男性慢性肝病患者勃起功能障碍研究进展*

目的 肝脏是性激素、脂质等多种物质代谢的重要器官。男性慢性肝病患者常合并性激素代谢紊乱、糖脂代谢紊乱和精神心理疾病等,容易发生勃起功能障碍,对患者的身心健康和家庭生活造成影响。现有研究表明,男性慢性肝病患者勃起功能障碍患病率在24.6%～85.0%之间,慢性肝炎患者勃起功能障碍患病率为8.6%～78.0%,而肝硬化患者勃起功能障碍患病率为41.2%～92.0%。本文对男性慢性肝病患者发生勃起功能障碍的发病状况、影响因素、可能的发病机制和治疗研究进展进行综述,期望引起广泛的关注,改善患者的身心健康。     

治疗勃起功能障碍的特效药

治疗ED的特效药——磷酸二酯酶抑制药 几年前科学家发明了一种能治疗ED的药物后，阴茎勃起功能异常便成了热门话题。现在在电视、报刊和网络随处都可看到几种能治疗ED药物的报道。这些药物就是5型磷酸二酯酶抑制药（PDE5）。这类药物对50％～70％合并有ED的1型或2型糖尿病患者有效。     

胰岛素强化治疗对糖尿病性勃起功能障碍的疗效观察

目的 探讨胰岛素强化治疗对糖尿病性勃起功能障碍（ED）的治疗效果.方法 使用勃起功能国际问卷（IIEF-5）诊断ED,将116例糖尿病性ED患者分为胰岛素组和口服药组,分别予胰岛素和口服药治疗6个月,治疗前后测定血糖、血清睾酮,并进行IIEF-5评分.结果 治疗后胰岛素组患者的空腹血糖（FBG）和糖化血红蛋白（HbAlc）较治疗前明显降低,IIEF-5评分明显升高.治疗后胰岛素组患者的FBG和HbAlc较口服药组降低,IIEF-5评分较口服药组明显升高.结论 胰岛素强化治疗能明显提高糖尿病性ED患者的勃起功能,其疗效优于口服药.     

2型糖尿病患者勃起功能障碍患病率及西地那非的疗效和安全性评价

目的调查内分泌门诊中糖尿病患者阴茎勃起功能障碍(ED)患病率,并评价西地那非(万艾可)在糖尿病合并ED患者中的疗效和安全性。方法多中心收集2型糖尿病男性患者6193例,入选6178例,患者签署知情同意书后,根据国际勃起功能指数表(IIEF5)患者进行自我评分。对3个月内服用3剂万艾可的患者除要求填写治疗前的IIEF5表评分外,还要求填写治疗后的总体疗效问题回答表,以评价万艾可治疗的疗效,并记录患者服药后的不良事件以评价其安全性。结果国内42家医院内分泌门诊2型糖尿病患者中ED的患病率为75.2%,其中重度、中度和轻度ED分别为9.1%、17.2%、48.9%。该受检人群中ED的知晓率为85.0%,但治疗率仅为9.4%。多因素回归分析显示患者年龄、糖尿病病程、血糖控制不佳(HbA1C>6.5%)与糖尿病患者ED的发生独立相关。共有389例患者服用万艾可治疗,治疗后患者IIEF5总评分和各问题的评分均显著高于治疗前(P<0.01);根据IIEF5评分,治疗后重、中度ED患者例数明显少于治疗前(P<0.01)。根据总体疗效评估问题的回答,给予万艾可治疗后勃起功能改善率达86.4%。对安全性评价显示服用万艾可后出现的与药物有关的不良事件主要是颜面潮红、头痛、心悸和口干等,大多为轻度。结论在2型糖尿病患者中ED是常见的合并症,万艾可治疗糖尿病合并ED疗效确切,并有良好的安全性。     

糖尿病勃起功能障碍的研究进展

勃起功能障碍（ED）的定义为：阴茎不能充分或维持勃起，以致不能完成满意的性生活。糖尿病（DM）是ED最重要的危险因子之一。Rendell等研究指出DM患者ED的发生率在美国高达50％。Dey等发现DM患者ED的发生率比非DM人群高3倍。2型糖尿病（T2DM）患者随着病程的延长，ED的发生率逐渐增高。吸烟史越长，吸烟的强度越大，DM患者发生ED的危险性也越高。     

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?     

Sildenafil（VIAGRA）治疗勃起功能障碍,安全性和心血管及其他副作用

男性勃起功能障碍 (Ｅｒｅｃｔｉｌｅｄｙｓｆｕｎｃ ｔｉｏｎ ,ＥＤ)是指阴茎不能勃起或不能维持勃起以完成性交[1～ 3],是最常见的男性性功能障碍。推算美国有 3千万和全世界超过 1亿男性有ＥＤ ,ＥＤ明显地与年龄相关 ,男性 4 0岁占 3 9% ,70岁占67% [2 ]。麻省 (Ｍａｓｓａｃｈｕｓｅｔｔｅ)男性老年化研究 1 2 90例 4 0～ 70岁男性 ,ＥＤ占52 % ,其中完全无勃起占 9 6% ,中度ＥＤ占 2 5 2 % ,轻度ＥＤ占 1 7 1 % [1],随人口老龄化 ,预测ＥＤ患病率将继续增加 ,中国未有关于ＥＤ流行病学资料。一、口服Ｓｉｌｄｅｎａｆｉｌ△ 治疗ＥＤ…     

α硫辛酸联合西地那非治疗糖尿病性勃起功能障碍的疗效观察

选择68例糖尿病性勃起功能障碍患者,随机分成2组,每组34例。治疗组给予α硫辛酸静滴,西地那非片口服。对照组单用西地那非片口服,疗程均为2周。观察2组治疗后的临床疗效。结果2组治疗前后的FPG、2hPG及血清睾酮差异均无统计学差异（均P〉0．05）。治疗组有效率（79．4％）与对照组总有效率（55．9％）差异有统计学意义（P〈0．05）。治疗后IIEF-5评分均较治疗前有显著提高（P〈0．05）,治疗后2组间IIEF-5评分差异无统计学意义（P〉0．05）,治疗后3个月治疗组较对照组IIEF-5评分有显著提高。结论α硫辛酸联合西地那非治疗糖尿病性勃起功能障碍较单用西地那非疗效显著。     

弥可保联合α-硫辛酸治疗糖尿病勃起功能障碍疗效观察

目的观察弥可保联合α-硫辛酸治疗糖尿病勃起功能障碍患者的疗效。方法将86例糖尿病勃起功能障碍患者随机分为对照组（给予常规改善循环治疗）和弥可保联合α-硫辛酸治疗的观察组,应用勃起功能障碍国际指数（IIEF-5）问卷表评分比较两组患者的治疗效果。结果观察组患者IIEF-5评分改善明显优于对照组,差异有统计学意义（P〈0．05）。结论弥可保联合α-硫辛酸治疗糖尿病患者的勃起功能障碍安全、有效。     

男性高血压患者非杓型血压与勃起功能障碍及内皮损害的关系

目的 探讨男性高血压患者非杓型血压与勃起功能障碍(ED)、血一氧化氮、内皮型一氧化氮合酶(eNOS)及循环内皮微粒的关系。方法 选择2019年1月-2021年5月,天津市第一中心医院心内科门诊和住院的首次诊断原发性高血压、剔除糖尿病、年龄40～60岁的男性患者190例作为研究对象,根据夜间收缩压下降率是否≥10%分为杓型组(n=120)和非杓型组(n=70)两组,采用勃起功能障碍国际指数问卷表-5和RigiScan阴茎硬度测量仪进行夜间勃起功能监测评估ED;酶联免疫吸附试验(ELISA)法测定血浆一氧化氮、eNOS,流式细胞技术测定血浆内皮微粒水平。结果 与杓型组比较,非杓型组ED发生率上升(50.00%比32.50%,χ²=5.694,P=0.017);非杓型组血浆一氧化氮浓度[(60.09±3.56)比(62.34±4.06)μmol/L,t=3.817]、eNOS浓度[(19.76±2.98)比(21.33±2.48)μmol/L,t=3.914]下降,血浆内皮微粒[(6.08±1.22)%比(5.04±1.41)%,t=5.173]上升(均P<0.0...     

Sildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus

Aims/hypothesis: Ninety percent of all men with diabetes have Type II (non-insulin-dependent) diabetes mellitus, and erectile dysfunction (ED) is common in this patient group. This study evaluated the effects of sildenafil on men with erectile dysfunction and Type II diabetes and compared the results with glycated haemoglobin concentrations and chronic diabetic complications. Methods: Patients (mean age, 59 years) in this double-blind, placebo-controlled trial were randomised to sildenafil (25–100 mg; n = 110) or matching placebo (n = 109) for 12 weeks. Primary criteria for efficacy included questions 3 (achieving an erection) and 4 (maintaining an erection) from the International Index of Erectile Function (IIEF, score range, 0–5). Secondary outcome measures included a global efficacy question (GEQ), patient event logs, a life satisfaction checklist, and the remaining IIEF questions. Results: After 12 weeks, the mean scores for questions 3 and 4 had improved significantly in patients receiving sildenafil (3.42 ± 0.23 and 3.35 ± 0.24) compared with placebo (1.86 ± 0.22 and 1.84 ± 0.23; p < 0.0001). Similarly, the GEQ score was higher in the sildenafil (64.6 %) than the placebo group (10.5 %). Even when correlating efficacy with glycated haemoglobin concentrations ( ≤ 8.3 % or > 8.3 %, the median concentration found in this study) or the number of diabetic complications (0 or ≥ 1), the mean scores for the GEQ and questions 3 and 4 from the IIEF remained higher for all the sildenafil groups compared with the placebo groups (p < 0.0001). Conclusion/interpretation: Sildenafil was well-tolerated and effective in improving erectile dysfunction in men with Type II diabetes, even in patients with poor glycaemic control and chronic complications. [Diabetologia (2001) 44: 1296–1301] Received: 20 April 2001 and in revised form: 16 July 2001     

From aspiration to achievement: assessment and noninvasive treatment of erectile dysfunction in aging men

More than 70% of elderly men (>or=65) remain sexually active, and more than 40%, according to one estimate, are dissatisfied with their sex lives. Declining sexual function and a reluctance to seek medical attention with advancing age are cross-cultural observations. Normal erection is largely dependent on intact function of the central and peripheral nervous systems and the penile vascular endothelium. Consequently, chronic conditions (e.g., cardiovascular disease, diabetes mellitus) and lifestyle factors (e.g., smoking) that have adverse effects on the vascular endothelium and central and peripheral nervous systems, as well as on endocrine function or connective tissues within the corpus cavernosum of the penis, can attenuate erectile function. Because of these associations, assessment of sexual function in elderly men often reveals not only erectile dysfunction (ED) but also other reversible conditions. An expanding array of noninvasive options is available to assist the clinician in individualizing ED therapy to the unique health and lifestyle needs of each elderly ED patient and his partner. These treatment alternatives include the phosphodiesterase type 5 inhibitors sildenafil, vardenafil, and tadalafil, as well as other oral medications, such as alpha-adrenoceptor antagonists and topical vasoactive or testosterone therapy.     

Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction

Aims Erectile dysfunction (ED) is a common comorbidity in men with diabetes mellitus. Tadalafil 10 or 20 mg taken on demand is efficacious and safe for men with diabetes and ED. Recently, continuous treatment with tadalafil has been proposed, addressing ED management as any other chronic condition. This study examined whether once‐daily tadalafil 2.5 and 5 mg is efficacious for men with diabetes and ED. Methods This randomized, double‐blind, placebo‐controlled, multicentre, 12‐week study enrolled 298 men with diabetes and ED to once‐daily treatment with placebo, tadalafil 2.5 mg or tadalafil 5 mg. Primary efficacy measures were International Index of Erectile Function Erectile Function (IIEF EF) Domain score, and patient success rates for vaginal penetration and completion of intercourse. Patient satisfaction, endothelial function biomarkers, and safety were also assessed. Results Patients receiving either dose of tadalafil had clinically and statistically significant improvements in IIEF EF and statistically significant improvements in mean success rates for vaginal penetration, completion of intercourse, and overall treatment satisfaction (P ≤ 0.005 tadalafil vs. placebo, all measures). Endothelial dysfunction biomarkers were unchanged. The most common adverse events were headache, back pain and dyspepsia. Conclusions In this first study of men with diabetes and ED, once‐daily tadalafil 2.5 and 5 mg was efficacious and well tolerated, suggesting this may be an alternative to on‐demand treatment for some men, eliminating the need to plan sex within a limited timeframe.     

Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence

Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.     

Sildenafil: study of a novel oral treatment for erectile dysfunction in diabetic men

The efficacy and safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, were evaluated in men with diabetes mellitus and erectile dysfunction (ED). Twenty-one men (aged 42–65 years) were enrolled in a double-blind, placebo-controlled, three-way crossover study conducted in two parts. In part I, the effect of a single dose (25 mg or 50 mg) of sildenafil or placebo on penile rigidity was assessed by penile plethysmography during visual sexual stimulation. In part II, daily diary records of erectile activity and a global efficacy question were used to evaluate once-daily dosing with 25 mg or 50 mg of sildenafil or placebo for 10 days. After a single 50 mg dose of sildenafil, the adjusted geometric mean duration (min) of penile rigidity >60 % at the base of the penis during visual sexual stimulation was significantly increased (10.1 min) compared with placebo (2.8 min; p = 0.0053). In part II, sildenafil significantly increased the number of erections considered sufficiently hard for vaginal penetration compared with placebo (p = 0.0005). Improved erections were reported by 50 % and 52 % of patients treated with 25 mg and 50 mg of sildenafil, respectively, compared with 10 % of those receiving placebo (p values < 0.05). Adverse events were mostly mild or moderate in nature and included muscular pains, headache, and dyspepsia. Sildenafil is a well-tolerated and potentially efficacious oral treatment for ED in men with diabetes mellitus. © 1998 John Wiley & Sons, Ltd.     

Erectile dysfunction

In the past 30 years, advances in basic science have been instrumental in the evolution of the male sexual health treatment paradigm from a psychosexual model to a new model, which includes oral and intracavernosal injection pharmacotherapy, vacuum constriction devices and penile prostheses for the treatment of erectile dysfunction. This progress has coincided with an increased understanding of the nature of male sexual health problems, and epidemiological data that confirm that these problems are widely prevalent and the source of considerable morbidity, both for individuals and within relationships.     

The efficacy and safety of acupuncture in the treatment of erectile dysfunction: A protocol for systematic review and meta-analysis

Background:Erectile dysfunction (ED) can negatively affect men''s mental health, interpersonal relationships, and overall well-being. ED has affected >150 million men worldwide, and this number will reach approximately 322 million by 2025. Although PDE5-Is is a landmark in the treatment of erectile dysfunction, it may have side effects such as penile pain, cardiovascular dysfunction, and deafness. Some studies have shown that acupuncture may have a positive effect on the pathophysiology of ED. Therefore, we will select all randomized controlled trials related to evaluate the efficacy and safety of acupuncture treatment of ED.Methods:This study will systematically search 7 digital databases including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, Cochrane Library, PubMed, and Embase for randomized controlled trials without language restrictions. Two researchers will independently read the title, abstract, and full text to screen for studies that can be included in the meta-analysis. If there is any dispute, the third party will be required to reach a consensus.Results:The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of ED and the difference in the impact of different types of acupuncture on ED.Conclusion:Judge whether acupuncture and moxibustion can help improve the symptoms of ED by evaluating relevant literatures, and make up for the lack of relevant research.INPLASY registration number:INPLASY 202140040     

Surgical management of erectile dysfunction

Since the introduction of sildenafil citrate, oral systemic therapy has become the first line of therapy for men with erectile dysfunction (ED). Men who are not candidates for or who fail treatment with an oral agent may choose second-line therapies such as intraurethral prostaglandins, penile injection therapy, sex therapy, or a vacuum erection device. These second-line therapies may be unpalatable or inadequate for some men, and these men constitute the candidates for surgical intervention for ED. This article reviews surgical management of vascular ED, surgical management of Peyronie’s disease, and penile prosthesis implantation. At the current time, the appropriate candidate for penile revascularization is a young man with proven arterial insufficiency resulting from pelvic trauma. Results in other populations are disappointing. Peyronie’s disease with curvature significant enough to interfere with intercourse may be managed with tunical lengthening or shortening procedures in potent men and with prosthetic implantation in men with ED. Modern three-piece penile prostheses are associated with excellent device reliability, high rates of patient satisfaction, and acceptably low complication rates.     

糖尿病视网膜病变与勃起功能障碍的关系

目的探讨糖尿病视网膜病变（DR）与勃起功能障碍（ED）的关系。方法对2型糖尿病（T2DM）合并视网膜病变组（DR组）22例、T2DM无视网膜病变组（非DR组）92例用国际勃起功能指数（IIEF）评分,比较两组间的评分情况。结果DR组的评分明显低于非DR组（P〈0．05）,DR组的ED发生率明显高于非DR组（P〈0．05）。结论糖尿病视网膜病变与ED的发生密切相关。     

Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence

Prevalence and severity of erectile dysfunction (ED) increase with aging and are often associated with illnesses, like diabetes mellitus, heart disease, and hypertension, pathologically characterized by endothelial dysfunction and whose prevalence increases with age. The assumption that ED is mainly a neurovascular disease is supported by the evidence that specific phosphodiesterase type 5 (PDE5) inhibition produces an efficient erection in a wide range of ages and conditions. The availability of specific PDE5 inhibitors has enabled the development of effective treatment strategies, in this contest, tadalafil may be considered as the least “typical” PDE5 inhibitor. In clinical trials, tadalafil significantly enhanced, in patients of different ages, all efficacy outcomes across disease etiologies and severities. With an effectiveness lasting up to 36h, tadalafil allows patients to choose when to have sexual activities without the need to time it, showing positive feedback in terms of quality of life related to the treatment. Headache and dyspepsia were the most frequent side-effects of tadalafil, followed by back pain, nasal congestion, myalgia, and flushing, but the impact that long time action could have on effectiveness and safety is not yet entirely defined. The aim of this article is to critically review the available evidence from the tadalafil clinical research program and give the physician a rational approach for intervention in the treatment of ED and related diseases.