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西药综合 学习笔记 倒计时154天

  • 2026-05-30 22:31:10
西药综合 学习笔记 倒计时154天

西药综合 学习笔记 倒计时154天

第十三章 免疫系统常见疾病
第一节 类风湿关节炎
第二节 系统性红斑狼疮

一、类风湿关节炎的治疗

1. 非甾体抗炎药

- 用药特点：非选择性伤胃肠，选择性伤肾
​
- 用药禁忌：避免同时服用≥2种
​
- 老年患者：宜选择半衰期短的药物
​
- 治疗局限：只能改善症状，必须与DMARDs联合应用

2. 改善病情的抗风湿药（DMARDs）

- 甲氨蝶呤（首选）：7.5~25mg/周，需补充叶酸；不良反应包括骨髓抑制、肺间质病变、畸胎
​
- 柳氮磺吡啶：磺胺类过敏者禁用；不良反应为腹痛腹泻、可逆性精子减少
​
- 氯喹/羟氯喹：可引起视网膜变性而致失明
​
- 环孢素：不良反应为齿龈增生、多毛

3. 生物制剂

- 肿瘤坏死因子（TNF-α）拮抗剂：依那西普、英夫利西单抗、阿达木单抗
​
- 白介素-6（IL-6）拮抗剂：托珠单抗、沙利鲁单抗
​
- 白介素-1（IL-1）拮抗剂：阿那白滞素
​
- 抗CD20单抗：利妥昔单抗

4. 糖皮质激素

- 用药原则：小剂量、短期使用，发挥“桥梁”作用
​
- 关节腔注射：1年内不宜超过3~4次

 

二、系统性红斑狼疮（SLE）

1. 治疗原则

- 轻度：羟氯喹/非甾体抗炎药，无法控制时选择小剂量糖皮质激素
​
- 中度：中等剂量糖皮质激素，难以控制可加量，可联合免疫抑制剂
​
- 重度：标准剂量糖皮质激素联合免疫抑制剂；若狼疮危象用糖皮质激素冲击联合免疫抑制剂；难治/复发性重症用利妥昔单抗

2. 药物治疗

- 糖皮质激素：基础治疗药物，根据病情轻重调整剂量与用法
​
- 免疫抑制剂：诱导缓解期常用环磷酰胺或霉酚酸酯
​
- 生物制剂：贝利尤单抗、泰它西普、利妥昔单抗

3. 注意事项

- 免疫抑制剂和生物制剂治疗的同时，应避免接种活疫苗
​
- 确诊新冠感染时，需停用或暂缓使用生物制剂
​
- SLE并非妊娠的绝对禁忌证
​
- 有习惯性流产病史和抗磷脂抗体阳性的孕妇，可用阿司匹林或肝素
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      1. CONNECT:[ UseTime:0.000517s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
      2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000758s ]
      3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000344s ]
      4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000312s ]
      5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000655s ]
      6. SELECT * FROM `set` [ RunTime:0.000220s ]
      7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000671s ]
      8. SELECT * FROM `article` WHERE `id` = 491789 LIMIT 1 [ RunTime:0.000383s ]
      9. UPDATE `article` SET `lasttime` = 1780164377 WHERE `id` = 491789 [ RunTime:0.008322s ]
      10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000273s ]
      11. SELECT * FROM `article` WHERE `id` < 491789 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001130s ]
      12. SELECT * FROM `article` WHERE `id` > 491789 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.000421s ]
      13. SELECT * FROM `article` WHERE `id` < 491789 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.000960s ]
      14. SELECT * FROM `article` WHERE `id` < 491789 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.005778s ]
      15. SELECT * FROM `article` WHERE `id` < 491789 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.004953s ]
      0.111448s