去氢表雄酮(DHEA)

去氢表雄酮(DHEA)

去氢表雄酮的功能

去氢表雄酮（DHEA）是肾上腺分泌的一种激素。在肾上腺分泌以后，它作为硫酸去氢表雄酮进入血液并转化称其他激素。

目前对于去氢表雄酮在体内的作用还知之甚少。^[1]实际上去氢表雄酮在男性、停经前妇女和绝经后妇女的作用不同。^[2]补充S-去氢表雄酮可以增加睾酮和雄烯二酮的水平。^[3]

去氢表雄酮转化成睾酮的水平降低发生在一些患有阳痿的男性身上。^[4]在一项双盲实验中每天服用50毫克的去氢表雄酮可以提高勃起功能。^[5]

一些（但不是所有的）试验发现去氢表雄酮补充剂可以不减少体重而降低脂肪的含量^{[6 7 8 9 10]}。在一项试验中，其降低脂肪的作用发生在男性身上而对于女性却无效。^[11]去氢表雄酮目前认为可以间接作用于血糖水平，但这一理论还不完善且存在争议。其为了降低血糖的作用在大剂量（每天1600毫克）时还会导致血糖的耐量降低。^{[12 13 14]}

去氢表雄酮可以调节免疫力。一组体内去氢表雄酮较低的老年男性每天给予50毫克的去氢表雄酮20周后明显提高了免疫力。^[15]绝经后的妇女在补充3个月后也发现可以提高免疫力。^[16]

一些报道称去氢表雄酮可以降低心脏病发生的危险，这可能与它降低胆固醇水平有关。去氢表雄酮对于降低血粘度的作用也可以帮助预防心脏病。^[17]可是，大多数支持去氢表雄酮预防心脏病的研究目前对于男性只有很弱的作用，而对于女性却没有任何作用。^{[19 20]}实际上，较高水平的去氢表雄酮和S-去氢表雄酮与女性的心血管危险因素有关，包括高血压和吸烟。^[21]另外，去氢表雄酮还发现可以降低高密度脂蛋白水平。直到现在，去氢表雄酮预防心脏病的作用还不能用于实践。

有人称去氢表雄酮具有一定的抗衰老作用。可是，实际上年轻人体内去氢表雄酮的水平比老年人高就表示补充去氢表雄酮可以让人更年轻。^{[22 23]}在一些双盲试验中（但不是所有的）发现，去氢表雄酮补充剂可以提高老年人的感觉。^[24]在一项双盲试验中，去氢表雄酮可以降低一些年龄老化后的副反应。在这项试验中，健康的老年女性和男性给予每天50毫克的去氢表雄酮或安慰剂维持1年。不仅发现了去氢表雄酮使人表现的更年轻，也发现其他激素如睾酮和雌激素水平轻度升高。在70岁以上的女性中，骨质的丢失得到了缓解。在这些老年女性中还发现大多数性欲测试结果明显提高。这些老年人的皮肤脱水、变厚、色素沉着和皮脂分泌现象也得到改善，但主要是女性。系统性红斑狼疮与性激素的异常代谢有关。在一项双盲试验中发现补充大剂量的去氢表雄酮（每天200毫克）可以提高其临床疗效和减少疾病加重的几率。一项以前的试验也证实了每天补充50~200毫克的去氢表雄酮对患有系统性红斑狼疮的人有帮助。^{[25 26 27]}

去氢表雄酮在预防抑郁症方面也有一定作用。有报道称患有抑郁症的老年女性体内去氢表雄酮的水平较低，但也有报道称一些严重的抑郁症体内去氢表雄酮水平升高。一些双盲实验通过让这些人每天服用50毫克的去氢表雄酮后发现生理和精神上得到了缓解。^[28]在另一项双盲试验中，每天服用超过90毫克的去氢表雄酮6周后发现至少50%的人其抑郁症的发生明显减少。^[29]其他研究者也报道了大剂量服用去氢表雄酮（每天90~450毫克，维持6周）可以降低40岁以后发生抑郁症的男性和绝经后发生抑郁症的女性的患病率。^[30]只服用2周对于治疗抑郁症一般不够。^[31]

尽管有报道称持续6周的治疗在临床上可以降低抑郁症的发生，但其作用是很细微的。^[32]另外，因为会发生潜在的副作用，大多数健康专家担心去氢表雄酮的使用是否安全。没有医生的指导，且不联合服用其他抗抑郁药的情况不要自行补充去氢表雄酮。

去氢表雄酮的分布

去氢表雄酮由肾上腺产生。其合成激素制成片剂、胶囊、液状和舌下含服形式都有效。一些产品称含有的去氢表雄酮天然来自野生薯芋。但是，机体并不能将这些物质转化称去氢表雄酮(即使在实验室可以获得这一反应)。

去氢表雄酮已经被应用于与以下疾病的治疗中。（以下所有信息适用于个体化健康情况）：

哪些人可能会缺乏去氢表雄酮？

去氢表雄酮含量有意义的食物并不存在，因此饮食缺乏也不存在。一些人不能合成足够的去氢表雄酮。去氢表雄酮在成年早期水平最高，之后逐渐下降。到60岁是去氢表雄酮只有最高时的5~15%。^[34]年龄相关的水平降低的去氢表雄酮是否与缺乏有关目前还不清楚。

肾上腺功能不全的人（如爱迪生氏病）体内去氢表雄酮水平降低。患有肾上腺功能不全的女性每天早晨补充50毫克的去氢表雄酮3~4个月后其体内的去氢表雄酮和S-去氢表雄酮水平变得正常，症状明显得到了改善。^{[35 36]}

一些研究报道了抑郁症患者去氢表雄酮水平降低。^{[37 38]}可是，在一项试验中发现严重的抑郁症患者血液内去氢表雄酮水平反而升高。^[39]尽管这些结论存在争议，但有少数临床试验发现抑郁症患者通过补充去氢表雄酮得到了缓解。

患有多发梗死性痴呆的人体内S-去氢表雄酮的水平比正常人要低。^[40]在试验中，每天静脉注射200毫克的去氢表雄酮4周后S-去氢表雄酮水平明显升高，并且改善了一些部分的智力功能，从而提高了日常生活能力。

有报道称患有艾滋病、胰岛素依赖性糖尿病、充血性心力衰竭、多发性硬化、哮喘、慢性疲劳综合征、类风湿性关节炎、骨质疏松和一些其他疾病的人体内去氢表雄酮水平较低。在大多数病例中，其缺乏的意义并不十分清楚。^{[41 42 43 44 45 46 47 48 49 50 51 52 53 54]}

60岁以下的男性患有勃起功能障碍者发现其体内S-去氢表雄酮水平较低。^[55]

大多数（并不是所有）的研究发现患有阿尔茨海默氏病的人体内S-去氢表雄酮水平较低。^{[56 57 58 59 60 61]}

一般需要多少去氢表雄酮？

大多数人并不需要补充去氢表雄酮。但目前就谁需要补充去氢表雄酮还存在争议。一些专家建议血液发现缺乏的妇女每天摄入5~15毫克的去氢表雄酮，而男性每天摄入10~30毫克。[62]有少数研究者认为绝经后的妇女需要每天补充50毫克，也有人认为这一水平太多了。^{[63 64]}补充去氢表雄酮前需先咨询一下医生。体内去氢表雄酮水平正常的健康人不需要补充。可是，一些医生建议一些患有抑郁症、自身免疫性疾病或其他一些疾病的人需要补充去氢表雄酮，即使他们体内水平正常。

患有系统性红斑狼疮的人通过每天服用100~200毫克的去氢表雄酮可以改善症状。但这么大剂量的摄入需在医生的监护下进行。

产品补充剂标签标明的剂量和实际含量有时不符合。但是报道这一现象的作者却没有说明是哪种牌子的去氢表雄酮产品。^[65]

是否有副作用和药物相互作用？

一些专家对于使用去氢表雄酮表示担心，尤其是其长期安全性目前还不清楚。大剂量摄入（，每天50~200毫克）的副作用有粉刺（大约50%的发生率）、毛发增多（18%）、出汗（8%）。在以前的一项试验中，去氢表雄酮还会导致一些罕见的副作用，包括乳腺发硬、体重增加、情绪波动、头痛、油性皮肤和月经不调。^[66]因为这一试验不是对照的，所以这些罕见的副作用在安慰剂中也可能会发生。有个案报道称一例老年男性每天服用200~300毫克6个月后出现躁狂。^[67]可是，在这篇报道中并没有除外其他引起躁狂的原因。

在一些研究中发现会明显增加男性和女性的睾酮水平。^{[68 69]}但也有研究发现这种情况只发生在女性。^[70]睾酮水平的增加会导致一些癌症的发生，也已发现较高水平的去氢表雄酮在动物实验中会引起癌症。^{[71 72 73]}另外，高水平的去氢表雄酮和前列腺癌的发生有关。至少有一例前列腺癌患者服用大剂量去氢表雄酮（每天超过700毫克）后导致其癌症更加恶化。[74]患有乳腺癌的年轻女性体内去氢表雄酮水平较低，但绝经后患乳腺癌的女性却发现去氢表雄酮水平升高。^{[75 76 77 78 79 80 81 82 83 84]}异常补充高剂量的去氢表雄酮（每天100毫克）会增加男性和女性的癌症发生率。^{[85 86]}但称升高的去氢表雄酮水平与卵巢癌的发生率升高或降低的报道都有。^{[87 88]}因此对于这一领域还不清楚。但去氢表雄酮补充剂会导致癌症发生率升高的担忧目前还没有证据来去除。因此，患有乳腺癌或前列腺癌或有家族史的人需避免服用去氢表雄酮。

尽管去氢表雄酮的抗癌作用也有人报道，^[89]但他们用于动物试验的方法还没能用于人类。因此，这些积极的结论还不能得到证实。一些医生建议服用去氢表雄酮时需规律检测肝酶。以前发现补充去氢表雄酮（每天25毫克）会导致心律失常。^[90]去氢表雄酮与血压、心脏病的关系目前还不清楚。血液中去氢表雄酮的水平升高与血压升高以及其他一些心血管危险因素有关。^{[91 92 93]}一项试验发现患有高血压的人体内去氢表雄酮的水平明显降低。^[94]除非这一关系的安全性得到证实，不然高血压患者不应补充去氢表雄酮。

每天服用25毫克时去氢表雄酮会降低高密度脂蛋白水平，也会增加胰岛素样生长因子的水平。高密度脂蛋白的降低会增加心脏病发生的危险。^[95]而胰岛素样生长因子的升高会增加乳腺癌发生的几率。

许多药物会与去氢表雄酮相互作用，参见药物间相互作用章节。

来自英国的推荐

去氢表雄酮需要医生的处方才能使用。服用前需咨询医生。

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