论文标题
建模口腔肾上腺皮质醇支持
Modelling oral adrenal cortisol support
论文作者
论文摘要
描述了肾上腺功能不全中口服氢化可的松递送的简化数学模型。该模型基于三个成分（胃氢化可的松，游离血清皮质醇和结合血清皮质醇），并根据线性动力学配制，考虑到糖皮质激素蛋白结合的动力学。由于需要在Covid-19感染的情况下优化皮质醇替代品的需要，该模型适合于50 mg剂量的最近发布的数据和10 mg剂量的早期数据。拟合模型用于预测对标准剂量方案的典型反应，该反应涉及早晨更大的剂量，当天晚些时候涉及1或2个较小的剂量，而剂量的相同剂量则翻了一番。在所有情况下，都会有昼夜节律的反应，而凌晨纳迪尔。该模型还用于考虑基于每24小时的四个相等和同等间隔的替代剂量策略，其剂量为10、20或30 mg，从而产生更均匀的反应，类似于对持续炎症应激的反应。
A simplified mathematical model of oral hydrocortisone delivery in adrenal insufficiency is described; the model is based on three components (gastric hydrocortisone, free serum cortisol and bound serum cortisol) and is formulated in terms of linear kinetics, taking into account the dynamics of glucocorticoid-protein binding. Motivated by the need to optimise cortisol replacement in the situations of COVID-19 infection, the model is fitted to recently-published data on 50 mg dosing and earlier data on 10 mg dosing. The fitted model is used to predict typical responses to standard dosing regimes, which involve a larger dose in the morning and 1 or 2 smaller doses later in the day, and the same regimes with doses doubled. In all cases there is a circadian-like response, with early morning nadir. The model is also used to consider an alternative dosing strategy based on four equal and equally-spaced doses of 10, 20 or 30 mg per 24 h, resulting in a more even response resembling a response to sustained inflammatory stress.
