肾上腺功能不全女性的脱氢表雄酮替代治疗

Dehydroepiandrosterone replacement in women with adrenal insufficiency.

作者信息

Arlt W, Callies F, van Vlijmen J C, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte H M, Allolio B

机构信息

Department of Endocrinology, Medical University Hospital, Wuerzburg, Germany.

出版信息

N Engl J Med. 1999 Sep 30;341(14):1013-20. doi: 10.1056/NEJM199909303411401.

DOI:10.1056/NEJM199909303411401

PMID:10502590

Abstract

BACKGROUND

The physiologic role of dehydroepiandrosterone in humans is still unclear. Adrenal insufficiency leads to a deficiency of dehydroepiandrosterone; we therefore, investigated the effects of dehydroepiandrosterone replacement, in patients with adrenal insufficiency.

METHODS

In a double-blind study, 24 women with adrenal insufficiency received in random order 50 mg of dehydroepiandrosterone orally each morning for four months and placebo daily for four months, with a one-month washout period. We measured serum steroid hormones, insulin-like growth factor I, lipids, and sex hormone-binding globulin, and we evaluated well-being and sexuality with the use of validated psychological questionnaires and visual-analogue scales, respectively. The women were assessed before treatment, after one and four months of treatment with dehydroepiandrosterone, after one and four months of placebo, and one month after the end of the second treatment period.

RESULTS

Treatment with dehydroepiandrosterone raised the initially low serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and testosterone into the normal range; serum concentrations of sex hormone-binding globulin, total cholesterol, and high-density lipoprotein cholesterol decreased significantly. Dehydroepiandrosterone significantly improved overall well-being as well as scores for depression and anxiety. For the global severity index, the mean (+/-SD) change from base line was -0.18+/-0.29 after four months of dehydroepiandrosterone therapy, as compared with 0.03+/-0.29 after four months of placebo (P=0.02). As compared with placebo, dehydroepiandrosterone significantly increased the frequency of sexual thoughts (P=0.006), sexual interest (P=0.002), and satisfaction with both mental and physical aspects of sexuality (P=0.009 and P=0.02, respectively).

CONCLUSIONS

Dehydroepiandrosterone improves well-being and sexuality in women with adrenal insufficiency.

摘要

背景

脱氢表雄酮在人体内的生理作用仍不明确。肾上腺功能不全导致脱氢表雄酮缺乏；因此，我们研究了脱氢表雄酮替代治疗对肾上腺功能不全患者的影响。

方法

在一项双盲研究中，24名肾上腺功能不全的女性被随机安排，每天早晨口服50毫克脱氢表雄酮，持续四个月，随后四个月每天服用安慰剂，中间有一个月的洗脱期。我们测量了血清类固醇激素、胰岛素样生长因子I、血脂以及性激素结合球蛋白，并分别使用经过验证的心理问卷和视觉模拟量表评估了幸福感和性功能。在治疗前、接受脱氢表雄酮治疗1个月和4个月后、接受安慰剂治疗1个月和4个月后以及第二个治疗期结束后1个月对这些女性进行了评估。

结果

脱氢表雄酮治疗使最初较低的血清脱氢表雄酮、硫酸脱氢表雄酮、雄烯二酮和睾酮浓度升高至正常范围；血清性激素结合球蛋白、总胆固醇和高密度脂蛋白胆固醇浓度显著降低。脱氢表雄酮显著改善了总体幸福感以及抑郁和焦虑评分。对于总体严重程度指数，脱氢表雄酮治疗四个月后与基线相比的平均（±标准差）变化为-0.18±0.29，而安慰剂治疗四个月后为0.03±0.29（P=0.02）。与安慰剂相比，脱氢表雄酮显著增加了性幻想频率（P=0.006）、性兴趣（P=0.002）以及对性心理和生理方面的满意度（分别为P=0.009和P=0.02）。