基于性激素治疗肌少症中西医研究进展

Research Progress of Traditional Chinese and Western Medicine in the Treatment of Sarcopenia Based on Sex Hormones

人体肌肉含量和肌力会随着年龄的增长不可避免地产生一定程度的下降,称为“肌肉减少症”或“肌少症”(sarcopenia)。近年来肌少症在中老年人群中,发病率逐步攀高,越来越受到人们的广泛关注。临床主要表现为行动困难,并限制正常的体育活动与基本的自理能力,是导致机体摔倒、扭伤、骨折、致残及致死的主要原因之一。肌肉含量变少与性腺功能衰退、性激素分泌减少等密切相关。性激素不仅能促进性器官成熟,维持人体第二性特征,而且能增加肌肉含量、促进生长激素分泌。治疗肌少症的性激素类药物较少,临床中常用的雌激素药物有补佳乐、替勃龙。雄激素主要为类固醇激素,天然的雄激素主要为睾酮,临床中主要使用的是人工合成睾酮的衍生物如安迪欧、安特尔等,但其适应证较为苛刻,且不良反应较多。中药中淫羊藿、肉苁蓉、杜仲等都有类性激素作用,但是其相关治疗及文献较少。该文基于人体内主要性激素与肌少症的相关性,探讨激素对肌少症的治疗机制,总结类性激素中药在中医基础研究和临床治疗肌少症的有效经验,以期为中医药临床治疗肌少症提供参考。

A decline in muscle content and muscle strength that inevitably occurs as we age is called“sarcopenia”.In recent years sarcopenia has gradually become a comprehensive disease with high morbidity in middle-aged and elderly people,and has been paid more and more attention by people.The main clinical manifestations are difficulty in movement,and restrict normal sports activities and basic self-care ability,which is one of the main causes of body fall,sprain,fracture,disability and death.The content of muscle is closely related to the decline of gonadal function and the decrease of sex hormone secretion.Sex hormone can not only promote the maturation of sexual organs,maintain secondary sexual characteristics of the human body,but also increase muscle content and promote growth hormone secretion.There are few sex hormone drugs in the treatment of sarcopenia,and the estrogen drugs commonly used in clinic are estradiol valerate tablets and tibolone.Androgen is mainly steroid hormone,and the natural androgen is mainly testosterone,and the synthetic derivatives of testosterone are mainly used in clinical practice,such as testosterone undecanoate and andriol testocaps.Its indication is more demanding,and side effects are more.In traditional Chinese medicine,Yinyanghuo(Epimedium Brevicornu Maxim),Roucongrong(Cistanche Deserticola Ma)and Duzhong(Eucommia Ulmoides Oliv)all have sex hormone-like effects.But the related treatment and literature are few.Based on the correlation between the main sex hormones and sarcopenia in human body,this paper discusses the pathogenesis of hormone on sarcopenia,the therapeutic effect of sex hormones on sarcopenia in traditional Chinese and Western medicine,and the experience of sex hormones in the basic research of traditional Chinese medicine and clinical treatment of sarcopenia,in order to provide reference for the treatment of sarcopenia in traditional Chinese medicine.