S-腺苷甲硫氨酸(SAMe)

S-腺苷甲硫氨酸(SAMe)

S-腺苷甲硫氨酸的功能

S-腺苷甲硫氨酸(SAMe)是人体内的重要化学物质，它参与了超过40个必需的生化反应。

S-腺苷甲硫氨酸参与了解毒反应，在大脑化学物质、抗氧化剂、关节组织和许多其他重要化合物的合成中发挥重要作用。^{[1 2]}

S-腺苷甲硫氨酸可以提高多巴胺水平，而多巴胺是调节情绪的重要的神经递质。^[3]而大脑内S-腺苷甲硫氨酸的水平升高后对于治疗抑郁症有一定的疗效。[4]双盲实验发现口服S-腺苷甲硫氨酸可以治疗一些抑郁症，但并不是所有的。^{[5 6 7 8 9]}因为它的疗效并不能完全与抗抑郁药相当，^[10]或者说它的作用只是短效的，通常只能维持1周。^[11]

S-腺苷甲硫氨酸还具有抗炎、减轻疼痛和促进组织愈合的作用。^{[12 13]}许多研究发现S-腺苷甲硫氨酸对于治疗骨关节炎的疼痛、僵硬和肿胀比安慰剂更有效，可以等同于布洛芬和萘普生。^{[14 15 16 17 18 19 20 21]}

有两个双盲实验发现静脉注射S-腺苷甲硫氨酸可以减轻纤维肌痛的疼痛症状，^{[22 23]}但在一项短期的（10天）的试验中却发现它并没有作用。^[24]在一项双盲试验中，口服S-腺苷甲硫氨酸具有明显的疗效，如减轻疼痛、疲劳和僵硬，并能提高情绪。^[25]

口服和静脉注射S-腺苷甲硫氨酸可以替代损伤肝脏的物质并能提高胆汁的流量。^{[26 27]}以前的试验发现S-腺苷甲硫氨酸可以帮助治疗各种肝病，包括胆汁淤积、吉尔伯氏综合征、酒精性肝病和肝硬化。^{[28 29 30]}在酒精性肝硬化中，损伤的肝脏不能有效生成天然的S-腺苷甲硫氨酸。在一项双盲实验中，患有酒精性肝硬化的人服用S-腺苷甲硫氨酸2年可以降低47%的死亡率或需要肝移植的可能。^[31]可是，这一作用并没有明显的统计学意义。在患有轻度肝硬化的人中，结果可能更有意义一些。以前的试验还发现口服S-腺苷甲硫氨酸可以增加不育男性的精子活性并可以帮助治疗偏头痛。^{[32 33]}在一项双盲试验中发现静脉注射S-腺苷甲硫氨酸可以比安慰剂明显降低脑震荡的后遗症。^[34]

S-腺苷甲硫氨酸的分布

S-腺苷甲硫氨酸在饮食中并不充足，尽管其前体甲硫氨酸在许多蛋白质饮食中含量丰富。目前还不清楚增加摄入甲硫氨酸是否可以增加机体合成S-腺苷甲硫氨酸。从1997年开始S-腺苷甲硫氨酸在美国开始作为有效的补充剂。

S-腺苷甲硫氨酸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S-腺苷甲硫氨酸？

S-腺苷甲硫氨酸通常由肝脏从甲硫氨酸合成而来。叶酸和维生素B12在合成S-腺苷甲硫氨酸时是必需的，如果缺乏这些维生素会导致S-腺苷甲硫氨酸在中枢神经系统的含量降低。^[35]血液中或中枢神经系统中S-腺苷甲硫氨酸的水平的降低在肝硬化^[36]、冠心病^[37]、阿尔茨海默氏病和抑郁症^[38]的患者中存在。

一般需要多少S-腺苷甲硫氨酸？

健康人并不需要补充S-腺苷甲硫氨酸。研究者在对各种疾病的研究中使用的量为：治疗抑郁症为每天1600毫克；骨关节炎，每天800~1200毫克；纤维肌痛，每天800毫克；肝损害，每天1200毫克；偏头痛，每天800毫克。

是否有副作用和药物相互作用？

临床试验发现服用S-腺苷甲硫氨酸两年以上的人并没有明显的副作用，比其他相比较的药物要好得多。^{[39 40]}偶尔会出现胃肠道不适。有报道称治疗双极紊乱（躁狂性抑郁症）的人会转化成躁狂症。^{[41 42]}

一些药物会与S-腺苷甲硫氨酸发生相互作用，参见药物间相互作用章节。

参考文献

1. Chiang PK, Gordon RK, Tal J, et al. S-Adenosylmethionine and methylation. FASEB J 1996;10:471–80 [review].

2. Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs 1994;48:137–52 [review].

3. Fava M, Rosenbaum JF, MacLaughlin R, et al. Neuroendocrine effects of S-adenosyl-L-methionine, a novel putative antidepressant. J Psychiatr Res 1990;24:177–84.

4. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

5. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

6. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

7. Salmaggi P, Bressa GM, Nicchia G, et al. Double-blind, placebo-controlled study of s-adenosyl-methionine in depressed post-menopausal women. Psychother Psychosom 1993;59:34–40.

8. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosyl-methionine in depression: A randomized, double-blind, placebo-controlled trial. Am J Psychiatry 1990;147:591–5.

9. Fava M, Rosenbaum JF, Birnbaum R, et al. The thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients. Acta Psychiatr Scand 1992;86:42–5.

10. De Vanna M, Rigamonti R. Oral S-adenosyl-L-methionine in depression. Curr Ther Res 1992;52:478–85.

11. Fava M, Giannelli A, Rapisarda V. Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine. Psychiatr Res 1995;56:295–7.

12. Schumacher HR. Osteoarthritis: The clinical picture, pathogenesis, and management with studies on a new therapeutic agent, S-adenosylmethionine. Am J Med 1987;83(suppl 5A):1–4 [review].

13. Harmand MF, Vilamitjana J, Maloche E, et al. Effects of S-adenosylmethionine on human articular chondrocyte differentiation: an in vitro study. Am J Med 1987;83(suppl 5A):48–54.

14. Domljan Z, Vrhovac B, Durrigl T, Pucar I. A double-blind trial of ademetionine vs naproxen in activated gonarthrosis. Int J Clin Pharmacol Ther Toxicol 1989;27:329–33.

15. Muller-Fassbender H. Double-blind clinical trial of S-adenosylmethionine in versus ibuprofen in the treatment of osteoarthritis. Am J Med 1987;83(suppl 5A):81–3.

16. Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med 1987;83(suppl 5A):78–80.

17. Maccagno A. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83(suppl 5A):72–7.

18. Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med 1987;83(suppl 5A):66–71.

19. Marcolongo R, Giordano N, Colombo B, et al. Double-blind multicentre study of the activity of s-adenosyl-methionine in hip and knee osteoarthritis. Curr Ther Res 1985;37:82–94.

20. Glorioso S, Todesco S, Mazzi A, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res 1985;5:39–49.

21. Montrone F, Fumagalli M, Sarzi Puttini P, et al. Double-blind study of S-adenosyl-methionine versus placebo in hip and knee arthrosis. Clin Rheumatol 1985;4:484–5.

22. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: a double-blind study. Clin Exp Rheumatol 1998;16:106–7 [letter].

23. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of S-adenosylmethionine in primary fibromyalgia: a double-blind crossover study. Am J Med 1987;83(suppl 5A):107–10.

24. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997;26:206–11.

25. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.

26. Lieber CS. Herman Award lecture, 1993: a personal perspective on alcohol, nutrition, and the liver. Am J Clin Nutr 1993;58:430–42 [review].

27. Osman E, Owen JS, Burroughs AK. S-adenosyl-L-methionine–a new therapeutic agent in liver disease? Aliment Pharmacol Ther 1993;7:21–8 [review].

28. Angelico M, Gandin C, Nistri A, et al. Oral S-adenosyl-L-methionine (SAMe) administration enhances bile salt conjugation with taurine in patients with liver cirrhosis. Scand J Clin Lab Invest 1994;54:459–64.

29. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosyl-methionine in the symptomatic treatment of intrahepatic cholestasis: a double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

30. Bombardieri G, Milani A, Bernardi L, Rossi L. Effects of S-adenosyl-L-methionine (SAMe) in the treatment of Gilbert’s syndrome. Curr Ther Res 1985;37:580–5.

31. Mato JM, Cámara J, Fernández J, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999;30:1081–9.

32. Piacentino R, Malara D, Zaccheo F, et al. Preliminary study of the use of s. adenosyl methionine in the management of male sterility. Minerva Ginecol 1991;43:191–3 [in Italian].

33. Gatto G, Caleri D, Michelacci S, Sicuteri F. Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial. Int J Clin Pharmacol Res 1986;6:15–7.

34. Ballerini FB, Anguera AL, Alcaraz P, et al. SAM in the management of postconcussional syndrome. Med Clin (Barc) 1983;80:161–4.

35. Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs 1994;48:137–52 [review].

36. Osman E, Owen JS, Burroughs AK. S-adenosyl-L-methionine–a new therapeutic agent in liver disease? Aliment Pharmacol Ther 1993;7:21–8 [review].

37. Loehrer FM, Angst CP, Haefeli WE, et al. Low whole-blood S-adenosylmethionine and correlation between 5-methyltetrahydrofolate and homocysteine in coronary artery disease. Arterioscler Thromb Vasc Biol 1996;16:727–33.

38. Bottiglieri T, Godfrey P, Flynn T, et al. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parenteral and oral S-adenosylmethionine. J Neurol Neurosurg Psychiatry 1990;53:1096–8.

39. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

40. Di Padova C. S-adenosyl-methionine in the treatment of osteoarthritis: review of the clinical studies. Am J Med 1987;83(suppl 5A):60–4.

41. Carney MWP, Chary TK, Bottiglieri T, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry 1989;154:48–51.

42. Carney MWP, Chary TK, Bottiglieri T, et al. Switch and S-adenosyl-methionine. Alabama J Med Sci 1988;25:316–9.