Muaj tseeb koj tau hnov txog cov tshuaj hormones steroid. Peb lub cev tsis tu ncua tsim lawv los tswj cov txheej txheem tseem ceeb. Hauv tsab xov xwm no, peb yuav saib glucocorticoids, steroid hormones uas tsim tawm hauv adrenal cortex. Txawm hais tias peb nyiam tshaj plaws hauv lawv cov khoom sib xyaw - GCS. Nws yog dab tsi hauv tshuaj? Lawv siv rau dab tsi thiab lawv ua rau mob dab tsi? Wb saib.
Cov ntaub ntawv dav dav txog GKS. Nws yog dab tsi hauv tshuaj?
Peb lub cev tsim cov tshuaj steroids xws li glucocorticoids. Lawv yog tsim los ntawm adrenal cortex thiab lawv siv feem ntau yog txuam nrog kev kho mob ntawm adrenal insufficiency. Niaj hnub no, tsis tsuas yog siv cov glucocorticoids ntuj, tab sis kuj yog lawv cov analogues hluavtaws - GCS. Nws yog dab tsi hauv tshuaj? Rau tib neeg, cov analogs no txhais tau ntau, vim lawv muaj kev tiv thaiv kab mob, tiv thaiv kab mob, tiv thaiv kev poob siab, tiv thaiv kev ua xua rau lub cev.
Glucocorticoids pib siv los uatshuaj (tom qab no hauv tsab xov xwm - tshuaj) rov qab rau hauv 40s ntawm lub xyoo pua nees nkaum. Thaum kawg ntawm xyoo 1930, cov kws tshawb fawb tau tshawb pom cov tshuaj steroid hormones hauv tib neeg adrenal cortex, thiab twb nyob rau xyoo 1937, cov mineralocorticoid deoxycorticosterone raug cais tawm. Thaum ntxov xyoo 1940, cov glucocorticoids hydrocortisone thiab cortisone kuj tau qhia. Cov tshuaj pharmacological ntawm cortisone thiab hydrocortisone muaj ntau haiv neeg uas nws tau txiav txim siab siv lawv los ua tshuaj. Tom qab qee lub sijhawm, cov kws tshawb fawb tau ua tiav lawv cov synthesis.
Cov nquag nquag ntawm glucocorticoid hauv tib neeg lub cev yog cortisol (ib qho analogue yog hydrocortisone, tus nqi ntawm 100-150 rubles), thiab nws suav tias yog lub ntsiab. Cov tsis tshua muaj zog kuj tuaj yeem paub qhov txawv: corticosterone, cortisone, 11-deoxycortisol, 11-dehydrocorticosterone.
Ntawm txhua lub ntuj glucocorticoids, tsuas yog hydrocortisone thiab cortisone tau siv los ua tshuaj. Txawm li cas los xij, tom kawg ua rau muaj kev phiv ntau dua li lwm cov tshuaj hormones, uas yog vim li cas nws siv hauv cov tshuaj tam sim no txwv. Txog niaj hnub no, ntawm glucocorticoids, tsuas yog hydrocortisone lossis nws cov esters (hydrocortisone hemisuccinate thiab hydrocortisone acetate) tau siv.
Raws li rau glucocorticosteroids (synthetic glucocorticoids), nyob rau hauv peb lub sij hawm ib tug xov tooj ntawm cov neeg ua hauj no tau raug synthesized, cov fluorinated (flumethasone, triamcinolone, betamethasone, dexamethasone, thiab lwm yam) thiab non-fluorinated (methylprednisolone, prednisolone, prednisone.) glucocorticoids tuaj yeem paub qhov txawv.
Cov kev kho no muaj zog dua li lawv cov khoom sib xws thiab xav tau tsawg duakoob tshuaj.
GCS action mechanism
Qhov kev txiav txim ntawm glucocorticosteroids ntawm qib molecular tsis tau qhia meej meej. Cov kws tshawb fawb ntseeg tias cov tshuaj no ua rau cov hlwb ntawm qib kev tswj hwm ntawm cov noob hloov pauv.
Glucocorticosteroids cuam tshuam nrog intracellular glucocorticoid receptors, uas muaj nyob hauv yuav luag txhua lub cell ntawm tib neeg lub cev. Thaum tsis muaj cov tshuaj no, cov receptors (lawv yog cytosolic proteins) tsuas yog tsis ua haujlwm. Nyob rau hauv lub xeev tsis muaj zog, lawv yog ib feem ntawm heterocomplexes, uas kuj muaj xws li immunophilin, kub poob siab proteins, thiab lwm yam.
Thaum glucocorticosteroids nkag mus rau hauv lub cell (los ntawm daim nyias nyias), lawv khi rau cov receptors thiab qhib lub "glucocorticoid + receptor" complex, tom qab uas nws nkag mus rau hauv lub cell nucleus thiab cuam tshuam nrog DNA cheeb tsam uas nyob rau hauv tus txhawb nqa. fragment ntawm cov steroid teb cov noob (lawv kuj hu ua glucocorticoid- teb cov ntsiab lus). Cov "glucocorticoid + receptor" complex muaj peev xwm tswj tau (suppress los yog, conversely, qhib) cov txheej txheem ntawm transcription ntawm ib co noob. Qhov no yog qhov ua rau muaj kev tawm tsam lossis kev txhawb nqa ntawm mRNA tsim, nrog rau kev hloov pauv hauv kev sib txuas ntawm ntau yam kev tswj hwm enzymes thiab cov proteins uas kho cov teebmeem ntawm tes.
Ntau yam kev tshawb fawb qhia tau hais tias glucocorticoid + receptor complex cuam tshuam nrog ntau yam kev hloov pauv, xws li nuclear factor kappa B (NF-kB) lossis transcription activator protein (AP-1), uas tswj. Cov noob koom nrog hauv kev tiv thaiv kab mob thiab kev mob (adhesion molecules, noob rau cytokines, proteinases, thiab lwm yam).
Cov teebmeem tseem ceeb ntawm GCS
Cov teebmeem ntawm glucocorticosteroids ntawm tib neeg lub cev muaj ntau heev. Cov tshuaj hormones no muaj antitoxic, antishock, immunosuppressive, antiallergic, desensitizing thiab anti-inflammatory teebmeem. Cia wb mus saib seb GCS ua haujlwm li cas.
- Cov tshuaj tiv thaiv kab mob ntawm corticosteroids. Vim yog kev tawm tsam ntawm kev ua haujlwm ntawm phospholipase A 2. Thaum cov enzyme no raug cuam tshuam hauv tib neeg lub cev, kev tso tawm (tso tawm) ntawm arachidonic acid yog suppressed thiab tsim ntawm ib co inflammatory mediators (xws li prostaglandins, leukotrienes, troboxane, thiab lwm yam) yog inhibited. Tsis tas li ntawd, kev noj cov tshuaj glucocorticosteroids ua rau txo qis hauv cov kua dej exudation, vasoconstriction (txo) ntawm capillaries, thiab txhim kho microcirculation hauv qhov chaw mob.
- Antiallergic nyhuv ntawm GCS. Qhov tshwm sim los ntawm kev txo qis hauv kev zais cia thiab kev sib txuas ntawm cov tshuaj tiv thaiv kev ua xua, txo qis hauv cov kab mob basophils, inhibition ntawm kev tso tawm ntawm histamine los ntawm basophils thiab sensitized mast cells, txo qis ntawm B- thiab T-lymphocytes, txo qis. nyob rau hauv lub rhiab heev ntawm cov hlwb rau cov kev tsis haum tshuaj kho mob, kev hloov nyob rau hauv lub cev lub cev tiv thaiv kab mob, thiab inhibition ntawm antibody tsim.
- Immunosuppressive kev ua haujlwm ntawm corticosteroids. Nws yog dab tsi hauv tshuaj? Qhov no txhais tau hais tias cov tshuaj inhibit immunogenesis, inhibit zus tau tej cov tshuaj tiv thaiv. Glucocorticosteroids inhibit qhov kev tsiv teb tsaws ntawm cov pob txha pob txha qia hlwb, inhibit qhov kev ua ntawm B- thiab T-lymphocytes,inhibit qhov tso tawm ntawm cytokines los ntawm macrophages thiab leukocytes.
- Antitoxic thiab antishock ua ntawm GCS. Cov nyhuv no ntawm cov tshuaj hormones yog vim kev nce ntshav siab hauv tib neeg, nrog rau kev ua kom lub siab enzymes uas koom nrog cov metabolism ntawm xeno- thiab endobiotics.
- Mineralocorticoid kev ua haujlwm. Glucocorticosteroids muaj peev xwm khaws sodium thiab dej hauv tib neeg lub cev, txhawb kev tso tawm ntawm cov poov tshuaj. Hauv qhov no, cov khoom siv hluavtaws tsis zoo li cov tshuaj hormones ntuj, tab sis lawv tseem muaj qhov cuam tshuam rau lub cev.
YPharmacokinetics
Los ntawm lub sijhawm ua haujlwm, cov kab ke glucocorticosteroids tuaj yeem muab faib ua:
- Short-acting glucocorticosteroids (xws li hydrocortisone, tus nqi uas txawv ntawm 100 txog 150 rubles).
- Glucocorticosteroids nrog lub sijhawm nruab nrab ntawm kev ua (prednisolone (uas tsis tau tshuaj xyuas zoo heev), methylprednisolone).
- Long acting glucocorticosteroids (triamcinolone acetonide, dexamethasone, betamethasone).
Tab sis glucocorticosteroids tuaj yeem txiav txim siab tsis yog los ntawm lub sijhawm ua haujlwm xwb. Lawv kev faib tawm kuj tuaj yeem ua raws li kev tswj hwm:
- lus;
- intranasal;
- nqus tau cov glucocorticosteroids.
Qhov kev faib tawm no, txawm li cas los xij, tsuas yog siv rau cov kab mob glucocorticosteroids xwb.
Tseem muaj qee qhov kev npaj hauv daim ntawv ntawm cov tshuaj pleev thiab cov tshuaj nplaum (cov tshuaj corticosteroids hauv zos). Piv txwv li, Afloderm. Kev tshuaj xyuas cov tshuaj no zoo.
Cia peb saibhom kab mob corticosteroids cais.
Qhov ncauj glucocorticosteroids tau nqus tau zoo nyob rau hauv lub plab zom mov yam tsis muaj teeb meem. Ua haujlwm khi rau plasma proteins (transcortin, albumin). Qhov siab tshaj plaws ntawm qhov ncauj corticosteroids hauv cov ntshav yog mus txog 1.5 teev tom qab noj. Lawv raug biotransformation nyob rau hauv daim siab, ob lub raum (ib nrab) thiab lwm yam ntaub so ntswg los ntawm conjugation nrog sulfate los yog glucuronide.
Kwv yees li 70% ntawm cov tshuaj corticosteroids conjugated tau tawm hauv cov zis, 20% ntxiv yuav raug tso tawm tom qab hauv cov quav, thiab cov seem hauv lwm cov kua hauv lub cev (xws li hws). Lub neej ib nrab yog 2 mus rau 4 teev.
Koj tuaj yeem ua lub rooj me me nrog cov tshuaj pharmacokinetic ntawm qhov ncauj corticosteroids.
| Glucocorticosteroids. Kev npaj (npe) | Tissue half-life | Plasma ib nrab-lub neej |
| YHydrocortisone | 8-12 teev | 0.5-1.5 teev |
| YCortisone | 8-12 teev | 0, 7-2 teev |
| Prednisolone (tsis zoo tshuaj xyuas) | 18-36 teev | 2-4 teev |
| Methylprednisolone | 18-36 teev | 2-4 teev |
| YFludrocortisone | 18-36 teev | 3, 5 teev |
| Dexamethasone | 36-54 teev | 5 teev |
nqus tau cov glucocorticosteroids hauv kev kho mob niaj hnub no yog sawv cev los ntawm triamcinolone acetonide, fluticasone propionate, mometasone furoate, budesonide thiab beclomethasone dipropionate.
Lawv cov tshuaj pharmacokinetic tseem tuaj yeem nthuav tawm ua lub rooj:
| Glucocorticosteroids. Kev npaj (npe) | Tshuaj tiv thaiv kab mob | ntim khoom faib | Plasma ib nrab-lub neej | Hepatic passage efficiency |
| YBeclomethasone dipropionate | 0, 64 units | - | 0, 5 teev | 70% |
| Budesonide | 1u | 4, 3L/kg | 1, 7-3, 4 teev | 90% |
| YTriamcinolone acetonide | 0, 27 units | 1,2L/kg | 1, 4-2 teev | 80-90% |
| YFluticasone Propionate | 1u | 3.7L/kg | 3, 1 teev | 99% |
| YFlunisolide | 0, 34 units | 1.8L/kg | 1, 6 teev | - |
Intranasal glucocorticosteroids hauv cov tshuaj niaj hnub no yog sawv cev los ntawm fluticasone propionate, flunisolide, triamcinolone acetonide, mometasone furoate, budesonide thiab beclomethasone dipropionate. Qee tus ntawm lawv hu ua tib yam li nqus tau corticosteroids.
Tom qab siv cov tshuaj intranasal corticosteroids, ib feem ntawm cov koob tshuaj tau nqus rau hauv txoj hnyuv, thiab lwm qhov yog los ntawm cov mucous membrane ntawm txoj hlab ntsws ncaj qha mus rau hauv cov ntshav.
Glucocorticosteroids uas nkag mus rau hauv plab hnyuv tau nqus los ntawm kwv yees li 1-8 feem pua thiab yuav luag tag nrho biotransformed rau cov metabolites tsis ua haujlwm thaum thawj zaug hla lub siab.
Glucocorticosteroids uas nkag mus rau hauv cov ntshav yog hydrolyzed rau cov tshuaj tsis ua haujlwm. Nov yog lub rooj nrog lawv cov tshuaj pharmacokinetic:
| Glucocorticosteroids. Tshuaj | Bioavailability thaum nkag mus rau cov ntshav, hauv feem pua | Bioavailability los ntawm kev nqus los ntawm txoj hnyuv, hauv feem pua |
| Budesonide | 34 | 11 |
| YBeclomethasone dipropionate | 44 | 20-25 |
| Mometasone furoate | <0, 1 | <1 |
| YTriamcinolone acetonide | No data | 10, 6-23 |
| Y Fluticasone propionate | 0, 5-2 | |
| YFlunisolide | 40-50 | 21 |
Cov tshuaj xws li "Afloderm" (kev tshuaj xyuas uas tau tshwm sim hauv lub network), nws tsis muaj txiaj ntsig los piav qhia nyias. Txhua ntawm lawv muaj lub ntsiab active ingredient, uas, feem ntau yuav, twb tau hais los saum toj no. Cov tshuaj no yog cov tshuaj glucocorticosteroids thiab feem ntau nthuav tawm ua cov tshuaj pleev lossis tshuaj pleev.
Qhov chaw ntawm GCS hauv kev kho mob (cov lus qhia rau kev siv)
Txhua hom glucocorticosteroid muaj nws tus kheej cov lus qhia rau kev siv. Yog li, qhov ncauj glucocorticosteroids yog siv los kho:
- Crohn's disease;
- ulcerative colitis;
- kab mob ntsws interstitial;
- mob ua pa nyuaj siab syndrome;
- mob ntsws hnyav;
- mob ntsws obstructive pulmonary nyob rau theem mob;
- bronchial hawb pob;
- subacute thyroiditis;
- congenital dysfunction ntawm lub adrenal cortex (qhov no, ib tug neeg tsis tsim corticoids nws tus kheej thiab raug yuam kom coj lawv cov analogues hluavtaws);
- mob qog adrenal insufficiency.
Tsis tas li, glucocorticosteroids tau siv los hloov kho rau thawj zaug thiab theem ob lub raum tsis txaus.
Intranasal glucocorticosteroids yog siv rau:
- Yidiopathic rhinitis (vasomotor);
- nonallergic rhinitis nrog eosinophilia;
- pilipose nas;
- perennial allergic rhinitis (persistent);
- caij nyoogAllergy rhinitis (ua tsis taus pa).
Inhaled corticosteroids yog siv los kho cov kab mob pulmonary ntev, mob ntsws asthma.
YContraindications
GCS yuav tsum tau kho nrog ceev faj hauv cov xwm txheej no:
- lactation;
- glaucoma;
- qee yam kab mob ntawm pob kws, uas ua ke nrog pathologies ntawm epithelium;
- kab mob fungal los yog kab mob qhov muag;
- kab mob purulent;
- lub sijhawm txhaj tshuaj tiv thaiv;
- syphilis;
- tuberculosis;
- kab mob herpetic;
- systemic mycoses;
- qee tus mob hlwb nrog cov tsos mob tshwm sim;
- mob raum tsis ua haujlwm;
- hlab ntshav siab;
- thromboembolism;
- duodenal rwj lossis plab rwj;
- mob ntshav qab zib mellitus;
- Itsenko-Cushing's disease.
Kev tswj hwm ntawm corticosteroids yog nruj me ntsis txwv tsis pub muaj cov xwm txheej zoo li no:
- keeb kwm ntawm lub qhov ntswg nquag;
- hemorrhagic diathesis;
- hypersensitivity.
Glucocorticosteroids: kev phiv
Cov kev mob tshwm sim ntawm corticosteroids tuaj yeem muab faib ua hauv zos thiab hauv lub cev.
Kev mob tshwm sim hauv zos
Muab faib ua cov teebmeem los ntawm qhov nqus tau thiab tso rau hauv corticosteroids.
1. Cov kev phiv hauv zos ntawm kev nqus cov glucocorticosteroids:
- hnoos;
- dysphonia;
- candidiasis ntawm pharynx thiab qhov ncauj kab noj hniav.
2. Cov teebmeem hauv zoslos ntawm intranasal corticosteroids:
- perforation ntawm qhov ntswg septum;
- nosebleeds;
- -hlawv thiab dryness ntawm mucous membrane ntawm pharynx thiab lub qhov ntswg;
- sneeze;
Systemic side effects
Sib faib raws li ib feem ntawm lub cev uas lawv tab tom ua.
1. Los ntawm sab ntawm lub hauv paus paj hlwb:
- psychosis;
- kev nyuaj siab;
- euphoria;
- insomnia;
- -nce kev kub ntxhov.
2. Los ntawm sab ntawm cov hlab plawv system:
- thromboembolism;
- deep vein thrombosis;
- nce ntshav siab;
- myocardial dystrophy.
3. Los ntawm txoj kev ua me nyuam:
- hirsutism;
- ncua kev puberty;
- kev sib deev dysfunction;
- kev coj khaub ncaws tsis ruaj khov.
4. Los ntawm digestive system:
- fatty siab;
- pancreatitis;
- GI ntshav;
- steroid ulcers ntawm txoj hnyuv thiab plab.
5. Los ntawm cov kab mob endocrine:
- mob ntshav qab zib mellitus;
- Cushing's syndrome;
- obesity;
- atrophy ntawm adrenal cortex vim inhibition ntawm nws cov haujlwm.
6. Los ntawm sab ntawm lub cev ntawm lub zeem muag:
- glaucoma;
- posterior subcapsular cataract.
7. Los ntawm cov musculoskeletal system:
- muscle hypotrophy;
- myopathy;
- stunting in me nyuam;
- aseptic necrosis thiabpob txha tawg;
- osteoporosis.
8. Los ntawm sab ntawm daim tawv nqaij:
- alopecia;
- stretch marks;
- thinning skin.
9. Lwm yam kev mob tshwm sim:
- exacerbation ntawm cov kab mob sib kis thiab mob ntev;
- edema;
- dej thiab sodium tuav hauv lub cev.
Kev Tiv Thaiv
Qee zaum, glucocorticosteroids yuav tsum tau siv ceev faj.
Piv txwv li, hauv cov neeg mob ntshav siab, hypothyroidism, hypoalbuminemia, nrog rau cov neeg mob uas muaj hnub nyoog laus lossis laus dua, cov txiaj ntsig ntawm GCS tuaj yeem nce ntxiv.
Thaum siv corticosteroids thaum cev xeeb tub, nws yuav tsum tau coj mus rau hauv tus account qhov kev xav tau ntawm kev kho mob rau leej niam thiab kev pheej hmoo ntawm cov tshuaj tsis zoo ntawm tus menyuam hauv plab, vim tias corticosteroids tuaj yeem ua rau muaj kev loj hlob ntawm fetus thiab txawm tias. tsis xws luag xws li cleft palate, thiab lwm yam.
Yog thaum siv corticosteroids tus neeg mob raug tus kab mob sib kis (kab mob qhua pias, qhua pias, thiab lwm yam), nws tuaj yeem nyuaj heev.
Nyob rau hauv kev kho mob ntawm corticosteroids nyob rau hauv cov neeg mob uas muaj autoimmune los yog inflammatory kab mob (rheumatoid mob caj dab, plab hnyuv kab mob, kab mob lupus erythematosus, thiab lwm yam), cov neeg mob ntawm steroid kuj yuav tshwm sim.
Cov neeg mob tau txais qhov ncauj glucocorticosteroids ntev ntev yuav tsum tau kuaj ntshav fecal occult ib ntus thiab tau txais fibroesophagogastroduodenoscopy, vim tias cov kab mob steroid yuav tsis thab thaum kho nrog GCS.
Hauv 30-50% ntawm cov neeg mob,Kev kho mob nrog glucocorticosteroids ntev, osteoporosis tshwm sim. Raws li txoj cai, nws cuam tshuam rau ko taw, tes, pob txha pelvic, tav, txha nraub qaum.
Kev sib tham nrog lwm yam tshuaj
Txhua glucocorticosteroids (kev faib tawm tsis muaj teeb meem ntawm no) thaum sib cuag nrog lwm cov tshuaj muab cov txiaj ntsig zoo, thiab cov txiaj ntsig no tsis yog ib txwm zoo rau peb lub cev. Nov yog yam koj yuav tsum paub ua ntej siv glucocorticosteroids nrog lwm cov tshuaj:
- GCS thiab antacids - nqus ntawm glucocorticosteroids txo qis.
- GCS thiab barbiturates, diphenin, hexamidine, diphenhydramine, carbamazepine, rifampicin - biotransformation ntawm glucocorticosteroids hauv siab nce.
- GCS thiab isoniazid, erythromycin - biotransformation ntawm glucocorticosteroids hauv daim siab txo qis.
- GCS thiab salicylates, butadione, barbiturates, digitoxin, penicillin, chloramphenicol - tag nrho cov tshuaj no nce kev tshem tawm.
- GCS thiab isoniazid - mob ntawm tib neeg lub siab lub ntsws.
- GCS thiab reserpine - qhov tsos ntawm lub xeev kev nyuaj siab.
- GCS thiab tricyclic antidepressants - nce intraocular siab.
- GCS thiab adrenomimetics - cov nyhuv ntawm cov tshuaj no tau txhim kho.
- GCS thiab theophylline - cov tshuaj tiv thaiv kab mob ntawm glucocorticosteroids txhim kho, cov teebmeem cardiotoxic tsim.
- GCS thiab diuretics, amphotericin, mineralocorticoids - nce kev pheej hmoo ntawm hypokalemia.
- GCS thiab indirect anticoagulants, fibrinolytics, butadine, ibuprofen, ethacrynic acid - tej zaum yuav ua raws li hemorrhagickev nyuaj siab.
- GCS thiab indomethacin, salicylates - qhov kev sib xyaw ua ke no tuaj yeem ua rau mob plab hnyuv.
- GCS thiab paracetamol - toxicity ntawm cov tshuaj no nce.
- GCS thiab azathioprine - nce kev pheej hmoo ntawm cataracts, myopathies.
- GCS thiab mercaptopurine - kev sib xyaw ua ke tuaj yeem ua rau muaj kev nce ntxiv ntawm uric acid hauv cov ntshav.
- GCS thiab Chingamine - qhov tsis xav tau ntawm cov tshuaj no tau txhim kho (pob pob txha, myopathy, dermatitis).
- GCS thiab methandrostenolone - cov teebmeem tsis zoo ntawm glucocorticosteroids tau txhim kho.
- GCS thiab kev npaj hlau, androgens - nce hauv kev sib txuas ntawm erythropoietin, thiab tawm tsam keeb kwm yav dhau los, nce hauv erythropoiesis.
- GCS thiab cov tshuaj hypoglycemic - yuav luag ua tiav hauv lawv cov txiaj ntsig.
Zoo kawg
Glucocorticosteroids yog cov tshuaj uas niaj hnub tshuaj tsis zoo li ua yam tsis muaj. Lawv siv ob qho tib si rau kev kho mob ntawm cov theem mob hnyav heev, thiab tsuas yog txhawm rau txhim kho cov nyhuv ntawm cov tshuaj. Txawm li cas los xij, zoo li txhua yam tshuaj, glucocorticosteroids kuj muaj kev phiv thiab contraindications. Tsis txhob hnov qab txog nws. Saum toj no, peb tau teev tag nrho cov xwm txheej thaum koj yuav tsum tsis txhob siv glucocorticosteroids, thiab kuj tau muab cov npe ntawm kev sib cuam tshuam ntawm GCS nrog lwm cov tshuaj. Tsis tas li ntawd, cov txheej txheem ntawm kev ua ntawm GCS thiab tag nrho lawv cov teebmeem tau piav qhia hauv qab no. Tam sim no txhua yam koj xav paub txog GCS nyob hauv ib qho chaw - kab lus no. Txawm li cas los xij, tsis muaj teeb meem koj yuav tsum pib kho xwbTom qab nyeem cov lus qhia dav dav txog GCS. Cov tshuaj no, tau kawg, tuaj yeem yuav yam tsis muaj kws kho mob sau, tab sis vim li cas koj xav tau? Ua ntej siv cov tshuaj, koj yuav tsum xub tham nrog tus kws kho mob tshwj xeeb. Noj qab nyob zoo thiab tsis txhob noj tshuaj rau tus kheej!
