Tác dụng phụ cần lưu ý của nhóm thuốc corticoid và cách khắc phục

r a VAN

Tac dung phu can luu y

cua nhom thuoc cortieoid

va each khae phue

Trin Nhan Thang*

Nhdm thuic cortieoid ddng vai trd quan trgng trong diiu hoa chuyin hoa chit va dugc coi la nhdm hormon

cd lien quan true tiip din cac hoat dgng cd tfnh chit sing cdn cua ca thi. Ngoai ra, nhdm hormon nay cdn

thi hien nhiiu tac dung dugc ly nhu: chong viem, ching dj dng, dc chi miin djch... Do dd, nhdm thuoc nay

cd pham vi ap dung rit rpng rai. Tuy nhien, liiu st? dung trong diiu trj thudng cao han nhiiu lin so vdi liiu

hormon thay thi, vi thi cac tac dung ngoai y cua nhdm thuic nay da trd thanh phd biin va la mpt vin di

nghiem trgng cin khac phuc va han chi. • ^ i •• •

Moi tie dung sinh ly cua cortieoid dSu II

nguon goc ciia cic tai biSn khi diing vdi

liSu cao vl dac biet la dii ngay. Viec sir

dung cac cortieoid khdng hgp ly dang gay ra nhiSu

tic dung ngoai y vdi nhirng biSu bien toan than

hoac tai cho, trudc mat hay lau dii.

1. Tac dung phu tren chuyen hoa chat

Vdi chuySn hoi protein, cortieoid ngan can

tong hgp protein tii acid amin, gay tang dj hoi pro￾tein, tang lugng nita thai qua nudc tiSu vl dan dSn

nhiSu to chirc bi anh hudng. TrSn chuySn hoi glu￾cose, cortieoid llm tang tdng hgp glucose tir acid

amin, ngoai ra cdn lam giam tiSt insulin va tang tiSt

glucagon dan dSn tang dudng huySt. Vi thS sir dung

cortieoid dii ngay cd thS gay dii thao dudng do

thuoc (diabetic cortieoid) hoac llm nang thSm tinh

trang dii thao dudng va thudng pbii tang lieu

insulin khi diSu trj kSt hgp. Vdi chuyen boa lipid,

thira cortieoid se gay lang dpng md, lam rdi loan

qui trinh phan bo md trong ca thS (md dpng nhiSu

d vung mat, cd va pban trSn ctia ca the). Vdi mo

liSn kSt, cortieoid uc chS sy hinh tblnb cac tS bao

sgi, giam tao collagen, giam sy binh thanh mo liSn

kSt, gay nhung vach dan dudi da, lam mdng da, teo

da, cham liSn seo. Vdi qui trinh tao mau, cortieoid

lam tang hdng cau, giam ddi sdng vl chtrc nang cua

bach cau, lam teo cle ca quan lympho. Trong dieu

trj, cortieoid cdn thS hien nhiSu tie dung khong

mong muon khlc nhu: Llm gilm strc de khlng ctia

ca thS, tang nguy ca nbiSm nam, nhiSm virus (do

irc chS miSn djch); gay kich thich thin kinh trung

uong (lam tang lac quan vl sau dd II but rirt, bon

chon, lo au, khd ngu, tang buySt ap); gay them an

do kich thich viing dudi ddi. Mgt so cortieoid con

gay Inh hudng dSn can bang dien giai...

2. Tac dung phu tren sutang trudng cua tre em

Vdi liSu sinh ly, cortieoid kich thich sy tiSt hor￾mon tang trudng. Ngugc lai, d liSu cao cortieoid uc

chS tiSt hormon tang trudng gay cham Idn cho tre em.

Hau qui nly con do cortieoid iic chS sy tao xuong va

lam giam boat dgng ciia cle hormon tuySn gilp. Vdi

tre em d tudi day thi, cortieoid uc chS hoat dpng ciia

tuySn sinh due cung la nguySn nhan gay cham Idn vl

roi loan chuc nang sinh due. DS khac phuc cac tic

dung phu nay, trudc hSt pbai han cbS viec kS don

nhom tbudc nly d tre em. DS khac phuc cac tie dung

phu nay, nSn khuySn clo bat budc cac nhl san xuat

phii ghi trSn nhan cle loai chS pham nay dong chir

"Gay cham Idn d tre em" de ngudi kS don va sir dung

luu y ban chS vdi tie em. Sir dung cic chS pham ty

* Benh vien Bach Mai

62 IY HOC LAM SANG So 46 (Ttiang 11/2009)