糖尿病性勃起功能障碍研究进展

勃起功能障碍是糖尿病患者常见的慢性并发症之一,糖尿病性勃起功能障碍的发病率为19.0%～ 86.3%,其发病是糖尿病性血管和神经病变、内分泌激素改变、社会和心理等多因素共同作用的结果.临床上应紧密结合糖尿病性勃起功能障碍的发病机制进行综合治疗,并遵循个体化治疗原则.严格控制血糖是基础治疗之一,同时根据情况选择不同作用机制的药物进行综合治疗以改善症状,必要时行手术治疗.基因治疗为糖尿病性勃起功能障碍患者带来曙光,也是目前的研究热点.     

糖尿病性勃起功能障碍研究进展

勃起功能障碍是糖尿病患者常见的慢性并发症之一,糖尿病性勃起功能障碍的发病率为19.0%～ 86.3%,其发病是糖尿病性血管和神经病变、内分泌激素改变、社会和心理等多因素共同作用的结果.临床上应紧密结合糖尿病性勃起功能障碍的发病机制进行综合治疗,并遵循个体化治疗原则.严格控制血糖是基础治疗之一,同时根据情况选择不同作用机...     

初发2型糖尿病患者勃起功能障碍与同型半胱氨酸关系的初步探讨

目的 探讨初发2型糖尿病患者勃起功能障碍与血清同型半胱氨酸水平的关系,并分析影响勃起功能的其他因素.方法收集30例初发2型糖尿病合并勃起功能障碍患者[根据国际勃起功能指数(IIEF-5)评分判定],同时收集33例初发2型糖尿病未合并勃起功能障碍患者为对照组,并设正常对照组30例.用特定蛋白分析仪免疫散射比浊法测定血清总同型半胱氨酸,并测定血糖、HbA_(IC)、胰岛素、血脂、尿酸、性激素等指标.结果糖尿病勃起功能障碍组血清总同型半胱氨酸水平[(12.9±1.2)μmol/L]明显高于糖尿病非勃起功能障碍组[(9.9±1.6)μmol/L,P<0.05]及正常对照组[(7.2±1.1)μmol/L,P<0.01];初发2型糖尿病患者IIEF-5评分与总同型半胱氨酸、年龄、吸烟、体重指数、HbA_(IC)、空腹血糖负相关(相关系数分别为-0.574、-0.413、-0.231、-0.242、-0.274、-0.371,P<0.05或P<0.01),与高密度脂蛋白胆固醇呈正相关(相关系数为0.275,P=0.013).结论糖尿病勃起功能障碍是一个多环节、多病因参与的结果,同型半胱氨酸可能是糖尿病性勃起功能障碍一个新的危险因素.     

糖尿病勃起功能障碍的口服药物治疗

勃起功能障碍(ED)是糖尿病常见并发症之一,是指不能达到或维持勃起以进行满意的性生活(阳萎-NIH协调大会)[1].国外报道40～70岁的男性糖尿病患者完全性ED,患病率是普通人的群的3倍以上[2].我院内分泌糖尿病门诊,对此类患者23例,进行以控制代谢为基础,以改善勃起功能为目的综合治疗,效果较满意,现报告如下.     

2型糖尿病勃起功能障碍者内皮细胞舒张功能与CRP的相关研究

收集30例初发2型糖尿病合并勃起功能障碍患者[根据国际勃起功能指数（IIEF-5）评分判定],同时收集2型糖尿病合并勃起功能障碍者一级亲组30例,初发2型糖尿病未合并勃起功能障碍患者组30,并设正常对照组30例。采用免疫比浊法检测hs—CRP水平,并测定颈动脉内膜中层厚度、血糖、胰岛素、血脂、尿酸、性激素、HbA1C等指标。结果：初发2型糖尿病勃起功能障碍组内皮细胞舒张功能障碍,其一级亲组已有升高。结论糖尿病勃起功能障碍是一个多环节、多病因参与的结果,血浆CRP浓度对于糖尿病勃起功能障碍可提供作为一敏感的诊断标志物。     

初发2型糖尿病患者勃起功能障碍与内皮细胞舒张功能关系

收集30例初发2型糖尿病合并勃起功能障碍患者[根据国际勃起功能指数（HEF-5）评分判定],同时收集2型糖尿病合并勃起功能障碍者一级亲组30例,初发2型糖尿病未合并勃起功能障碍患者组30,并设正常对照组30例。用彩色多普勒超声显像仪进行血管内皮功能的检测。结果：初发2型糖尿病勃起功能障碍组内皮细胞舒张功能障碍,其一级亲组已有降低,初发2型糖尿病患者IIEF-5评分与年龄、吸烟、体重指数、HbA1C、空腹血糖负相关,与高密度脂胆固醇呈正相关。结论糖尿病勃起功能障碍是一个多环节、多病因参与的结果,血管内皮细胞舒张功能障碍可能是其一个危险因素。     

糖尿病勃起功能障碍的综合治疗

勃起功能障碍(ED)与糖尿病之间的关系，很早就已引起人们的注意。Naunyn于1906年首先提出勃起功能障碍是糖尿病最常见的并发症之一。糖尿病患者ED的发病率是非糖尿病患者的3～5倍。糖尿病患者能否走出勃起功能障碍的困境，重振昔日雄风?     

糖尿病勃起功能障碍的识别及临床处理

糖尿病勃起功能障碍(erectile dysfunction,ED)是男性糖尿病患者常见的并发症之一,是严重影响患者生活质量而又易被医生忽视的问题.     

老年男性性功能障碍危险因素

目的 研究≥65岁老年男性患者性功能障碍的患病情况及主要危险因素.方法 搜集该院655例老年男性体检患者作为研究对象,采用男性性功能问卷(O'Leary 1995)、国际勃起功能问卷评分(IIEF-5)评价患者的性功能障碍程度,并记录患者的国际前列腺症状评分(IPSS)、体质指数、前列腺体积、基础疾病、吸烟、饮酒等一般情况,采用logistic回归分析老年男性性功能障碍的危险因素.结果 655例患者中,性欲低下、勃起功能障碍及射精障碍的患病率分别为82.8％ 、86.4％ 、36.2％.性欲低下的危险因素主要包括:年龄、心脑血管疾病、糖尿病、夫妻感情不合.勃起功能障碍的危险因素包括:年龄、体质指数、IPSS评分、前列腺体积、糖尿病.而射精障碍的危险因素包括:年龄、前列腺体积、饮酒、糖尿病.结论 年龄及糖尿病是老年男性性欲低下、勃起功能障碍及射精障碍的共同危险因素,夫妻感情是性欲低下的危险因素,体质指数及前列腺体积是勃起功能障碍的危险因素,而射精障碍的危险因素主要包括前列腺体积和饮酒等.     

网上快讯

美国糖尿病协会 (ＡＤＡ)第 2 0 0 2年 6 2届年会消息1.Ｖａｒｄｅｎａｆｉｌ可持续改善糖尿病男性患者的勃起功能障碍在第 6 2届美国糖尿病协会 (ＡＤＡ)年会上报道的一项双盲、随机、对照研究认为 ,Ｖａｒｄｅｎａｆｉｌ可长期 (6月 )改善 1型糖尿病及 2型糖尿病患者的勃起功能。该研究中 ,具有勃起功能障碍 (ＥＤ)的男性糖尿病者分别接受 10ｍｇ或 2 0ｍｇ的Ｖａｒｄｅｎａｆｉｌ治疗 3月或 6月 ,结果显示Ｖａｒｄｅｎａｆｉｌ可有效改善糖尿病者的勃起功能。该药最常见的副作用为头痛、潮红 ,但耐受性好。在ＡＤＡ年会上公布的另一则消…     

Sexualstörungen bei Diabetes mellitus

In diabetology sexual dysfunction has been for years and still is a neglected area. Diabetologists may fail to recognize that sexual disorders, especially erectile dysfunction, are complications of diabetic metabolism. Thus sexual dysfunction in diabetic patients may be considered to represent only a slight change in lifestyle and not a disease that needs to be treated. A main objective in treating diabetic patients today is to keep their quality of life as high as possible. Sexual dysfunction means a reduction in quality of life. Therefore, if desired, it should be treated. In diabetic patients sexual dysfunction is found more often and at a younger age than in the non-diabetic population. Sexual dysfunction in diabetic women has not been well investigated and treated. Erectile dysfunction is the most important sexual disorder in diabetic men. There are many therapeutic opportunities that work very well in these men. At present many of these men prefer to take PDE-5 inhibitors which is the most comfortable treatment.     

Sexualstörungen bei Diabetes mellitus

Sexual dysfunction is widely neglected in diabetology. Diabetologists are often of the opinion that treating other problems in the diabetic patient should take priority. Sexual dysfunction is considered as only a disorder rather than as a disease. Although the main goal of treating diabetic patients today is achieving a high quality of life, the psychological and somatic effects of sexual dysfunction in diabetic men and women is underestimated. Sexual dysfunction represents a significant impairment on quality of life. When this is the case and a patient wishes treatment, this should be available in the same way as other treatments for diabetic complications. Sexual dysfunction is found in diabetic patients more often and at a younger age than in the non-diabetic population. Sexual dysfunction in diabetic women comprises disorders of sexual desire, arousal, orgasm and satisfaction. Sexual dysfunction in diabetic men comprises disorders of sexual desire, orgasm, ejaculation and erection. Although effectiveness and acceptance of treatment regimes for these sexual dysfunctions are rated differently, there is no doubt that treatment for erectile dysfunction in diabetic men is very effective using PDE-5 inhibitors.     

Treatment of hypertension in diabetic men: problems with sexual dysfunction

Hypertension occurs 2 to 3 times more frequently in diabetic persons than in nondiabetic persons. Care must be taken in treating hypertension in diabetic patients because the choice of antihypertensive agent may worsen the diabetic state or its complications or cause additional health problems for the patient. Sexual dysfunction is a common problem in diabetic patients; however, diabetes need not be the cause. Diabetic men with hypertension have an increased sensitivity to the side effect of sexual dysfunction, which occurs from the use of centrally acting antihypertensive agents. By using prazosin, an alpha 1-adrenergic blocking agent, this cause of sexual dysfunction was eliminated. The reasons for the increased prevalence of hypertension in diabetic patients are discussed and a rational approach is given for the treatment of elevated blood pressure in these individuals.     

Diabetes and complications after cardiac surgery: comparison with a non-diabetic population

Diabetes is a well-recognized independent risk factor for mortality due to coronary artery disease. When diabetic patients need cardiac surgery, either coronary-aortic by-pass (CABP) or valve operations (VO), the presence of diabetes represents an additional risk factor for these major surgical procedures. Because of controversial data on mortality rates and post-operative complications in diabetic patients, probably due to not exactly comparable groups of patients, this retrospective study aimed to compare two homogeneous populations, which were different only for the presence or absence of diabetes. We studied 700 patients undergoing cardiac surgery: 350 with and 350 without diabetes, mean age 62 ± 9 years (67% males); 441 underwent CABP and 259 VO. Apart from the diabetes, the two groups were strictly matched for age, body mass index, concomitant pathologies and smoking habits, except for previous neurological injuries (more frequent in diabetic patients), and for a slightly lower ejection fraction in the diabetic group. Intra- and post-operative complications or events were evaluated carefully: death, number staying in post-operative intensive care unit (ICU), renal, hepatic and respiratory complications, necessity for reoperation and hemotransfusions. Anesthesia and surgical procedures (including extra-coproreal circulation techniques) remained substantially unchanged over the period of recruitment of patients (1996–1998) and applied equally to both groups of patients. All diabetic patients were treated with insulin by using standard procedures in order to optimize metabolic control. Diabetic patients in our study, did not show higher rates of mortality in comparison with non-diabetic patients, but had more total neurological complications, more renal complications, a higher re-opening rate, more prolonged ICU stay, and they needed more blood transfusions. Diabetes remains an independent risk factor for these events even in a multivariate logistic regression model analysis. In the subgroup of diabetic patients who underwent CABP a higher rate of renal dysfunction, re-opening, need for hemotransfusions and prolonged ICU stay were confirmed. In the subgroup of diabetic patients undergoing VO we found a higher rate of renal dysfunction, reopening, prolonged ICU stay and major lung complications. In conclusion, diabetes does not seem to increase the mortality rates of cardiac surgery, but diabetic patients undergoing CABP have, on the basis of the relative risk evaluation, a 5-fold risk for renal complications, a 3.5-fold risk for neurological dysfunction, a double risk of being hemotransfused, reoperated or being kept 3 or more days in the ICU in comparison with non-diabetic patients. Moreover, diabetic patients undergoing VO have a 5-fold risk of being affected by major lung complications. Received: 2 February 1999 / Accepted in revised form: 19 May 1999     

2型糖尿病患者左心室功能评价的临床研究

利用多巴酚丁胺负荷超声心动图评价糖尿病患者左心功能早期变化，结果提示，新诊断2型糖尿病患者在无器质性心脏病表现时已存在心功能障碍，尤其是左心舒张功能障碍；多巴酚丁胺负荷可提高超声心动图对糖尿病患者早期左心功能障碍的检出率。     

Erectile dysfunction and diabetes in Conakry (Guinea): frequency and clinical characteristics from 187 diabetic patients

Sexual dysfunction is frequent in the diabetic population. In Africa, medical care for erectile dysfunction is underprovided, profoundly altering the quality of life of the patients. We report the prevalence of erectile dysfunction in 187 diabetic patients followed in the department of Endocrinology of the Conakry teaching hospital. Prevalence was estimated from the French version of the International Index of Erectile Function (IIEF). Erectile dysfunction concerned 90 patients (48%) of whom a severe form was observed in 54%, a moderate form in 35% and a mild form in 12%. The patients who presented erectile dysfunction were significantly older, displayed longer duration of diabetes with more complications (sensorial neuropathy and macroangiopathy) and often took drugs for associated cardiovascular diseases. In 28% of the cases, erectile dysfunction was associated with a decline in libido and in 26% with ejaculation disorders. In conclusion, erectile dysfunction is frequent and severe among diabetic patients in Guinea. The medical staff plays an essential role to initiate early diagnosis, promote psychological support and provide medication, if possible.     

The association between urodynamic findings and micro-vascular complications in type 2 diabetic patients with or without voiding symptoms

The aim of the present study was to evaluate the association between diabetic micro-vascular complications with the varied urodynamic manifestations of diabetic cystopathy in both asymptomatic and symptomatic subgroup of patients as shown in previous studies. A total of 63 type 2 diabetic patients are stratified into those with and without voiding dysfunction according to International Prostate Symptom Score (IPSS) score. Urine for albumin/creatinine ratio, direct ophthalmoscopy, and nerve conduction study (NCS) along with multichannel urodynamic study (UDS) were performed to detect diabetic micro-vascular complications. Correlation between urodynamic and micro-vascular complications was evaluated in patients with and without voiding symptoms and compared. Among the 63 patients (34 patients asymptomatic and 29 patients symptomatic), diabetic nephropathy, diabetic retinopathy, motor conduction study (MCS) abnormality, sensory conduction study (SCS) abnormality, and combined NCS abnormality were seen in 74.6, 49.2, 66.7, 65.1, and 65.1 % patients, respectively. On urodynamic study, diabetic cystopathy motor (DCM), diabetic cystopathy sensory (DCS), detrusor overactivity (DO), and bladder outlet obstruction (BOO) were found in 58.7, 54, 34.9, and 36.5 % cases, respectively. Among the micro-vascular complications, sensory nerve conduction studies (SCS), motor nerve conduction studies (MCS), and combined NCS abnormality had significant association with UDS abnormalities in diabetic patients. The association was stronger in symptomatic patients. A large proportion of type 2 diabetic patients have shown clinical and electrophysiologic evidence of neurologic dysfunction which can predict the presence or absence of DCS and DCM even in the asymptomatic stage. The correlation is stronger in the symptomatic group.     

Elevated levels of plasma prorenin (inactive renin) in diabetic and nondiabetic patients with autonomic dysfunction

We measured plasma inactive renin (prorenin) levels in 46 diabetic patients, 4 nondiabetic patients with idiopathic autonomic dysfunction, and 115 normal subjects. Plasma inactive renin levels were normal in the diabetic patients who had no complications (n = 6) and in those with microvascular disease (n = 8) who did not have coexistent autonomic dysfunction. Plasma inactive renin was either grossly elevated or in the upper limit of the normal range in diabetic patients with autonomic dysfunction (n = 18). No correlation was found between plasma inactive renin and glycemic control, as measured by hemoglobin A1c. High plasma inactive renin levels were also found in the 4 nondiabetic patients with idiopathic autonomic dysfunction. These data suggest that increased plasma inactive renin levels in diabetic patients are a consequence of coexistent autonomic dysfunction. This finding is consistent with other evidence that suggests autonomic regulation of the processing of prorenin to renin within the kidney.     

Cognitive dysfunction: An emerging concept of a new diabetic complication in the elderly

The incidence of type 2 diabetes mellitus (T2DM) has risen, and this trend is likely to continue. Recent advances suggest that T2DM is a risk factor for cognitive decline. We are now encountering novel complications of T2DM, namely cognitive dysfunction and dementia. Although the treatment strategy for diabetic patients with neurocognitive dysfunction has received a great deal of attention, the appropriate level of glycemic control for the prevention of the development and/or progression of cognitive decline in elderly diabetic patients remains to be elucidated. Another issue in diabetic treatment in patients with cognitive dysfunction is the selection of medicines. The best choice and combination of antidiabetic medications for the preservation of cognition should also be studied. Ample studies suggest that exercise helps to preserve cognitive function, although existing evidence does not necessarily indicate its effectiveness exclusively in diabetic patients. Exercise is a helpful non‐pharmacological therapy. Considering the progressive aging of the worldwide population, more research to investigate the best way to manage this population is important. Geriatr Gerontol Int 2012; ••: ••–•• .     

A comparative analysis of fructosamine with other risk factors for kidney dysfunction in diabetic patients with or without chronic kidney disease

BackgroundHyperglycemia is the driving force for the development of diabetic nephropathy leading to the end stage renal disease. It is well known that in hyperglycaemic condition, serum proteins become glycated through non-enzymatic glycation. With the other risk factors, serum fructosamine may be an important risk factor for kidney impairment. To assess coexistence of frequently documented risk factors of kidney dysfunction with serum fructosamine in diabetic patients with chronic kidney disease (CKD).MethodsIn this study, total 150 individuals, as control, type2 diabetic patients without complication and with CKD were included. Blood samples were collected from all the samples to estimate blood glucose, HbA1c, serum creatinine, fructosamine levels and lipid profile. Statistical analysis i.e. regression and correlation between serum fructosamine and other documented risk factors for diabetic CKD has been done. P < 0.001 was considered significant.ResultsSerum fructosamine, HbA1c, creatinine levels, cholesterol and LDL were increased significantly (P < 0.001) in diabetic patients with CKD compared to without complications. Systolic and diastolic blood pressure and BMI were also significantly higher in diabetic patients compared to control. Serum creatinine, total cholesterol and LDL showed a significant positive correlation but HDL showed a negative correlation with fructosamine in CKD diabetic patients. No significant correlation was found with any risk factors in diabetic patients without complications expect HbA1c.ConclusionIt is concluded that elevated serum fructosamine level is strongly associated with kidney dysfunction in diabetic patients. As there is a significant link between serum fructosamine and other risk factors for CKD diabetic patients.