老年男性痴呆病人雄激素补充治疗初探

目的 :探讨老年男性痴呆病人内分泌激素水平及雄激素补充治疗效果。　方法 :选择 9例没有雄激素补充治疗禁忌证且经精神科确诊为老年痴呆的男性病人 ,进行一般健康状况、精神状况、内分泌激素水平等的全面评价 ,并给予补充十一酸睾酮酯 (商品名 :安特尔 ) 12 0mg/d ,连续口服 6周 ,观察并记录治疗前后的变化。　结果 :治疗前 9例老年痴呆病人简易精神状态检查表 (MMSE)平均积分为 5 .3 3分 ,汉米尔顿抑郁量表 (HAMD)评分平均为14.5 6分 ,总体衰退量表 (GDS)平均积分为 5 .0级 ,老年男性雄激素部分缺乏 (PADAM )量表评分平均为 3 2 .5 6分 ,睾丸体积偏小 (平均体积 8.3 3ml)。补充睾酮治疗终止 1周后 ,血清总睾酮水平显著降低 (从 2 .88ng/ml降至 2 .47ng/ml,P <0 .0 5 ) ,游离睾酮水平也有一定程度的降低 ,但差别无显著性 (P >0 .0 5 )。治疗前后临床总体印象 (CGI)表明 ,2例病情无明显改变 ;7例均有不同程度改善 ,其中 3例病人明显改善 ,表现在HAMD平均积分降低 ( 10 .67分 )、PADAM量表平均评分降低 ( 2 8.11分 ) ,病人的体能症状和精神心理症状明显改善 ,血管舒缩症状改善不明显 ,而性方面的症状无改善。　结论 :老年男性痴呆病人体内雄激素水平偏低 ,并明显存在雄激素缺乏的相关症状 ,雄激素补充治?

A Tentative Research of Testosterone Supplement Therapy on Male Senile Dementia

Objectives: To understand the hormone levels in male senile dementia patients and the effects of testosterone supplement theraphy (TST) on male senile dementia. Methods: The general health condition, mental health condition, hormone levels, and some other aspects were evaluated in 9 patients with male senile dementia without significant contradiction for TST. 9 patients were treated with oral testosterone undecanoate 120 mg per day for six weeks, and relative changes were observed, detected and recorded. Results: In 9 cases of male senile dementia, the average score was 5.33 in mini-mental state examination (MMSE), 14.56 in Hamilton depression scale (HAMD), 5.0 in geriatric depression scale (GDS), 32.56 in partial androgen deficiency of the aging male (PADAM) measuring form. The volume of testis was small ( 8.33 ml on average). After 1 week of having finished TST, the levels of serum testosterone (T) dropped significantly(dropped from average 2.88 ng/ml to 2.47 ng/ml,P< 0.05) in 9 patients with TST. General evaluation with clinician's global impression(CGI) for 9 patients showed 2 cases fail and 7 cases with progress (3 of them progress significantly). Average score dropped in HAMD form ( 10.67) and PADAM form ( 28.11). Physical strength and psychological status improved significantly, but vasomotor symptoms and sexual function failed response to the treatment. Conclusions: The levels of androgen is low, and the symptoms of androgen deficiency are readily seen in male senile dementia. TST can improve life quality of most patients to some extent. Natl J Androl,2003,9(3):193-196