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雄激素对骨骼肌的影响:对虚弱症发展和管理的启示。

Androgen effects on skeletal muscle: implications for the development and management of frailty.

作者信息

O'Connell Matthew D L, Wu Frederick C W

机构信息

Andrology Research Unit, Institute of Human Development, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, United Kingdom.

出版信息

Asian J Androl. 2014 Mar-Apr;16(2):203-12. doi: 10.4103/1008-682X.122581.

Abstract

Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well-tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs) suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.

摘要

雄激素对骨骼肌具有强大的合成代谢作用,且随着年龄增长而下降,与肌肉质量和力量的丧失同步。这种肌肉质量和功能的丧失,即肌肉减少症,是衰弱发展过程中的核心事件,衰弱是一种脆弱的健康状态,预示着老年人不良后果和快速的功能衰退。因此,雄激素水平下降在衰弱发展中的潜在作用及其作为老年男性功能促进疗法的效用引起了相当大的关注。本综述总结了肌肉衰老、肌肉减少症和衰弱的当前概念和定义,并评估了雄激素与衰弱研究的最新进展。观察性和干预性研究的现有证据有力地支持了雄激素对老年男性肌肉质量的影响,但对肌肉力量尤其是身体功能的影响尚不清楚。在老年男性的研究中,雄激素治疗总体上耐受性良好,但对于高剂量治疗以及在心血管风险高的人群中使用仍存在担忧。选择性雄激素受体调节剂(SARMs)的首批试验表明,其对老年人肌肉质量和功能的影响与传统雄激素疗法相似。未来重要的方向包括将这些药物与运动训练相结合,以促进不同老年人群的功能能力,以及在观察性研究中更多地关注激素水平、身体成分和身体功能同时变化之间的关系。

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