金硫葡萄糖
金硫葡萄糖是一種注射用**金鹽**，歷史上在獸醫學中用於其免疫調節和抗發炎特性。 * 這種被稱為**金鹽療法 (chrysotherapy)** 的治療方法，主要用於治療嚴重的免疫介導性皮膚病（如**落葉型天皰瘡**）和免疫介導性多發性關節炎。 * **臨床要點：** 由於更安全、起效更快且更有效的免疫抑制劑（如環孢素、麥考酚酯、糖皮質激素）的出現，金硫葡萄糖在現代獸醫臨床中已很少使用。 * 它需要較長的起效時間（通常為數週至數月），並且具有嚴重的、可能危及生命的不良反應風險，包括嚴重的骨髓抑制和腎毒性。
作用機制: The exact mechanism of **chrysotherapy** remains incompletely understood, but it is known to exert profound immunomodulatory effects. * **Macrophage Inhibition:** Gold compounds are taken up by **macrophages** → inhibition of phagocytosis → decreased release of lysosomal enzymes and inflammatory mediators. * **T-Cell Modulation:** Alters cellular immunity by reducing the proliferation and activation of **T-lymphocytes**. * **Autoantibody Reduction:** Decreases the production of **rheumatoid factor** and other autoantibodies. * Inhibits **prostaglandin synthesis** and complement activation, contributing to its anti-inflammatory effects.
給藥途徑
禁忌症
- Pre-existing renal disease
- Hepatic dysfunction
- Severe hematologic disorders or pre-existing cytopenias
- Systemic lupus erythematosus (SLE)
- Pregnancy and lactation
- History of severe toxicity to heavy metals
不良反應
- Bone marrow suppression (thrombocytopenia, anemia, leukopenia)
- Nephrotoxicity (proteinuria, glomerulonephritis)
- Hepatotoxicity
- Stomatitis and oral ulcers
- Dermatologic reactions (Toxic epidermal necrolysis, Erythema multiforme)
- Anaphylaxis (rare)
藥物相互作用
- Penicillamine · Increased risk of severe hematologic and renal toxicity.
- Immunosuppressants (e.g., cyclophosphamide, azathioprine) · Synergistic bone marrow suppression; use together with extreme caution.
- Phenylbutazone · Increased risk of blood dyscrasias.
監測
- Complete Blood Count (CBC) with platelets (prior to every dose)
- Urinalysis (specifically monitoring for proteinuria prior to every dose)
- Liver enzyme panels
- Renal function panels (BUN, Creatinine)
- Clinical signs of bleeding, bruising, or oral ulcers
過量
Overdosage can lead to severe heavy metal toxicity. * **Symptoms:** Profound bone marrow suppression (bleeding, severe infections), acute renal failure, and severe gastrointestinal signs. * **Treatment:** Involves immediate discontinuation of the drug, aggressive supportive care, and potential use of heavy metal chelating agents such as **dimercaprol (BAL)** to enhance excretion.
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