导的机制。接下来,证据的合成显示了SOTR中常用的免疫抑制剂对黑色素瘤和非黑色素瘤皮肤癌风险的不同作用。这些包括全身性钙调蛋白抑制剂,硫嘌呤,IMDH(肌苷一磷酸脱氢酶)抑制剂,mTOR(乳脂蛋白的哺乳动物靶标)抑制剂和全身性皮质类固醇。最后,讨论了SOTR中皮肤癌筛查的建议。我们进一步为某些非移植患者提供建议,这些患者可能会因与特定免疫抑制剂暴露有关的风险而受益于常规皮肤癌筛查,并且我们提出了基于证据的策略,以最大程度地减少在临床实践中使用高风险免疫抑制剂。(J Am Acad Dermatol 2023; 88:521-30。)
地塞米松是一种强效的合成糖皮质激素,其抗炎作用是皮质醇的 30-35 倍。皮质类固醇在细胞水平上发挥作用的机制尚不清楚,但已提出了几种机制。有证据表明,皮质类固醇能够解除靶细胞核中 DNA 转录为 mRNA 的抑制。皮质类固醇作用的其他机制包括通过类固醇抑制磷酸二酯酶(否则磷酸二酯酶会代谢环磷酸腺苷)来提高细胞中环磷酸腺苷的水平。皮质类固醇的部分抗炎活性可能是由于抑制前列腺素合成,即抑制前列腺素前体花生四烯酸从细胞膜释放。
皮质类固醇可能会掩盖某些感染的迹象,并且在使用过程中可能会出现新的感染。使用皮质类固醇时,可能会降低电阻和无法定位感染。此外,与未服用这些药物的患者相比,使用免疫抑制剂药物(包括皮质类固醇)的患者更容易受到感染。此外,在皮质类固醇的患者中,水痘和麻疹可能会更严重甚至致命的病程。在此类儿童中,或者接受没有这些疾病的皮质类固醇的成年人,应特别注意避免暴露。如果暴露,可以指出适当的静脉内免疫球蛋白(VZIG)或合并的静脉免疫球蛋白(IVIG)治疗。如果水痘或带状疱疹会出现,则可以考虑使用抗病毒剂治疗。类似地,皮质类固醇应谨慎使用,在较强的虫(Threadworm)侵扰的患者中,因为皮质类固醇诱导的免疫抑制可能会导致强烈的肌链蛋白酶过度感染和传播,并通过广泛的幼虫迁移,通常伴随着严重的肠肠炎和潜在的致命性毛刺肠层。
* ........................................................................................................................48 *CEPHALOSPORINS* ......................................................................................................................................................... 48 *CHEMICALS* ......................................................................................................................................................................48 *CONTRACEPTIVES* .........................................................................................................................................................48 *CORTICOSTEROIDS* .......................................................................................................................................................54 *COUGH/COLD/ALLERGY* ..............................................................................................................................................55 *DERMATOLOGICALS* .................................................................................................................................................... 58 *DIAGNOSTIC PRODUCTS* ..............................................................................................................................................65 *DIGESTIVE AIDS* ..............................................................................................................................................................66 *DIURETICS* ........................................................................................................................................................................ 66 *ENDOCRINE AND METABOLIC AGENTS - MISC.* .................................................................................................. 66 *ESTROGENS* ......................................................................................................................................................................67 *FLUOROQUINOLONES* .................................................................................................................................................. 68 *GASTROINTESTINAL AGENTS - MISC.* .....................................................................................................................68 *GENITOURINARY AGENTS - MISCELLANEOUS* ....................................................................................................69 *GOUT AGENTS* ................................................................................................................................................................. 69 *HEMATOLOGICAL AGENTS - MISC.* .........................................................................................................................69 *HEMATOPOIETIC AGENTS* ..........................................................................................................................................70
S03CA | 皮质类固醇和抗感染药物的复方药 S02CA | 皮质类固醇和抗感染药物的复方药 S | 感觉器官 R06AD | 吩噻嗪衍生物 R05FA | 鸦片衍生物和祛痰药 R03DC | 白三烯受体拮抗剂 R03DA | 黄嘌呤 R03CC | 选择性β-2-肾上腺素受体激动剂 R03BB | 抗胆碱能药物 R03BA | 糖皮质激素 R03AL | 肾上腺素能药物与抗胆碱能药物的复方药 R03AK | 吸入性β-肾上腺素能药物和皮质类固醇 R03AC | 选择性β-2-肾上腺素能受体激动剂 R02AX | 其他咽喉制剂 R01AD | 皮质类固醇 R | 呼吸系统 P02CA | 苯并咪唑衍生物 P | 抗寄生虫产品 N07BB |用于治疗酒精依赖的药物 N07BA | 用于治疗尼古丁依赖的药物 N07AA | 抗胆碱酯酶药物 N02CX | 其他抗偏头痛药物 N | 神经系统 M03BB | 恶唑、噻嗪和三嗪衍生物 M03BA | 氨基甲酸酯 M01AX | 其他非甾体抗炎和抗风湿药 M01AE | 丙酸衍生物 M01AB | 乙酸衍生物和相关物质 M | 肌肉骨骼系统 L01AA | 氮芥类似物 L | 抗肿瘤和免疫调节剂 J02AC | 三唑衍生物 J01FA | 大环内酯类 J01CR | 青霉素组合,包括β内酰胺酶抑制剂 J01CE | 对β内酰胺酶敏感的青霉素 J01AA | 四环素类 J |全身用抗感染药 H02AB | 糖皮质激素 H | 全身激素 G03FB | 孕激素和雌激素,序贯制剂 G03FA | 孕激素和雌激素,固定组合 G03DC | 雌二醇衍生物 G03DA | 孕烯(4)衍生物 G03CX | 其他雌激素 G03CB | 合成雌激素,普通 G03AC | 孕激素 G03AA | 孕激素和雌激素,固定组合 G01AF | 咪唑衍生物 G | 生殖泌尿系统和性激素 D10BA | 用于治疗痤疮的类视黄酸 D07CC | 皮质类固醇,强效,与抗生素复方 D07CB | 皮质类固醇,中效,与抗生素复方 D07CA | 皮质类固醇,弱效,与抗生素复方 D07BC |强效皮质类固醇,与防腐剂复方 D07BB | 中效皮质类固醇,与防腐剂复方 D07AD | 强效皮质类固醇(IV 类) D01AC | 咪唑和三唑衍生物 D01AA | 抗生素 D | 皮肤病学药物 C08DB | 苯并噻嗪类衍生物 C07CB | 选择性β受体阻滞剂和其他利尿剂 C07BB | 选择性β受体阻滞剂和噻嗪类 C07AB | β受体阻滞剂 C07AA | β受体阻滞剂,非选择性 C05AA | 皮质类固醇 C03EA | 低限利尿剂和保钾剂 C03DA | 醛固酮拮抗剂 C03CB | 磺胺类和钾复方药 C03CA | 袢利尿剂 C03AB | 噻嗪类和钾 C01AA | 洋地黄苷 C | 心血管系统 B02BA | 维生素 K B01AF | 直接 Xa 因子抑制剂 B01AA | 维生素 K 拮抗剂 B | 血液和造血器官 A12BA | 钾 A07AC | 咪唑衍生物 A02BC | 质子泵抑制剂 A02BA | H2 受体拮抗剂 A01AD | 其他局部口服治疗药物 A01AB | 用于局部口服治疗的抗感染药和防腐药 A | 消化系统
*.................................................................................................................................................13 *Antimalarials*.........................................................................................................................................................................13 *Antineoplastics And Adjunctive Therapies*........................................................................................................................... 13 *Antiparkinson And Related Therapy Agents*........................................................................................................................ 13 *Antipsychotics/Antimanic Agents*......................................................................................................................................... 13 *Beta Blockers*....................................................................................................................................................................... 13 *Cardiovascular Agents - Misc.*..............................................................................................................................22 *Estrogens*............................................................................................................................................................................. 23 *Gastrointestinal Agents - Misc.*..............................................................................................................................................14 *Cephalosporins*.................................................................................................................................................................... 15 *Contraceptives*..................................................................................................................................................................... 15 *Corticosteroids*..................................................................................................................................................................... 16 *Cough/Cold/Allergy*.............................................................................................................................................................. 17 *Dermatologicals*....................................................................................................................................................................17 *利尿剂 *...........................................................................................................................................................................................................................................................................................................*............................................................................................................28 *Tetracyclines*........................................................................................................................................................................ 28 *Thyroid Agents*..................................................................................................................................................................... 29 *Ulcer Drugs/Antispasmodics/Anticholinergics*...................................................................................................................... 30 *Urinary反杂菌*.....................................................................................................................................................................................................................................................................................................
先前的试验对死亡率产生了矛盾的结果,但对于这种结果而言大多是能力不足,并且总体而言,它们与皮质类固醇对死亡率无显着影响或减少三分之一一致。5最近的CoD CoD试验报告说,与ICU患者的皮质类固醇使用相关的死亡率显着降低,但在类似的逃生试验中未观察到影响。6,7皮质类固醇在CAP中的作用尚不清楚,在临床实践中使用是可变的。在当前或英国CAP治疗指南中,不建议使用皮质类固醇治疗。8,9欧洲严重帽指南表明,如果存在休克,则使用皮质类固醇。10需要足够的动力随机试验来解决这种不确定性。资格
* ...........................................................................................51 *ANTIMALARIALS* .................................................................................................................... 52 *ANTIMYASTHENIC/CHOLINERGIC AGENTS* .............................................................................52 *ANTIMYCOBACTERIAL AGENTS* ...............................................................................................53 *ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES* ..................................................................53 *ANTIPARKINSON AND RELATED THERAPY AGENTS* ................................................................ 56 *ANTIPSYCHOTICS/ANTIMANIC AGENTS* ........................................................................................................................................................................................................................... ..................................................................................................................... 64 *CALCIUM CHANNEL BLOCKERS* ............................................................................................... 65 *CARDIOTONICS* ...................................................................................................................... 65 *CARDIOVASCULAR AGENTS - MISC.在 .................................................................................................................. 67 *CORTICOSTEROIDS* ................................................................................................................ 75 *COUGH/COLD/ALLERGY* ......................................................................................................... 77 *DERMATOLOGICALS* ............................................................................................................................................................................................................................................................................................................................................................. ........................................................................................................................... 120 *ENDOCRINE AND METABOLIC AGENTS - MISC.* ......................................................................121 *ESTROGENS* .......................................................................................................................... 123 *FLUOROQUINOLONES* ........................................................................................................... 124 *GASTROINTESTINAL AGENTS - MISC.* ................................................................................... 124 *GENITOURINARY AGENTS - MISCELLANEOUS* ....................................................................... 127 *GOUT AGENTS* .......................................................................................................................128 *HEMATOLOGICAL AGENTS - MISC.* ........................................................................................ 129 *HEMATOPOIETIC AGENTS* ..................................................................................................... 131 *HEMOSTATICS* ...................................................................................................................... 134
皮质类固醇应谨慎使用最近患有心脏梗塞的患者,因为有报道称这些患者使用皮质类固醇与使用皮质类固醇与左心室无壁破裂之间存在明显关联。在患有严重情感障碍史的患者中,特别是类固醇诱发的精神病;患有类固醇肌病,肝衰竭,肾功能不全,青光眼(或青光眼家族史)的患者;血栓栓塞性疾病的患者;自临时横纹肌溶解和肌红蛋白尿症以来,Duchenne的肌营养不良症患者在剧烈的体育锻炼后已有报道。库欣病;由于糖皮质激素在长时间给药上可能会加速外周期闭合,因此不完整的成熟生长。皮质类固醇对甲状腺功能减退症或肝硬化患者的作用增强。