Dehydroepiandrosterone:a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient  

作　　者：Conor Bentley Jon Hazeldine Carolyn Greig Janet Lord Mark Foster 

机构地区：[1]NIHR Surgical Reconstruction and Microbiology Research Centre,University Hospital Birmingham,Birmingham B152WB,UK [2]School of Sport,Exercise and Rehabilitation Sciences,University of Birmingham,Birmingham,UK [3]MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research,Institute of Inflammation and Ageing,Birmingham University Medical School,Birmingham B152TT,UK [4]NIHR Biomedical Research Centre,University Hospital Birmingham,Birmingham,UK [5]Royal Centre for Defence Medicine,Birmingham Research Park,Birmingham B152SQ,UK.

出　　处：《Burns & Trauma》2019年第1期248-260,共13页烧伤与创伤（英文）

基　　金：the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre,which is jointly funded by the Department of Health and Ministry of Defence(www.nihr.ac.uk).

摘　　要：Severe injuries are the major cause of death in those aged under 40,mainly due to road traffic collisions.Endocrine,metabolic and immune pathways respond to limit the tissue damage sustained and initiate wound healing,repair and regeneration mechanisms.However,depending on age and sex,the response to injury and patient prognosis differ significantly.Glucocorticoids are catabolic and immunosuppressive and are produced as part of the stress response to injury leading to an intra-adrenal shift in steroid biosynthesis at the expense of the anabolic and immune enhancing steroid hormone dehydroepiandrosterone(DHEA)and its sulphated metabolite dehydroepiandrosterone sulphate(DHEAS).The balance of these steroids after injury appears to influence outcomes in injured humans,with high cortisol:DHEAS ratio associated with increased morbidity and mortality.Animal models of trauma,sepsis,wound healing,neuroprotection and burns have all shown a reduction in proinflammatory cytokines,improved survival and increased resistance to pathological challenges with DHEA supplementation.Human supplementation studies,which have focused on post-menopausal females,older adults,or adrenal insufficiency have shown that restoring the cortisol:DHEAS ratio improves wound healing,mood,bone remodelling and psychological well-being.Currently,there are no DHEA or DHEAS supplementation studies in trauma patients,but we review here the evidence for this potential therapeutic agent in the treatment and rehabilitation of the severely injured patient.

关 键 词：DEHYDROEPIANDROSTERONE Dehydroepiandrosterone sulphate Traumatic injury Intensive care IMMUNE REHABILITATION 

分 类 号：R65[医药卫生—外科学]