101例ED患者阴茎海绵体肌电图检测结果分析

目的 观察勃起功能障碍(erectile dysfunction,ED)患者中阴茎海绵体平滑肌存在病变的比例及特征.方法 采用德国WIEST公司Space 7500型阴茎海绵体肌电图(corpus cavernosum electromyogram,CC-EMG)检测仪对门诊101位ED患者进行检测.患者平均年龄(31.46±8.89)岁,病程(2.62±1.36)年.结果 CC-EMG检测结果未见异常者69人(68.32%),异常者32人(31.68%).描记图未见异常组与异常组图形各参数比较:时程分别为(3.95±1.87)s和(6.03±5.28)s,两组差异比较(P<0.01),波幅分别为(299.86±54.88)μ V和(268.13±76.93)μV,两组差异比较(P<0.05);相位分别为(6.79±3,43)s vs(6.53±3.07)s,两组差异比较(P>0.05),频率分别为(1.54±0.23)次/min vs(1.51±0.32)次/min,两组差异比较(P>0.05).结论 阴茎海绵体平滑肌病变(包括自主神经功能紊乱)在ED患者中占有一定的比例.CC-EMG异常ED患者描记图主要表现为波形同步不良,出现bursts波、whips波和slaves波,波幅减小,时程明显延长.     

糖尿病大鼠阴茎海绵体组织nNOS神经变化的实验研究

目的 :研究糖尿病对大鼠阴茎海绵体组织nNOS神经纤维的影响。　方法 :34只SD雄性大鼠分为 6周组(17只 )和 8周组 (17只 ) ,其中每组各 11只腹腔注射链脲佐菌素制备糖尿病模型 ,其余各 6只注射柠檬酸缓冲液作为空白对照 ,分别在注射 6周和 8周后 ,观察大鼠阴茎勃起功能 ,并采用免疫组化SP法检测糖尿病大鼠阴茎组织nNOS神经纤维的数量。　结果 :2组糖尿病大鼠的阴茎勃起率分别为 37.5 %和 14 .3% ,差异有显著性 (P <0 .0 5 ) ,均明显低于对照组 (P <0 .0 1)。 2组糖尿病大鼠nNOS神经纤维的表达明显低于对照组 (P <0 .0 1)。 8周组中糖尿病大鼠阴茎的勃起功能和nNOS神经纤维的数量明显低于 6周组 ,分别为 (37.6 0± 6 .76 )条和 (2 8.0 0±5 .2 9)条 ,即随着病程的延长 ,勃起功能和nNOS神经纤维的表达下降 (P <0 .0 5 ) ,而对照组大鼠nNOS神经纤维的数量差异无显著性 [(83.0 0± 3.2 2 )vs(81.0 0± 3.6 1) ]。　结论 :糖尿病严重影响勃起功能和nNOS神经纤维的表达。糖尿病大鼠阴茎海绵体组织中nNOS神经纤维的数量明显减少 ,且与病程正相关 ,这可能是糖尿病性勃起功能障碍的发病机理之一。     

Recording the Corpus Cavernosum Electromyogram: Principles and Problems

Purpose

To apply digital signal acquisition and analyzing techniques to the collection and interpretation of electromyographic data of the cavernous body.

Materials and Methods

Electromyographic recordings were performed in the cavernous bodies of anesthetized, spontaneously breathing dogs under resting conditions and after intracavernous pharmacostimulation with norepinephrine, angiotensin II, phentolamine/papaverine, diethylether and T61.

Results

Resting corpus cavernosum activity was ill-coordinated and provided little information. Signal energy was confined largely to the range below 20 Hz. Pharmacostimulation with norepinephrine or angiotensin increased frequency and amplitude of the potential transients and decreased the random components. Administration of a combination of phentolamine and papaverine made the signals very regular and increased periodicity. Blockade of electrical membrane events with diethylether removed all signal components except for electrical and biological noise.

Conclusions

Our findings indicate that electromyograms from the corpus cavernosum can be recorded even under adverse conditions. Signal properties, however, are such that the application of computer-aided data processing and analysis to the evaluation of these myograms is imperative.     

钙通道阻滞剂舒张阴茎海绵体平滑肌的研究进展

钙通道广泛存在于心肌、骨骼肌、平滑肌及神经元细胞膜上 ,钙通道阻滞剂因其舒张血管平滑肌而广泛应用于心血管疾病的治疗。本文综述了钙通道阻滞剂舒张阴茎海绵体平滑肌的实验研究的最新进展 ,能否应用于阴茎勃起功能障碍的诊断和治疗尚有待进一步研究和探讨     

激肽释放酶激肽系统在大鼠阴茎海绵体表达的研究

目的:研究激肽释放酶激肽系统在成年大鼠阴茎海绵体的表达。方法:利用逆转录聚合酶链反应(RTPCR)技术分别检测SD大鼠阴茎和心脏组织中组织型激肽释放酶Ⅰ和激肽B2型受体mRNA的表达情况。结果:大鼠心脏与阴茎海绵体组织中均表达组织型激肽释放酶Ⅰ和激肽B2型受体mRNA,两者有几乎相同的表达水平,差异无显著性(P>0.05)。结论:在生理状态下,激肽释放酶激肽系统存在于阴茎海绵体组织中,而且与心血管系统的表达水平相当。     

血红素氧合酶在去势大鼠阴茎海绵体的表达

目的:研究血红素氧合酶(HO)在去势大鼠阴茎海绵体的表达,探讨其在雄激素缺乏的勃起功能障碍发生中的机制。方法:40只10周龄雄性SD大鼠随机分成:假手术2周组(A组),假手术4周组(B组),去势2周组(C组),去势4周组(D组)。术后2、4周检测血清睾酮水平,免疫组化及RT-PCR技术检测HO及nNOS在大鼠阴茎海绵体的表达。结果:去势组大鼠较假手术组血清睾酮水平显著下降,[AvsC:(283.222±117.171)ng/dlvs(7.117±3.700)ng/dl;BvsD:(289.280±87.413)ng/dlvs(48.826±19.477)ng/dl](P<0.01)、HO-1、HO-2蛋白表达明显降低(P<0.01),去势组HO-1、HO-2及nNOSmRNA表达较假手术组显著降低(P<0.01)。结论:雄激素可能通过HO-CO系统部分调控阴茎勃起功能。     

Study of Etiologic Relationship of Arterial Atherosclerosis to Corporal Veno-Occlusive Dysfunction in the Rabbit

Purpose

The aim of this study was to explore the possible etiologic relationship of hypercholesterolemia and atherosclerosis to corporal veno-occlusive dysfunction.

Materials and Methods

In the New Zealand White rabbit, the competence of the corporal veno-occlusive mechanism was examined at various intervals after exposure to control diet, high cholesterol diet, or aortoiliac atherosclerosis.

Results

Initially, all animals showed normal erectile function and corporal veno-occlusion. After 8 weeks and 16 weeks, the control animals preserved normal erection and corporal veno-occlusion, while most of the hypercholesterolemic and atherosclerotic animals developed corporal veno-occlusive dysfunction. The incidence of corporal veno-occlusive dysfunction in the hypercholesterolemia and atherosclerotic animals increased with time.

Conclusions

This study suggests that a close relationship exists between prolonged atherosclerotic occlusion of major penile arteries and the development of corporal veno-occlusive dysfunction. Ischemia-induced corporal veno-occlusive dysfunction may be the result of alterations in corporal smooth muscle relaxation or changes in the structure and fibroelastic properties of erectile tissue.     

血红素氧合酶2在去势大鼠阴茎海绵体内的表达

目的:研究去势大鼠阴茎海绵体血红素氧合酶2(HO-2)和内皮型一氧化氮合酶(eNOS)的表达,探讨雄激素与HO-2、eNOS在ED中的作用及相关性。方法:10周龄雄性SD大鼠40只,分为4、8、12周组和正常对照组各10只,实验组采取手术切除双侧睾丸,对照组采取假手术。分别于术后4、8、12周测定大鼠血清睾酮(T)、阴茎海绵体内压(ICP)、平均颈动脉压(MAP),取阴茎标本,采用Western印迹分析阴茎海绵体HO-2含量,免疫组化分析HO-2和eNOS的表达。结果:去势各组血清T水平较正常对照组显著下降(P<0.05)。经3V、5V电压刺激后去势各组ICP/MAP值明显下降(P<0.05)。HO-2在正常和去势大鼠阴茎海绵体组织均有表达,去势4周组HO-2光密度分布曲线下面积(341.50±99.70)较正常组(876±443.36)和去势8周组(705.00±152.74)明显下降(P<0.05),去势8周与正常组之间无显著变化(P>0.05),去势12周没有检测到HO-2的表达。eNOS主要表达于阴茎海绵体血管内皮细胞,去势组eNOS(123.94±30.23)较正常组(421.21±125.12)差异有显著性(P<0.05)。T与eNOS和HO-2表达呈高度正相关(r=0.976、0.946,P均<0.05)。结论:雄激素可能通过影响大鼠阴茎海绵体HO-2、eNOS的表达参与阴茎勃起功能调控。     

低氧对SD大鼠阴茎海绵体平滑肌细胞凋亡的影响

目的:探讨低氧和SD大鼠阴茎海绵体平滑肌细胞(CCSMC)凋亡的关系。方法:体外培养CCSMC,免疫组化鉴定细胞;低氧(1%O2浓度)干预12、24、48、72 h,常规氧浓度作为对照,流式细胞术测定细胞周期变化和凋亡情况。结果:体外培养的CCSMC生长良好,抗平滑肌α-肌动蛋白单克隆抗体免疫组化DAB法染色阳性。流式细胞术检测CCSMC G0/G1期在48 h内细胞比例逐渐增加,后下降;S期细胞比例与G0/G1期呈相反趋势;G2/M期细胞比例无明显规律。结论:CCSMC在低氧环境下,随时间的延长凋亡程度加重,48 h达到最大值,进一步延长时间细胞裂解,不能加重凋亡。     

成人及家兔阴茎海绵体平滑肌细胞培养和鉴定

目的 :探索阴茎海绵体平滑肌细胞 (CCSM)体外培养及鉴定方法。　方法 :采用勃起功能正常的成年男子及新西兰家兔的新鲜阴茎标本 ,经处理后采用原代细胞培养法 ,对阴茎海绵体组织块进行培养 ,获得CCSM后用光镜、透射电镜和免疫组化等多种方法从细胞形态学及CCSM生长特性等不同侧面对培养的人及新西兰家兔的CCSM进行鉴定 ,并测定CCSM在体外培养时的细胞增殖情况。　结果 :经 2 4h潜伏期 ,体外培养的CCSM进入指数增长期 ,维持约 96h后进入平台期 ;从接种组织块至长成单层细胞约需 15～ 2 0d ,传代后约 4～ 7d后长成单层 ;传代后的细胞增殖旺盛 ,成束状生长 ,并呈现层叠排列及“峰 谷”现象 ;CCSM在体外可稳定传 7～ 12代 ,传代期间其形态及增殖活性变化不明显 ;各种检测鉴定均证实所获细胞为CCSM。　结论 :CCSM原代细胞培养法简便、稳定、可靠 ,对研究阴茎的勃起机制及勃起功能障碍的发生、发展、调控及其治疗药物筛选有重要理论及现实意义。     

乙醇对离体家兔阴茎海绵体的松弛效应及其作用机制

目的:观察乙醇对离体家兔阴茎海绵体的效应并探讨其可能机制。方法:台式生理记录仪测定海绵体张力,放射免疫测定法测定阴茎海绵体cAMP和cGMP含量。结果:①1.25%(V/V)的乙醇能明显增强异丙肾上腺素(10-9～10-5mol/L)对海绵体肌条的舒张效应。②100、300μmol/L的腺苷酸环化酶抑制剂SQ22536能使乙醇(0.25%～3.5%,V/V)对去氧肾上腺素诱导收缩的肌条的舒张曲线右移,100、300μmol/LSQ22536分别使最大舒张效应由(105.12±3.39)%降低到(97.00±2.57)%和(91.09±2.42)%,EC50由(1.18±0.09)%分别增加到(1.36±0.10)%和(1.68±0.13)%(P均<0.05)。③乙醇可浓度依赖性增加家兔阴茎海绵体cAMP含量,而对cGMP含量无影响。④对于提取的兔离体海绵体组织细胞膜碎片上的腺苷酸环化酶,乙醇可浓度依赖性地增强其活性。结论:乙醇可舒张离体家兔海绵体平滑肌,其作用可能是通过cAMP信号转导通路实现的。     

Rho激酶及血红素氧合酶在自发性高血压大鼠阴茎海绵体中的表达

目的:探讨NOS/NO、HO/CO、RhoA/Rho激酶等信号通路在自发性高血压大鼠(SHR)阴茎海绵体中的表达及相互关系。方法:健康成年雄性SPF级SHR与对照组WKY大鼠各7只,16周龄,体重250~300g。麻醉后颈动脉和海绵体内插管连续监测平均动脉压(MAP)和海绵体内压(ICP)。利用电刺激海绵体神经,记录ICP/MAP比值变化。利用免疫组化和Western印迹方法分析ROCK2、HO-2、eNOS在阴茎海绵体中的表达变化。结果:SHR组在利用电刺激海绵体神经后ICP/MAP比值升高不明显(P>0.05),海绵体组织中ROCK2蛋白表达水平升高显著(P=0.017),HO-2表达水平则降低显著(P=0.006)。HO-2主要位于阴茎海绵体的平滑肌细胞及神经细胞内,eNOS则主要位于阴茎海绵体血管内皮细胞,两者在SHR组表达明显降低。结论:NOS/NO、HO/CO、RhoA/Rho激酶与SHRED有关,并且可能互相影响。     

去势对大鼠阴茎海绵体功能和结构的影响

目的 :探讨雄激素对阴茎海绵体功能和结构的影响。　方法 :30只成年雄性大白鼠随机分为 3组 :阉割组、替代组及假手术对照组。于 1周后取阴茎海绵体 ,用紫外分光光度计测定其一氧化氮合酶 (NOS)活性 ,同时用ISEL法检测其细胞凋亡情况。　结果 :阉割组海绵体NOS活性下降 70 %并出现细胞凋亡 (P <0 .0 1) ,睾酮替代能阻止NOS活性降低及凋亡的发生 (P >0 .0 5 )。　结论 :雄激素可通过调节NOS活性及细胞的增殖与凋亡而维持阴茎海绵体的结构与功能。     

阴茎包埋对海绵体内一氧化氮合酶的影响

目的:探讨阴茎包埋对海绵体内一氧化氮合酶(NOS)活性的影响。方法:通过建立大鼠隐匿阴茎模型获得实验标本,分2个月组、4个月组和6个月组进行观测,每组80只大鼠。各阶段中包括包埋组(n=50)、假手术组(n=15)和正常组(n=15)。称量大鼠体重和海绵体重量后,采用化学比色法检测海绵体内NOS活性。结果:各阶段包埋组阴茎海绵体重量、体重及两者的比值与正常组和假手术组比较均无显著性差异(P>0.05);包埋降低大鼠阴茎海绵体组织的NOS活性(2个月组P>0.05,4个月组P<0.05,6个月组P<0.01)。结论:阴茎包埋可影响海绵体内NOS活性,且与包埋时间呈正相关,但对海绵体外观和重量无明显影响。     

Diffuse Veno-Occlusive Dysfunction: The Underlying Hemodynamic Abnormality Resulting in Failure to Respond to Intracavernous Pharmacotherapy

Purpose

We established hemodynamic predictors of response to intracavernous pharmacotherapy.

Materials and Methods

Specific characterization and quantification of hemodynamic abnormalities of the cavernous arterial inflow and corporeal veno-occlusive mechanism associated with failure to respond to intracavernous pharmacotherapy were performed retrospectively in 69 patients with nonendocrinological impotence. We investigated atherosclerotic vascular risk factors, duplex ultrasonography peak systolic and end diastolic velocities (10 microgram prostaglandin E1), and dynamic infusion cavernosometry and cavernosography parameters (60 mg. papaverine and 6 mg. phentolamine).

Results

The patients were stratified by severity of the various hemodynamic parameters encountered and mean dose required for response. Response subsequently was characterized as excellent (75 percent or greater rigid erections) in 36 patients, adequate (erections sufficient for intromission) in 17 and poor or absent in 16. Psychogenic, neurogenic and mild vasculogenic causes were noted in patients with an excellent response. The adequate responses included all 3 cases with mild to moderate vascular etiologies whereas patients with a poor or no response had only severe venogenic and combined arteriogenic and venogenic etiologies. Mean flow-to-maintain values plus or minus standard deviation of 9.7 plus/minus 3.7, 10.8 plus/minus 9.5 and 59.5 plus/minus 24.2 ml. per minute were demonstrated in the excellent, adequate and poor or no response groups, respectively. There was a good correlation between mean flow-to-maintain values and mean doses of our standard vasoactive solution (r² = 0.88, p less than 0.0001). Pharmaco-cavernosography demonstrated diffuse or pan-cavernous corporeal veno-occlusive dysfunction in the poor or no response group.

Conclusions

Corporeal veno-occlusive dysfunction alone or combined with arterial disease is the specific hemodynamic abnormality causing nonresponse to intracavernous pharmacotherapy. Diffuse drainage, particularly involving the glans penis and corpus spongiosum, is greatly predictive of a poor or no response, reflecting the underlying cavernous smooth muscle myopathy and collagen degenerative alterations in these patients with end-organ failure.     

睾酮对体外大鼠阴茎海绵体组织细胞增殖的影响

目的:探讨睾酮对雄性SD大鼠阴茎海绵体组织细胞增殖的影响。方法:无菌条件下获取大鼠阴茎海绵体组织,免疫组化法检测其雄激素受体的表达,再分别采用酶消化法培养平滑肌细胞和贴壁法培养成纤维细胞,用四氮唑蓝(MTT)还原法观察对照组及睾酮10-8mol/L、10-7mol/L、10-6mol/L、10-5mol/L、10-4mol/L、10-3mol/L浓度组对海绵体组织细胞增殖的影响。结果:雄激素受体在大鼠阴茎海绵体组织表达,10-5mol/L睾酮刺激可促进大鼠阴茎海绵体平滑肌细胞和成纤维细胞增殖,MTT还原法测定分别为68100±2200和70200±1300(P<0.05);10-4mol/L睾酮刺激可抑制平滑肌细胞和成纤维细胞增殖,MTT法测定A值为分别55000±1400和59100±1500(P<0.01);其他组作用不显著。结论:大鼠阴茎海绵体组织存在雄激素受体,睾酮可经雄激素受体途径对阴茎海绵体组织细胞增殖的产生影响,不同浓度睾酮可促进或抑制海绵体平滑肌细胞和成纤维细胞的增殖。     

川芎嗪舒张离体兔阴茎海绵体平滑肌的作用及其机制的初步研究

目的 :探讨川芎嗪 (Chuanxiongzine ,Ligustrazine)对离体兔阴茎海绵体平滑肌条的舒张效应及其作用机制。　方法 :采用离体家兔阴茎海绵体肌条张力记录法 ,观察川芎嗪对去氧肾上腺素 (phenylephrine,PE)诱导收缩的阴茎海绵体肌条的舒张作用 ;应用亚硝基左旋精氨酸甲酯 (L NAME)、ODQ预处理和去除内皮 ,分别记录川芎嗪对阴茎海绵体肌的舒张作用。采用放射免疫法测定川芎嗪对阴茎海绵体平滑肌肌条中cGMP和cAMP含量的影响。　结果 :川芎嗪对阴茎海绵体平滑肌具有浓度依赖性舒张作用 ,其EC50 为 1 .5 8× 1 0 -4mol/L ,ODQ可部分抑制川芎嗪对肌条的舒张效应 (P <0 .0 5 ) ,而L NAME预处理和去除内皮对川芎嗪舒张肌条的效应没有影响 (P >0 .0 5 )。川芎嗪处理组阴茎海绵体平滑肌肌条中的cGMP和cAMP含量分别是对照组的 1 .5和 2 .3倍 ,差异有显著性 (P <0 .0 5 )。　结论 :川芎嗪对阴茎海绵体平滑肌具有浓度依赖性的舒张效应 ,其舒张作用机制与增加cGMP、cAMP浓度有关     

Single Potential Analysis of Corpus Cavernosum Electromyography for the Assessment of Erectile Dysfunction: Provocation, Reproducibility and Age Dependence-Findings in 36 Healthy Volunteers and 324 Patients

Purpose

Corpus cavernosum electromyography is a controversial method for assessing erectile failure. For its application as a diagnostic tool with clinical relevance, intra-individual stability of the parameters in independent recordings as well as information about provocation and age dependence are required.

Materials and Methods

We investigated reproducibility, provocation and age dependence of 11 parameters of single potential analysis of corpus cavernosum electromyography for 36 healthy volunteers in 2 independent recordings with surface electrodes using a visual evaluation technique. Recording 1 results were compared to findings for 324 men with erectile dysfunction.

Results

In healthy subjects all parameters varied extremely among individuals and they were poorly reproducible at repetition. The definition of a normal range as mean plus or minus 2.5 standard deviations did not result in useful diagnostic criteria for individual cases. Activity was not age dependent. Significant differences between healthy and impotent men as defined groups were found in provocation (overall maximum likelihood chi-square 15.5, dF = 2, p <0.0005).

Conclusions

Single potential analysis of corpus cavernosum electromyography seems to be appropriate for distinguishing potent volunteers from patients with erectile dysfunction. Provocation of slow cavernous electric activity seems to be a promising parameter that should be considered for ongoing studies. However, a high range of variation of findings even intra-individually does not currently qualify the method for routine clinical use. Further research will show whether different means of documentation or evaluation, that is corpus cavernosum electromyography pattern analysis at rest after audiovisual sexual stimulation, drug application or digital conversion of data, will lead to better results.     

衰老对大鼠阴茎海绵体内皮细胞功能的影响

目的 :探讨衰老对大鼠阴茎海绵体内皮细胞功能的影响。　方法 :利用YH 4压力传感器分别检测了青龄(5个月 )和老龄 (2 0个月 )两组大鼠阴茎海绵体内压 (ICP)在乙酰胆碱 (Ach)、硝普钠 (SNP)和A2 3187作用下的变化 ;并测定了两组大鼠阴茎海绵体一氧化氮合酶 (NOS)的活性。　结果 :青龄组基础ICP为 (9.4± 2 .3)mmHg(1mmHg=0 .133kPa) ,老龄组为 (7.2± 1.7)mmHg,二者间差异无显著性 (P >0 .0 5 )。在浓度分别为 10 -6、10 -5、10 -4mol/L的Ach作用下 ,两组大鼠ICP值间差异均有显著性 (P <0 .0 1)。当Ach浓度为 10 -4mol/L时 ,两组大鼠ICP值达到最高 ,青龄组为 (5 4 .8± 4 .2 )mmHg ,老龄组为 (40 .3± 2 .8)mmHg。A2 3187(10 μmol/L)可以进一步提高老龄组ICP值 ,由(40 .3± 2 .8)mmHg上升到 (5 6 .2± 4 .1)mmHg ,两者间差异有显著性 (P <0 .0 1) ;青龄组提高不明显 ,由 (5 4 .8± 4 .2 )mmHg上升到 (5 5 .8± 4 .7)mmHg ,两者间差异无显著性 (P >0 .0 5 )。在SNP(10 -4mol/L)作用下青龄组ICP值为(5 8.9± 4 .7)mmHg ,老龄组为 (5 1.7± 5 .3)mmHg ,两者间差异无统计学意义 (P >0 .0 5 )。两组大鼠阴茎海绵体内NOS的活性差异无统计学意义 (P >0 .0 5 )。　结论 :大鼠阴茎海绵体内皮细胞对内皮细胞激动剂