老年性勃起功能障碍的基因治疗

勃起功能障碍(ED)的发病率随着年龄的增长而增高,基因治疗是近年来新兴的一种治疗方法,各种靶基因、不同的载体以及不同的治疗策略用于ED的基因治疗,均取得了一定的治疗效果。本文就老年性ED的基因治疗现状作一综述。     

阴茎勃起功能障碍的基因治疗进展

50～70岁男性中50%以上患有勃起功能障碍(ED),40岁的男性中有40%的患有不同程度的ED,全球范围内ED患者已超过1亿人,ED已成为困扰全球男性的重要疾病之一。在过去的20年里,对于ED发生机制及治疗有了很大的进展,现有的PDE5抑制剂对大部分ED患者疗效较好,但是对糖尿病性ED、前列腺癌根治术后ED及严重的心血管病变导致的ED疗效欠佳。人们正在寻找更好的治疗ED的方法——基因治疗。本文总结了近年来临床前期基因治疗ED的新进展,即糖尿病ED、老年性ED、神经损伤性ED及血管病变导致的ED的基因治疗。     

胰岛素样生长因子-1在勃起功能障碍基因治疗中的价值

一、目前ED基因治疗的现状 基因治疗勃起功能障碍（erectile dysfunction，ED）是随着分子生物学实验技术的成熟发展起来的一种新兴的治疗方法，初步研究显示了较好的治疗前景，国际上近几年进行了大量的研究，但仍存在很多的问题需要探讨。     

生长因子与勃起功能障碍的基因治疗

生长因子具有广泛的生物学作用。勃起功能障碍(ED)的基因治疗是ED治疗的新探索,本文就生长因子,尤其是血管内皮生长因子(VEGF)和胰岛素样生长因子1(IGF-1)在ED基因治疗中的作用和价值作一综述。     

勃起功能障碍的治疗进展

勃起功能障碍（Erectiledysfunction,ED）的治疗方式在近10年获得了飞速的进展,从磷酸二酯酶抑制剂（PDE-5i）的临床广泛应用,新型PDE-5i的市场准入,到阴茎假体的临床应用.从基因治疗到目前热门的干细胞治疗勃起功能障碍的理论提出及治疗方式的初步尝试,为ED的治疗提供了新的研究方向.随着分子生物学对ED病因和形成机制研究的深入,转基因治疗在不久的将来会成为治愈ED最有效的方法之一.     

高脂血症与男性勃起功能障碍

勃起功能障碍(ED)是男性,尤其是老年男性的常见病。高脂血症是引起男性ED的重要危险因子之一,流行病学研究发现高密度脂蛋白(HDL)水平的下降和总胆固醇/高密度脂蛋白比值(TC/HDL)的上升与ED有明显相关性。目前研究显示高脂血症引起的动脉狭窄和闭塞可能只是高脂血症引起ED的晚期机制。高脂血症早期即可影响阴茎的内皮细胞、平滑肌细胞及支配阴茎勃起的外周神经而使阴茎勃起功能受损。对高脂血症所致ED的治疗除针对高脂血症的饮食治疗和药物治疗外,针对ED的中药治疗和基因治疗有望成为治疗高脂血症所致ED的重要方法。     

阴茎勃起功能障碍基础研究新动向

阴茎勃起功能障碍(ED)是指阴茎不能达到或维持充分勃起,以完成满意的性交。据文献报道,全球约有一亿多ED患者,40～70岁的男性中,约有52％的男性有不同程度的阴茎勃起功能障碍。因此,ED是一种影响男性健康的常见疾病。近20年来,人们对ED的发病基础作了大量的研究,通过利用各种ED动物模型,筛选安全有效的、增强阴茎海绵体平滑肌松弛作用的药物,为ED的治疗提供了光明的前景。其中一氧化氮-环磷酸鸟苷(NO-cGMP)通路、离子通道、细胞间通讯、基因治疗是近年来研究的新热点,本文将较详细阐述ED基础研究最新动向。     

男性勃起功能障碍的治疗进展

勃起功能障碍（Erectile Dysfunction，ED）是指阴茎持续或经常不能达到和，或维持足够的勃起状态以进行满意的性交。其发病率非常高，1995年全世界约有1．52亿男性患有ED，估计2025年将有3．22亿。2000年美国麻省男子增龄研究（MMAS）显示：40-69岁男性ED年发病率为2．6％，总发病率为44％。由于不同患者病情特异性大，选择的治疗方法也多种多样，有第一线的性心理治疗、口服药物和负压式辅助装置等；第二线的经尿道内给药以及海绵体内药物注鼽第三线假体植入手术治疗等。另外基因治疗的研究得到飞速发展，并取得了可喜的成果。     

勃起功能障碍治疗的现状与进展

勃起功能障碍(erectile dysfunction,ED)是指阴茎经常性的不能达到和保持足以进行满意性交要求的勃起.据报道,40～70岁的男性52%存在不同程度的ED,到2025年,全世界大约有3.22亿男性存在性功能障碍的问题,而大多数ED患者缺乏系统的临床治疗,即先从损害较小的口服药物治疗开始,第二步应用局部药物治疗(如海绵体注射和经尿道给药),最后的选择是外科治疗(阴茎假体置入);另外,血管外科技术对血管源性的ED患者也是一种可尝试的方法,基因治疗和组织工程技术在动物实验研究方面也取得可喜的成果.本文就目前阴茎ED治疗的现状与进展作一综述.     

西地那非治疗选择性5-羟色胺再摄取抑制剂引发的老年男性勃起功能障碍

抗抑郁治疗尤其是5-羟色胺再摄取抑制剂治疗常有性功能障碍的不良的反应。勃起功能障碍（ED）治疗的一线口服药西地那非对此类患者是否有效呢？Aizenberg等人研究了西地那非对抗抑郁药物所致老年ED的治疗作用。符合条件的患者在抗抑郁治疗时增加西地那非（25～50mg／d），在开始给药及4周后评估ED状况。所有患者皆反映勃起功能得到改善，10例中有7例勃起功能恢复正常。     

伐地那非治疗糖尿病患者的勃起功能障碍

勃起功能障碍 (erectiledysfunction ,ED)在糖尿病患者中发生率要高于非糖尿病人群 ,而且更难治疗。伐地那非是一种高选择性的新型磷酸二酯酶 5抑制剂 ,是广泛ED人群的一线治疗药物。最近发表的大型临床试验表明 ,无论糖尿病合并ED的患者基线时的病情严重程度如何 ,也无论他们的血糖控制情况如何 ,伐地那非都能有效地改善其勃起功能 ,而且使用安全 ,耐受性良好     

Bacille Calmette‐Guérin intravesical instillation and erectile function: is there a concern?

The aim of our study was to evaluate the effect of bacille Calmette-Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P=0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P=0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P=0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.     

Effects of testosterone on erectile function: implications for the therapy of erectile dysfunction

Sexual potency declines with age, as does the efficiency of erection. Many studies show that different patterns of erectile dysfunction (ED), varying from occasional inability to obtain a full erection, impairment throughout intercourse and total absence of erectile response, might not be triggered by psychological factors only. Recent research indicates that ED relies on organic causes, and has challenged the development of new therapies. One therapeutic approach in patients who have testosterone deficiency is based on androgen therapy. Thus, we reviewed data on testosterone-induced effects relative to erectile function, summarizing the results from studies reported in 1991-2006 on testosterone therapy in patients with ED and hypogonadism, with a special focus on men not responding to phosphodiesterase-5 (PDE-5) inhibitors. We searched several computerized databases parallel with printed bibliographic references. Many studies have established animal models, which confirm that testosterone is important in modulating the central and peripheral regulation of ED. Testosterone deprivation has a strong negative impact on the structure of penile tissues and erectile nerves, which can be prevented by androgen administration. Combined therapy regimens with PDE-5 inhibitors and testosterone might improve ED in patients with hypogonadism of different causes. Thus, androgen treatment in hypogonadic patients, including those unresponsive to PDE-5 inhibitors, often results in an improvement of ED. Testosterone therapy is safe and convenient, while rapidly correcting low testosterone levels.     

应用新的治疗满意度量表来评估ED患者及其性伴侣对伐地那非治疗的满意度

治疗满意度量表(TSS)是为评估男性勃起功能障碍(ED)患者及其性伴侣对ED治疗的满意度而制订的一个新量表。该自我报告式的调查问卷由四大部分组成:未治疗期的患者,治疗期的患者,未治疗期患者的性伴侣,以及治疗期患者的性伴侣。对以下6个方面进行评估:自信心、勃起的容易度、对勃起功能的满意度、性快感、对性高潮的满意度以及治疗满意度。TSS量表已经过多国有效性检验和心理学测验,被证明能可靠评价患者及其伴侣对ED治疗的满意度。在最近完成的一项双盲、多中心、平行组、灵活剂量的临床试验中,应用这个新的TSS量表比较了ED患者及其伴侣对伐地那非和安慰剂治疗的满意度。结果发现,伐地那非能显着改善勃起功能以及ED患者和伴侣的自信心、感知到的勃起容易度、性快感、对勃起功能、高潮和药物治疗的满意度。     

Testosteron und erektile Dysfunktion

Primary hypogonadism represents a classic but rare cause of erectile dysfunction (ED) in men. Therapy with testosterone as monotherapy is therefore unlikely to cure ED in the typical ED patient. However, recent developments indicate a much greater role of testosterone in erectile function than has been supposed in the past. Serum testosterone levels decline in men with increasing age. Aging men might develop late-onset hypogonadism (LOH) associated with characteristic symptoms. Typical symptoms of LOH are represented by decreased libido and sexual function, osteoporosis, altered distribution of body fat, overall reduction in physical strength, and alterations in the general mood. Experimental and clinical studies over the last few years have also pointed out that hypogonadism results in characteristic alterations of the erectile tissue of the penis. These alterations might be reversible in response to hormone therapy with testosterone. Particularly testosterone might be a helpful supportive therapy in cases where PDE-5 antagonists have tended to lose their effectiveness on the erectile tissue in the treatment of ED.     

The Role of Apomorphine SL in the Treatment of Erectile Dysfunction

Epidemiological data indicate that erectile dysfunction (ED) affects over 140 million men worldwide, with the highest prevalence in men over 60 years. While the condition is often associated with coronary artery disease, hyperlipidemia, hypertension and diabetes, and may be a marker for these conditions, most men who present with ED for treatment have mild to moderate dysfunction. Treatment guidelines developed by an international, multidisciplinary panel of experts as a “process of care model for erectile dysfunction” recommend the implementation of oral agents as first-line therapy. Sublingual apomorphine SL is the first medication for the treatment of erectile dysfunction with a central mechanism of action. In clinical studies, apomorphine SL provides clinical erectogenic benefits at 2 and 3 mg doses particularly in those patients with mild to moderate ED. Apomorphine SL has the added advantages of a rapid onset of action, resulting in erection in less than half the time required by sildenafil, and a highly favorable tolerability and safety profile, especially in patients with coronary artery disease receiving nitrates. Apomorphine SL is an important addition to the armamentarium of primary care clinicians and urologists treating male erectile dysfunction, due to enhanced erectile function, speed of onset, convenience of dosing, and favorable side effect profile. Apomorphine SL 2 and 3 mg is an effective first-line treatment option for men presenting with mild to moderate ED, who have a degree of residual erectile function that is inadequate for satisfactory sexual performance.     

持续气道正压通气对睡眠呼吸暂停综合征合并勃起功能障碍的治疗

目的 :探讨经鼻持续气道正压通气 (nCPAP)对睡眠呼吸暂停综合征 (SAS)合并勃起功能障碍 (ED)患者勃起功能的影响。　方法 :SAS合并ED患者 2 7例 ,随机分为治疗组 15例和对照组 12例 ,治疗组使用BIPAP呼吸机以nCPAP治疗 1个月 ,比较两组治疗前后睡眠呼吸暂停低通气指数 (AHI)、最低SaO2 和勃起功能国际问卷 5 (IIEF 5 )评分的变化。　结果 :两组患者治疗前AHI、最低SaO2 、勃起功能、IIEF 5评分无明显差异 ,治疗组在治疗后比治疗前、对照组均有明显改善 ,差异均有显著性 (P <0 .0 5 )。而对照组在治疗前后上述指标无明显变化 (P >0 .0 5 )。结论 :nCPAP可改善SAS合并ED患者的勃起功能。     

长期口服小剂量伐地那非治疗按需服药无效ED的疗效观察

目的:评估持续口服小剂量伐地那非治疗按需服药无效的勃起功能障碍(ED)患者的疗效及停药后效果维持状况.方法:将按需服药无效的39例ED患者改用长期口服小剂量伐地那非治疗3个月,在治疗前后及停药后3个月分别记录患者国际勃起功能指数-5(International index of erectile function-5,IIEF-5)评分及患者性生活日记中插入和保持勃起的成功率,并且记录治疗前后夫妻性满意度.结果:本组患者治疗后主要疗效指标均高于治疗前,且治疗前后指标差异有统计学意义(P<0.01);停药后3个月,主要指标仍高于基线水平,且差异有统计学意义(P<0.05).结论:每天口服小剂量伐地那非对约半数(48.6%)按需服药无效的ED患者,可改善勃起功能,且安全、有效.