每日一题_2022.11.23

A 23-year-old athletically built woman comes to the physician complaining of multiple red, ring-like lesions on her body. A careful history and physical reveals the woman has tinea corporis acquired while working on poorly cleaned yoga mats at a local gym. The physician prescribes a medicine to clear her erythematous lesions. After 15 days of treatment the lesions she returns to the office. While the lesions are clearing, she has noticed that patches of her skin have become darker than normal. Which of the following drugs did this patient most likely receive?

一名23岁的体格健壮的女性来就诊，主诉她身体上有多个红色、环状病变。经过仔细的体格和体格检查发现，这名妇女在当地的健身房里做清洁不良的瑜伽垫时，出现了体癣。医生开了一种药来清除她的红斑病变。治疗15天后，她将病变返回诊室。当病变正在清除时，她注意到她的皮肤斑块变得比正常情况下深。该患者最有可能接受以下哪种药物治疗？

(A) Amphotericin B 两性霉素 B

(B) Fluconazole 氟康唑

(C) Flucytosine 氟胞嘧啶

(D) Itraconazole 伊曲康唑

(E) Ketoconazole 酮康唑

答案解析：

酮康唑是一种抗真菌药物，用于治疗体癣，通过阻断真菌膜甾醇的形成发挥作用。它还具有内分泌作用，因为它能阻断肾上腺从胆甾醇中产生睾酮和皮质醇所必需的酶——脱水解酶/CYP-450scc。游离皮质醇负责 POMC 基因的反馈抑制，该基因编码ACTH、促脂激素、促黑素细胞激素和一些内源性内啡肽的合成。如果没有产生皮质醇的解糖酶活性，这种反馈抑制被重新移动，因此 POMC 基因产物被自由转录。过量的促黑素细胞激素可引起皮肤色素沉着增加，如艾迪生病患者。其他内分泌作用包括降低男性的性欲、阳痿和女性乳房发育。

正确答案：E