枸橼酸西地那非与酚妥拉明口服治疗勃起功能障碍的疗效和安全性比较

枸橼酸西地那非是第一个治疗勃起功能障碍(ED)的5型磷酸二酯酶抑制剂,而酚妥拉明是治疗ED的传统口服药物,二者的疗效和安全性有何差别呢?Ugarte F等人在墨西哥进行的一项多中心研究,回答了上述问题。该研究中,患者服用西地那非(25~100 mg;n=123)或酚妥拉明(40 mg;n=119)8周,采用国际勃起功能指数(IIEF)和整体疗效问卷进行评估。结果显示,IIEF量表勃起功能方面的评分,西地那非组[(27.23±0.62)分]显著高于酚妥拉明组[(19.35±0.66)分]。西地那非组在下列方面的有效率均多出酚妥拉明组1倍左右,如成功性交、勃起改善和性交能力改善。最常…     

西地那非规律服用治疗勃起功能障碍疗效及安全性评估

目的:探讨西地那非规律服用治疗阴茎勃起功能障碍(ED)的疗效及安全性。方法:334例ED患者随机分为3组,分别给予西地那非50 mg每日1次口服(西地那非规律治疗组,n=111)、西地那非100 mg性生活前30 min口服(西地那非按需治疗组,n=102)、他达拉非10 mg每日1次口服(他达拉非规律治疗组,n=121)。3个月后评估国际勃起功能指数(IIEF-5)评分、阴茎勃起硬度评分(EHS)以及不良反应等。结果:334例ED患者中316例获得随访,3组患者年龄、BMI、受教育情况、病程、失访率、基线IIEF-5评分及EHS评分无统计学差异(P0.05)。3组患者治疗后IIEF-5评分及EHS评分均较治疗前明显改善,差异有统计学意义(P0.05)。治疗后西地那非规律治疗组、西地那非按需治疗组及他达拉非规律治疗组IIEF-5评分[(15.15±2.05)分vs(15.55±2.36)分vs(15.54±2.27)分]无统计学差异(P0.05),但西地那非规律治疗组EHS评分[(3.12±1.52)分]低于西地那非按需治疗组[(3.48±1.80)分](P0.05)。西地那非规律治疗组、西地那非按需治疗组及他达拉非规律治疗组治疗有效率分别为76.2%、62.4%和80.8%,西地那非按需治疗组明显低于其他两组(P0.05)。3组不良反应均较轻微,且3组之间不良反应发生率无明显统计学差异(P0.05)。结论:西地那非规律治疗与他达拉非规律治疗疗效相当,优于西地那非按需治疗,且不良反应无明显增加,是一种值得推荐的ED治疗方法。     

西地那非有效改善应用促红细胞生成素和(或)睾酮无效的透析患者的勃起功能

男性透析患者中勃起功能障碍(ED)是非常普遍的问题。Tas等进行了一项研究,以评价重组人促红细胞生成素(Epo)、睾酮(T)或者两者的联合应用治疗血透患者的勃起功能障碍的疗效,最后对联合疗法无反应的患者用西地那非治疗并评估疗效。入选的23例患者被分成两组。使用国际勃起功能指数问卷(IIEF)评价勃起功能和治疗效果。患者先接受12周的Epo或者T治疗,稍后两组患者一起再接受另外12周的联合治疗。联合治疗后两组患者的IIEF评分都有显著增加,且评分的变化相似。经过联合治疗后,16例IIEF评分仍小于26分的患者接受西地那非和Epo联合治疗,同…     

枸橼酸西地那非治疗男子多发性硬化症患者ED

多发性硬化(MS)可导致勃起功能障碍(ED),枸橼酸西地那非对于此类患者的治疗效果怎样呢?Fowler CJ等人进行了相关研究。一共有217个患者接受了西地那非(25～100mg；n=104)或者安慰剂(n=113)治疗,为期12周。疗效根据国际勃起功能指数问卷(IIEF)中的获得勃起(Q3)和维持勃起(Q4)问题,以及总评题(GEQ)进行评价,同时也评估生活质量。12周后,西地那非组的IIEF Q3和Q4的平均分值比安慰剂组高(P＜0．0001),西地那非组有89%(92/103)的患者报     

他达拉非不同给药方案对初次性生活失败的男性勃起功能障碍患者疗效观察

目的:评估他达拉非3种不同给药方案对初次性生活失败的年轻男性勃起功能障碍(ED)患者疗效。方法:将夜间阴茎勃起硬度检查正常、心理治疗无效的初次性生活失败的年轻男性ED患者分为他达拉非每日小剂量口服组(每日夜间睡前1~2 h口服他达拉非5 mg)、按需治疗组(性生活前1~2 h口服他达拉非10~20 mg,根据勃起硬度调整剂量)、每日小剂量与按需治疗联合组(无性生活时每日夜间口服他达拉非5 mg,性生活当日于性生活前1~2 h一次性服用他达拉非10~20 mg、其剂量根据勃起硬度确定)共3组,分别给予相应治疗2~3个月。以国际勃起功能指数(IIEF)5个专项评分分别评估疗效。结果:3组IIEF勃起功能、性高潮、插入满意度、总体满意度专项评分较治疗前均显著提高(P均0.05或0.01);按需治疗较每日小剂量治疗显著提高勃起功能和性高潮专项评分(P0.05),但在性欲专项评分方面,其效果低于每日小剂量治疗;当给予联合治疗时,5个专项评分均得到了最佳改善(P均0.05)。结论:由于缺乏专业的性心理治疗机构和医生,单纯心理治疗对心理性ED患者疗效较差,以每日小剂量口服联合按需服用他达拉非可明显提高初次性生活失败的年轻男性ED患者疗效。     

西地那非(万艾可)治疗勃起功能障碍的有效性和安全性

作为治疗勃起功能障碍的口服制剂，枸橼酸西地那非（万艾可）的有效性已经在全世界范围内得到认可。Levinson等对埃及和南非地区患有勃起功能障碍的患者进行了为期12周的随机、双盲、安慰剂对照、可调整剂量的平行对照研究，以评估西地那非的有效性和安全性。将不同病因的ED患者随机分为两组，一组服用西地那非50mg（n=128），另一组服用安慰剂（n=126），剂量从25mg到100mg进行调整。     

他达那非联合十一酸睾酮治疗糖尿病合并勃起功能障碍的疗效观察

目的评估他达那非联合十一酸睾酮治疗糖尿病合并勃起功能障碍(ED)的有效性和安全性。方法选取80例ED合并糖尿病的患者,随机分为两组:联合用药组(他达那非联合十一酸睾酮)和单一用药组(单用他达那非),两组各为40例。治疗8周后以国际勃起功能问卷5(IIEF-5)评估治疗的有效性,以不良反应发生率评估治疗的安全性。结果治疗后联合用药组IIEF-5由(13.20±3.33)分上升至(19.05±2.05)分,单一用药组由(11.78±3.41)分上升至(17.87±2.54)分,两组患者的IIEF-5评分均有显著提高,差异均有统计学意义(P均0.001)。且联合用药组疗效显著优于单一用药组,差异也具统计学意义(P0.05)。两组不良反应发生率无明显差异。结论他达那非治疗ED合并糖尿病的患者,安全有效,联合十一酸睾酮疗效更佳。     

按时口服他达拉非治疗按需口服西地那非治疗无效的勃起功能障碍(附15例报告)

目的:总结他达拉非治疗西地那非治疗无效的勃起功能障碍患者的诊疗经验。方法:回顾总结2010年9月至2012年3月15例按需口服西地那非治疗无效的勃起功能障碍患者的病例资料。结果:15例按需口服西地那非治疗无效的勃起功能障碍患者中,11例治疗后勃起功能改善明显,4例改善不明显,有效率73.3%。治疗前后IIEF-5评分比较有显著性差异(P<0.05),疗效满意。4例患者出现不良反应,其中轻微头痛2例,颜面潮红1例,1例出现轻微的腰背痛,均为一过性,继续用药后减轻或消失。结论:按时口服他达拉非是治疗按需口服西地那非治疗无效的勃起功能障碍患者的安全有效方法。     

希爱力专栏

他达拉非治疗接受抗抑郁药治疗的勃起功能障碍患者的疗效J Clin Psychopharmacol,2007,27(1):62-66.Segraves等进行了一项事后分析(post hoc analysis),评估勃起功能障碍(ED)治疗药物———他达拉非对接受抗抑郁药治疗的患者的疗效。这项回顾性的汇总分析包括19项双盲、安慰剂对照的研究(n=3 864),其中男性ED患者205例,平均年龄55岁(27~79岁),患者在接受抗抑郁药治疗的同时服用他达拉非10 mg(n=38)、20 mg(n=113),或者安慰剂(n=54)。疗效评估以国际勃起功能指数(IIEF)、患者性生活日记(SEP)和全球评估问卷(GAQ)为准。他达拉非耐受性…     

枸缘酸西地那非治疗男性Ⅰ型糖尿病患者勃起功能障碍

5％～10％男性Ⅰ型糖尿病患者并发勃起功能障碍（ED），这是一种常见并严重影响患者生活质量的并发症。因此，枸缘酸西地那非对男性Ⅰ型糖尿病患者ED的治疗作用显得非常重要。Stuckey等人进行了相关研究。共185例患者随机分组，应用枸缘酸西地那非（25～100mg，n=95）或安慰剂（n=95）治疗12周。疗效评估应用国际勃起功能障碍评分标准（IIEF）问题3（能否勃起）和问题4（勃起持续时间），     

Efficacy of oral sildenafil in hemodialysis patients with erectile dysfunction

The aim of this study was to evaluate the efficacy and safety of oral sildenafil to treat erectile dysfunction (ED) in chronic renal failure in patients on hemodialysis (HD). A double-blind, randomized, placebo-controlled study of oral sildenafil (50 mg) administered as required in HD patients with ED was designed. Patients on HD for at least 6 mo and who had a stable relationship with a female sexual partner were included. Patients older than 70 yr with penile anatomic abnormalities, cirrhosis, diabetes, angina, severe anemia, and those who were on nitrate treatment or with a recent history of stroke or myocardial infarction were not included. The International Index of Erectile Dysfunction (IIEF) was employed to evaluate ED and treatment response. Forty-one patients were evaluated (21 received placebo, and 20 sildenafil). Baseline clinical and demographic parameters were similar in both groups. Sildenafil was associated with improvement in the score of all questions and domains of the IIEF, except those related to sexual desire. Using the erectile function domain to evaluate primary efficacy, improvement was observed in 85% of the sildenafil patients compared with 9.5% of placebo patients. Sildenafil use resulted in normal EF scores in 35% of sildenafil patients. Sildenafil was well tolerated. Headaches and flushing occurred in both groups. Dyspepsia was reported by two patients in the sildenafil group. In conclusion, oral sildenafil seems to be an effective and safe treatment for ED in selected patients with chronic renal failure on hemodialysis.     

蔗糖铁注射液联合红细胞生成素治疗肾性贫血的临床观察

目的 观察蔗糖铁注射液联合红细胞生成素治疗伴有缺铁的维持性血液透析肾性贫血患者疗效及安全性.方法 选取尿毒症维持性血液透析患者46例,按随机数字表法分为治疗组(26例)和对照组(20例).治疗组采用静脉滴注蔗糖铁100 mg,每周2次,总量达1000 mg改为100 mg,每周1次;对照组采用口服乳酸亚铁0.2 g,每日3次.红细胞生成素的使用剂量和方法两组相同,总疗程均为10周.结果 经治疗后治疗组患者血红蛋白、红细胞压积、血清铁蛋白水平与对照组比较差异有统计学意义(P<0.05).结论 蔗糖铁联合红细胞生成素治疗肾性贫血疗效优于口服铁剂联合红细胞生成素治疗.不良反应发生率更低,可作为肾性贫血患者长期补铁的方法之一.     

Efficacy and safety of sildenafil citrate in hemodialysis patients

Erectile dysfunction (ED) is more frequent among end-stage renal failure patients than the normal population. Sildenafil citrate has been successfully used for the symptomatic treatment of erectile dysfunction. The aim of this study was to determine the efficacy and safety of sildenafil citrate in the treatment of ED in patients on hemodialysis. Fifty-five hemodialysis patients above 18 years suffering from ED with steady sexual partners were included in the study. The first five and fifteenth questions of the International Index of Erectile Function were employed to evaluate ED in the patient group. A Single 50-mg sildenafil citrate tablet was prescribed for each patient. The patients were encouraged to take it on the day after hemodialysis and 1 hour before sexual intercourse. The erectile function of the patients after the treatment was re-evaluated in the same manner by International Index of Erectile Function. The ages of the patients ranged between 30 and 73 years (mean 50.6 +/- 10.9). The overall response rate was 74.5% (38/51). Side effects were nausea (n = 2), palpitation (n = 2), flushing (n = 1), and angina (n = 1). Sildenafil citrate (50 mg) was observed to be safe and effective for treatment of hemodialysis patients with careful evaluation and proper patient selection.     

消瘿合剂及甲状腺片治疗桥本甲状腺炎疗效观察

目的 :观察消瘿合剂和甲状腺片联合治疗桥本甲状腺炎的疗效。 方法 :将患者分为消瘿合剂治疗组 (治疗组 )4 6例和西药对照组 (对照组 ) 30例。两组均口服甲状腺片。对照组口服强的松 10mg,3次 /d ,每月递减 1/ 3。治疗组口服消瘿合剂 5 0mL ,3次 /d。 3个月后观察临床疗效。 结果 :治疗组有效率为 88 7% ,对照组为 6 3 3% ,两组比较 ,差异有显著性 (P <0 0 5 )。两组治疗前后TG -Ab、TM -Ab、TSH变化 ,经统计学处理 ,差异均有显著性 (P <0 0 1)。 结论 :消瘿合剂和甲状腺片联合治疗桥本甲状腺炎疗效佳 ,并能改善患者机体的免疫功能     

Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil

OBJECTIVE: Many patients with erectile dysfunction (ED) stop using sildenafil due to subjective failure. This study examined whether counseling and maximal dosing (100 mg) could achieve better treatment compliance and could possibly improve treatment outcome. MATERIAL AND METHODS: Patients were recruited by newspaper advertisements and referred to 5 ED centers throughout the country. Details about their previous experiences with sildenafil were recorded and following an explicit explanation about the nature and action of the drug, were offered to enter the study. Instructions on drug use were provided during each visit in which four 100 mg Sildenafil tablets were provided. Treatment outcomes were assessed by the international index of erectile function (IIEF) questionnaire after taking 4 and 8 tablets. In 2 ED centers a short video with sexual counseling content was added in between visits. RESULTS: The study cohort was comprised of 220 patients aged 27-88 years. The majority reported having received limited or no instructions on drug use when sildenafil was first prescribed. A significant increase in IIEF erectile function domain scores (EFDS) between visits 1, 2 and 3 was observed (10.96+/-0.40, 16.73+/-0.51 and 17.82+/-0.55 mean+/-SE, respectively), with 23.6% of the study patients achieving normal erectile function at the end of the study. The parameters of age and initial severity of ED most influenced treatment success. CONCLUSIONS: Counseling and dose adjustment were directly influential in achieving an excellent response to a second trial of sildenafil in patients with ED who had previously failed treatment with the drug, and obviated their needing to seek more invasive measures.     

Prognostic factors predicting successful response to sildenafil after radical cystoprostatectomy

OBJECTIVES: To assess the efficacy and safety of sildenafil citrate in the management of erectile dysfunction (ED) following radical cystectomy (RC) and to define the different prognostic factors predicting the response to sildenafil in such a challenging group of patients. MATERIAL AND METHODS: One hundred patients with ED following RC participated in an open-label, non-randomized, prospective, dose-escalation study. The median age of the patients was 53 years and the mean period after RC was 80.7 +/- 54.8 months. The study duration was 12 weeks, comprising a 4-week run-in period followed by two active treatment periods of 4 weeks each with 50 and 100 mg of sildenafil. Patients were assessed by means of the International Index of Erectile Function (IIEF) questionnaire at baseline and after each treatment period. At the end of the study, the Global Efficacy Assessment Question was used to evaluate treatment satisfaction. Factors affecting the patient's response to sildenafil were assessed by means of uni- and multivariate analysis. RESULTS: The entire study group was suffering from severe ED at baseline, with a mean erectile function (EF) domain score of 6.5 +/- 0.93. EF scores improved to 12.2 +/- 7.76 and 18 +/- 10.3 with 50 and 100 mg of sildenafil, respectively. Sildenafil therapy significantly improved the ability of many patients to achieve and maintain an erection. The mean scores for question 3 of the IIEF were 1 +/- 0.14, 2.1 +/- 1.4 and 3 +/- 1.8 at baseline and with 50 and 100 mg of sildenafil, respectively, while the corresponding scores for question 4 were 1 +/- 0.10, 1.9 +/- 1.35 and 3 +/- 1.85. The satisfaction rate was 54%. The response was dose-dependent but the incidence of adverse effects increased from 6% with 50 mg of sildenafil to 34% with 100 mg. In univariate analysis, tumor histology and grade and postoperative partial tumescence were found to significantly impact the patient's response to sildenafil. In multivariate analysis, postoperative partial tumescence was the only independent predictive variable. CONCLUSIONS. Sildenafil was found to be a safe and satisfactory treatment for post-RC ED. The effect was dose-related. Patients with postoperative partial tumescence were the best responders.     

Erectile dysfunction in kidney transplanted patients: efficacy of sildenafil

BACKGROUND: Erectile dysfunction (ED) is the inability to achieve and/or maintain an erection for satisfactory sexual performance. The effects of kidney transplantation on pre-existing ED are poorly understood, as well as the onset of new ED cases after kidney transplantation. This study aimed to evaluate the effects of kidney transplantation on pre-existing ED, to assess the onset of new ED cases after renal transplantation and to assess both the efficacy and safety of sildenafil. METHODS: Erectile function was assessed using the self-administered International Index of Erectile Function (IIEF) to kidney transplanted patients. A 50 mg dose of sildenafil was prescribed. Sildenafil efficacy was assessed by re-administering the questionnaire after 4 weeks of therapy. Blood chemistry and serum cyclosporine concentration were evaluated at the beginning of the study and, in patients treated with sildenafil, after 4 weeks of treatment. RESULTS: One hundred and thirteen patients (87.5%) completed the questionnaire. Fifty-three patients (47%) did not complain of ED, the remaining 60 patients (53%) reported ED. ED was already present during dialysis in 40 patients; it appeared ex novo in 20 patients after transplantation. Pre-existing ED disappeared in 8 patients (20%), ameliorated in 13 patients (32.5%), worsened in 2 patients (5%), and remained unchanged in 17 patients (42.5%) after transplantation. The IIEF score significantly improved in sildenafil-treated patients (n=20); there were no observed changes in blood chemistry, blood pressure (BP), renal function and cyclosporine concentration. The side-effects were minimal. CONCLUSIONS: ED was still present in a large cohort of kidney transplanted men. Renal transplantation cures few ED cases. ED can appear ex novo after transplantation. Sildenafil is an effective ED treatment in kidney transplanted men.     

腺苷蛋氨酸对慢性乙型重型肝炎患者抑郁情绪干预治疗的疗效观察

目的探讨腺苷蛋氨酸（思美泰）对慢性乙型重型肝炎抑郁情绪干预治疗的疗效。方法将49例慢性乙型重型肝炎患者随机分为：观察组（32例）,即在常规内科综合治疗基础上加用思美泰治疗;对照组（17例）,即常规内科综合治疗。两组分别在治疗前、治疗2周和治疗4周时,采用汉密尔顿抑郁量表（HAMD 17）评定抑郁情绪分值。结果观察组HAMD评分从治疗2周起开始下降,但在2周时两组间比较差异无统计学意义,而至第4周末观察组HAMD评分显著下降,两组间差异有统计学意义（P〈0.05）。结论腺苷蛋氨酸在治疗重型肝炎的同时,对慢性乙型重型肝炎患者抑郁情绪也有一定干预治疗作用。     

Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men

A 12-week, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of flexible-dose sildenafil citrate (Viagra) treatment (25, 50 or 100 mg) in Brazilian and Mexican men with erectile dysfunction (ED) of broad-spectrum etiology. Efficacy was assessed on the basis of responses to the 15-item International Index of Erectile Function (IIEF) questionnaire, completed at baseline and after 12 weeks of treatment. At end point, mean scores for all IIEF domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were significantly (P<0.0001) higher in the sildenafil group (n=109) than in the placebo group (n=105). These findings confirm the significant increases in frequency of penetration and frequency of maintained erections reported previously. Sildenafil treatment was well tolerated. The most common adverse events were headache and flushing. In conclusion, sildenafil is a well-tolerated and effective treatment for ED of broad-spectrum etiology in Latin American men.     

溶菌酶肠溶片联合冷冻治疗扁平疣疗效观察

目的：探讨溶菌酶肠溶片联合液氮冷冻治疗扁平疣的临床疗效及并发症,比较溶菌酶肠溶片联合液氮冷冻与单用液氮冷冻或单纯服用溶菌酶肠溶片治疗扁平疣的临床疗效。方法：将140例扁平疣患者随机分为三组,治疗组：55例,溶菌酶肠溶片联合液氮冷冻治疗;对照1组：45例,单纯用液氮冷冻治疗;对照2组：40例,单纯服用溶菌酶肠溶片。均采用五级分类法来统计并判断疗效情况,观察三组的临床疗效及近期、远期并发症。结果：治疗组总有效率达92.73%,对照1组总有效率66.67,%对照2组总有效率57.50%。治疗组分别与对照1、2组比较,具有显著性差异（,χ12=10.92,χ22=16.69,P〈0.05）具有统计学意义。结论：溶菌酶肠溶片联合液氮冷冻治疗扁平疣临床疗效好,而且并发症较少。