万艾可对伴高血压ED患者的血压和心率无明显影响

男性高血压患者中有一定的勃起功能障碍(ED)发生率,而此类患者往往都服用一种以上的抗高血压药物,那么万艾可在治疗同时服用抗高血压药物的ED患者时是否会对血压和心率产生影响呢?ZusmanRM等人对此进行了一项前瞻性、对照研究。共有1685例病程大于6个月的ED患者参加了该项研究。其中联合用药组中667例被随机分成万艾可治疗组(n=406)和安慰剂对照组(n=261)。联合应用的抗高血压药物包括α-受体阻滞剂、β-受体阻滞剂、利尿药、AC(E血管紧张素转换酶)抑制剂、钙通道拮抗剂。联合用药组中共有608例(91%)完成了全程研究,其中万艾可治疗组37…     

枸橼酸西地那非对男性勃起功能障碍合并使用抗高血压药物的患者血压、心率的影响

在高血压患者中，很多男性患有勃起功能障碍（ED），西地那非对这些长期服用抗高血压药治疗患者的血压、心率有影响吗？Zusman RM等进行的相关研究有助于对此问题的进一步了解，研究者将1685例病程6个月以上的ED患者按其以往是否使用抗高血压药物（利尿剂、β受体阻制剂，α受体阻制剂，血管紧张素转化酶抑制剂，     

枸橼酸西地那非治疗合并心血管疾病ED患者有效且安全

心血管疾病患者比普通人群更容易患勃起功能障碍(ED),因为心血管疾病本身就是ED的危险因素,并且一些治疗心血管疾病的药物也容易导致ED。Olsson AM等人对枸橼酸西地那非治疗合并心血管疾病ED患者的有效性和安全性进行了研究。这些患者同时服用非硝酸盐类的药物如β-受体阻滞剂、血管紧张素转换酶抑制剂和(或)钙通道阻滞剂来治疗心血     

西地那非治疗患有心血管疾病的男性勃起功能障碍患者的疗效和安全性

男性心血管疾病患者较一般人群更易患勃起功能障碍(ED),因为此两种疾病的诱发因素相同,而且一些心血管疾病治疗药物的不良反应就是ED。对于合并心血管疾病的ED患者,西地那非是否像普通人群中所证实的一样有效而安全呢?Olsson AM等人在一项研究中评价了西地那非治疗合并心血管疾病的ED患者的疗效和安全性[Int J Clin Pract,2001,55(3):171-176]。他们让正在服用β受体阻滞剂、血管紧张素转换酶抑制剂、钙离子拮抗剂或联合用药而未用硝酸甘油治疗的ED患者接受口服西地那非治疗。结果显示,患者接受西地那非治疗后,国际勃起功能问卷中评…     

西地那非与氯沙坦长期联合应用对高血压大鼠勃起组织功能及形态学上的改善

勃起功能障碍（ED）与心血管疾病，特别是动脉性高血压密切相关。PDE-5抑制剂及血管紧张素Ⅱ受体阻滞剂（ARB）分别为常用的有效治疗ED和动脉性高血压患者的药物。为评价PDE-5抑制剂西地那非、血管紧张素Ⅱ受体阻滞剂氯沙坦连续长期联合应用对高血压大鼠阴茎结构的影响，Toblli等进行了一项相关研究。     

抗高血压药与骨质疏松症

骨质疏松症和高血压有共同的发病高危因素和病理生理机制,多见于老年人群。对于患者个体而言,二者往往同时存在。因此在进行抗高血压治疗的同时,有必要考虑抗高血压药物对骨密度和脆性骨折发生的影响。目前文献证实,除了袢利尿剂对骨量有负性作用外,噻嗪类利尿剂、血管紧张素转化酶抑制剂(ACEI)和血管紧张素II受体阻滞剂(ARB)、β受体阻滞剂和钙离子通道阻滞剂似乎都有一定骨保护作用,可增加骨密度和强度,降低骨质疏松骨折的发生几率。但尚需要双盲随机对照的临床试验和更多基础实验室证据支持骨质疏松症和高血压的相关性及抗高血压药物缓解骨丢失的作用。     

顽固性高血压中西医结合治疗疗效分析

目的:观察中西医结合治疗顽固性高血压的疗效.方法:根据2003年美国高血压预防、检测、评估与治疗全国联合委员会第7次报告(JNC 7)对顽固性高血压诊断标准随机分为治疗组(36人)和对照组(36人),基础治疗相同,治疗组选用中药基础方配合西药阿司匹林肠溶片、他汀类或贝特类降脂药、利尿剂、β受体阻滞剂、钙离子拮抗剂、血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体拮抗剂(ARB)等,对照组单用西药口服降压.结果治疗组15天一个疗程,显效75%,有效19.3%,总有效率94.3%.对照组显效50%,有效27.8%,总有效率77.8%.结论中西医结合治疗方法,共同发挥了降低血压、血脂,扩张血管,利尿等作用,相较于单纯运用降压药起到了良好的降压效果.     

蛋白尿患者高血压治疗的研究进展

蛋白尿是肾脏疾病进展和并发心血管疾病的重要危险因素,降低尿蛋白可延缓肾功能减退并降低心血管事件发生的危险性。而血压升高在慢性肾脏病的进展中也起着重要作用,近来所有的指南都推荐蛋白尿患者血压控制的靶目标为低于130／80mmHg以达到最大的肾脏和心血管保护作用。大量研究证明作用于肾素-血管紧张素系统的药物（如血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂）有独立于降压之外的降低蛋白尿的作用,因此可作为蛋白尿患者的一线高血压治疗药物,若应用这类药物后血压仍不达标,可在此基础上加用利尿剂或其他高血压药物。血管紧张素转换酶抑制剂与血管紧张素受体拮抗剂或其他类型药物（如非二氢吡啶类钙离子通道阻断剂或醛固酮受体拮抗剂）联合应用可进一步减少尿蛋白。     

上海邮电系统慢性肾脏病患者高血压横断面研究

目的 对上海邮电系统职工慢性肾脏病(CKD)患者的高血压患病率、知晓率、控制率和降压药使用情况进行横断面研究.方法 回顾性分析在本院肾内科门诊就诊的上海邮电系统职工初诊CKD患者810例,其中男性422例(52.1％),女性388例(47.9％),年龄(26 ～96)岁.结果 ①83.58％的CKD患者伴高血压,高血压知晓率为占92.02％,治疗率达到了80.35％,高血压控制率为19.65％;②吸烟、肥胖、糖尿病、尿酸、肾功能减退、高龄,这些变量均为上海邮电系统职工CKD门诊患者高血压发病的危险因素;③上海邮电系统初诊CKD患者使用l、2和3种或以上降压药物者分别为72.8％ (493/677)、24.3％ (165/677)和2.9％(19/677).在已服药的544例中,单药服用的患者中,降压药物中使用比例最高药物是钙离子拮抗剂(CCB)48.0％ (261/544),血管紧张素受体Ⅱ受体拮抗剂(ARB) 31.6％ (172/544),其次为血管紧张素转换酶抑制剂(ACEI)9.9％ (54/544).联合治疗方案中,使用最多的是ARB+ CCB占18.8％(102/544);④上海邮电系统初诊CKD患者的CKD知晓率:46.67％.结论 上海邮电系统职工CKD患者的高血压发病率高,高血压知晓率与治疗率均较高,而CKD的知晓率低,且高血压的控制率仍低;吸烟、肥胖、糖尿病、尿酸、肾功能减退、高龄,这些变量均为CKD患者高血压发病的危险因素.     

抗高血压药物对自发性高血压大鼠勃起功能和nNOS神经纤维的影响

目的 :研究抗高血压药物对自发性高血压大鼠 (SHR)勃起功能和神经元型一氧化氮合酶 (nNOS)神经纤维的影响。　方法 :18只 6周龄雄性SHR随机均分为 3组 :缬沙坦 [30mg (kg·d) ]干预组、螺内酯 [2 0mg (kg·d) ]干预组和对照组。 12周后 ,观察大鼠阴茎勃起功能 ,并用免疫组化SP法检测阴茎组织中nNOS神经纤维的数目。　结果 :缬沙坦干预组勃起次数与另外两组相比差异有显著性 (P <0 .0 5 ) ,后两组之间差异无显著性 (P >0 .0 5 ) ,勃起率 3组之间差异不明显 (P >0 .0 5 ) ,阴茎组织中nNOS神经纤维数目 ,两干预组与对照组之间差异有显著性 (P <0 .0 1) ,而两干预组之间差异无显著性 (P >0 .0 5 )。　结论 :缬沙坦能改善SHR的勃起功能 ,而螺内酯无改善作用 ,这种差异与nNOS神经纤维数目无关 ,可能与血管紧张素Ⅱ(AngⅡ)受体阻滞剂引起血管重构等其他作用有关     

小剂量每日服用他达那非改善勃起功能障碍患者内皮舒张功能及勃起硬度的研究

目的:探讨小剂量每日服用他达那非对改善勃起功能障碍(ED)患者内皮舒张功能及勃起硬度的作用。方法:通过国际勃起功能问卷评分-5(IIEF-5)、勃起硬度分级评分(EHGS)以及肱动脉血流介导的舒张反应(FMD)等方法对24例勃起功能正常者及60例ED患者口服5mg/d他达那非6～8周治疗前后进行评估。结果:51例ED患者完成治疗及随访。与对照组相比,ED患者IIEF-5、EHGS以及FMD明显降低(P均<0.01)。他达那非治疗ED的有效率为96.1%(49/51),治疗后较治疗前IIEF-5、EHGS以及FMD明显改善(P均<0.01)。结论:长期小剂量服用他达那非可明显改善ED患者的血管内皮功能及勃起硬度。     

Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome

Pathogenesis of erectile dysfunction (ED) is related to endothelial dysfunction and therefore associated with cardiovascular risk factors. Patients with a combination of risk factors, as in metabolic syndrome, are thus likely to have an increased risk of developing endothelial and ED. The angiotensin receptor antagonist irbesartan has been shown to improve endothelial function in cardiovascular high-risk patients, which suggests a beneficial effect of treatment with irbesartan on ED. The aim of the present study was to determine the influence of irbesartan on ED in patients with a metabolic syndrome. A total of 1069 consecutive hypertensive patients with a metabolic syndrome from the Documentation of hypertension and metabolic syndrome in patients with Irbesartan Treatment survey were included. Patients were treated with irbesartan or the combination of irbesartan/hydrochlorothiazide for 6 months. ED was assessed using the international index of erectile function. The Cologne Evaluation Questionnaire of Erectile Dysfunction served as a control. Erectile function increased significantly (P<0.0001) after 6 months of treatment with irbesartan, irrespective of dosage and independent of additional treatment with hydrochlorothiazide. Prevalence of ED declined to 63.7% from 78.5% at baseline, along with a significant increase in orgasmic function (P<0.001) and intercourse satisfaction (P<0.001). Treatment with irbesartan alone, as well as in combination with hydrochlorothiazide is associated with an improvement of sexual desire, frequency of sexual contacts and erectile function in hypertensive patients with the metabolic syndrome. These results suggest a beneficial role of angiotensin receptor antagonists in the treatment of metabolic syndrome, and ED.     

The impact of age, body mass index and testosterone on erectile dysfunction

PURPOSE: Erectile dysfunction (ED) may be associated with low serum total testosterone (T), low serum bioavailable testosterone (BAT) and high body mass index (BMI) in aging men. MATERIALS AND METHODS: A total of 675 workers (age range 45 to 60 years old) were entered into this study. Investigations were performed directly at their place of work. Exclusion criteria were abnormal urogenital status, antihypertensive drugs, medication possibly affecting the endocrine function and a history of previous pelvic trauma. T and sex hormone-binding globulin were measured with commercially available assays, and BAT was calculated from T and sex hormone-binding globulin. BMI was assessed and every individual completed a self-administrated questionnaire for erectile function (International Index of Erectile Function [IIEF-5]). RESULTS: T and BAT showed a significantly negative correlation with age and BMI. Each additional year of increase in age caused a decrease in the IIEF-5 score of 0.195 (p <0.001). Increase in BMI by 1 kg/m reduced IIEF-5 by 0.141, independent of age (p =0.005). Multiple logistic regression analyses confirmed the influence of increased age and higher BMI on the risk of ED. The corresponding odds ratio for ED was 1.082 (p <0.001) and 1.076 (p <0.001), respectively. These data indicate an increase in ED risk by 8.2% per year and by 7.6% per kg/m BMI. Severe cases of ED (IIEF-5 score 7 or less) were significantly associated with a decrease in T and BAT. Individuals with low BAT (1 ng/ml or less) had a 3 times higher risk of severe ED compared with men with BAT greater than 1 ng/ml (odds ratio 3.045, 95% CI 1.088 to 8.522, p =0.034). The result of the multiple logistic regression analysis was adjusted to age and BMI, and did not show a significant influence on the incidence of severe ED. CONCLUSIONS: BMI contributes strongly to ED. Low T or BAT are only relevant if IIEF-5 questionnaire results in severe ED.     

每日小剂量他达拉非治疗骨盆骨折尿道断裂后勃起功能障碍的疗效观察

目的:评价每日小剂量他达拉非治疗骨盆骨折尿道断裂(PFUD)后勃起功能障碍(ED)的疗效。方法:2008年1月至2011年12月共有46例骨盆骨折尿道断裂后ED患者纳入观察。患者年龄25～51(33.9±7.2)岁,受伤时间3～72(19.6±12.7)个月。所有患者自诉受伤前的性功能正常。患者在未服用5型磷酸二酯酶抑制剂的情况下进行夜间勃起周径和硬度测量(NPTR)。根据NPTR检测结果将患者分为有夜间勃起异常组和无夜间勃起组。对所有患者给予每晚他达拉非10 mg治疗3个月,采用IIEF-5评分、性生活日记问题2和问题3评价治疗效果。结果:38例(82.6%)患者完成检查和治疗,8例失访。NPTR检测证实夜间勃起异常26例(68.4%),无夜间勃起12例(31.6%)。他达拉非治疗3个月后,夜间勃起异常组患者IIEF-5改善明显高于无夜间勃起组(P<0.05),夜间勃起异常组患者对SEP2和SEP3回答"是"的比例明显高于无夜间勃起组(76.9%vs41.7%,65.4%vs 25.0%,P<0.05)。结论:每日小剂量他达拉非可有效改善PFUD后ED患者的勃起功能,有夜间勃起的患者治疗效果更明显。     

老年男性腔隙性脑梗死患者性功能问卷调查

目的:探讨老年男性腔隙性脑梗死患者性功能改变的特点,以利患者全面康复。方法:38例老年(60~70岁)患者,分为腔隙性脑梗死组20例,非脑梗死组18例,排除明显运动障碍、卒中后抑郁、帕金森病、严重系统性疾病等。于出院时及出院后6个月分别行国际勃起功能评分5(IIEF-5)问卷调查,比较各组之间以及随访前后IIEF-5评分的变化。结果:腔隙性脑梗死组19例(95.0%)发生勃起功能障碍(ED),较非梗死组(15例,83.3%)明显增高,且重度ED的发生率较高(60.0%vs44.4%,P<0.05),两组中合并糖尿病患者的ED程度较重。随访康复治疗6个月后脑梗死患者的IIEF-5评分较出院明显增加(11.2±3.2vs15.6±2.2,P<0.05)。结论:老年男性腔隙性脑梗死后ED的发病明显增加,程度更严重。合并糖尿病的患者ED更严重。卒中后康复治疗有助于患者勃起功能的恢复。     

微能量体外冲击波治疗男性勃起功能障碍的疗效观察

目的观察微能量体外冲击波治疗男性勃起功能障碍(ED)的临床疗效。方法选取2018年1月至12月在本院就诊的ED患者22例,采用微能量体外冲击波治疗,每周治疗2次,连续3周,间隔3周,再每周治疗2次,连续3周,共12次。分别在治疗前和治疗后4周、10周评估患者国际勃起功能指数(IIEF-5)、勃起硬度分级(EHS)和不良反应。结果22例患者IIEF-5、EHS在治疗后4周、10周较治疗前有显著改善(P<0.01),而治疗后4周、10周组间比较差异无明显统计学意义(P>0.05)。治疗4周和10周总有效率分别为72.73%(16/22)和68.18%(15/22)。结论微能量体外冲击波治疗可以明显改善男性勃起功能障碍,且无明显不良反应。     

High prevalence of erectile dysfunction after renal transplantation

BACKGROUND AND METHODS: A cross-sectional study of multifaceted male sexual function in 323 consecutive kidney transplant recipients was conducted by mail by means of the validated International Index of Erectile Function (IIEF). All five IIEF domains (IIEF-5), i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, were scored for each responder. IIEF-5 scoring that conformed to the National Institutes of Health definition of erectile dysfunction (ED) was computed for all patients sexually active within the past 4 weeks. RESULTS: Two hundred and seventy-one patients replied. Compared to the controls used for IIEF psychometric validation, kidney transplant recipients gave lower erectile function (P<0.01) and intercourse satisfaction (P<0.05) scores, despite their being younger. ED, according to the IIEF-5 method, was demonstrated in 55.7% of the sexually active patients (n=212). Age, time on dialysis, and iterative transplants were significantly and negatively related to erectile dysfunction. CONCLUSION: IIEF proved to be a valuable means of unveiling highly prevalent erectile dysfunction in male kidney transplant recipients. The negative impact of the time on dialysis was emphasized in the results.     

Patient-reported validated functional outcome after extraperitoneal robotic-assisted nerve-sparing radical prostatectomy.

BACKGROUND AND OBJECTIVES: Erectile function after prostate surgery is an important criterion for patients when they are choosing a treatment modality for prostate cancer. Improved visualization, dexterity, and precision afforded by the da Vinci robot allow a precise dissection of the neurovascular bundles. We objectively assessed erectile function after robot-assisted extraperitoneal prostatectomy by using the SHIM (IIEF-5) validated questionnaire. METHODS: Between July 2003 and September 2004, 150 consecutive men underwent da Vinci robot-assisted extraperitoneal radical prostatectomy for clinically localized prostate cancer. The IIEF-5 questionnaire was used to assess postoperative potency in 67 patients who were at least 6 months postsurgery. Erectile function was classified as impotent (<11), moderate dysfunction (11 to 15), mild dysfunction (16 to 21), and potent (22 to 25). All patients used oral pharmacological assistance postprocedure. RESULTS: Sixty-seven patients were available to complete the IIEF-5 questionnaire 6 months to 1 year postprostatectomy. Twelve patients were excluded from the study who abstained from all sexual activity after surgery for emotional or social reasons. Of the 55 patients evaluated, 22 (40%) were impotent, 3 (5.5%) had moderate erectile dysfunction (ED), 12 (21.8%) had mild ED, and 18 (32.7%) were fully potent. The table compares IIEF-5 scores with nerve-sparing status. Of patients who had bilateral nerve sparing, 28/45 (62.2%) had mild or no ED within 6 to 12 months postsurgery, and all expressed satisfaction with their current sexual function or rate of improvement after robotic prostatectomy. CONCLUSION: Robot-assisted extraperitoneal prostatectomy provides comparable outcomes to those of open surgery with regards to erectile function. Assessment of the ultimate maximal erectile function will require continued analysis, as this is likely to further improve beyond 6 to 12 months.     

小剂量他达那非治疗骨盆骨折后勃起功能障碍的疗效观察

目的:评估小剂量他达那非每日给药一次治疗骨盆骨折后勃起功能障碍(ED)的疗效。方法:42例骨盆骨折后ED患者依据外伤后时间分为3组,A组:<1个月组、B组:6～24个月组和C组:>24个月组,每天给予5 mg他达那非连续治疗12周,应用IIEF-5评分和"性活动日志"(SEP)评估疗效。结果:共34例患者完成研究,3组均对骨盆骨折后ED有一定的疗效。A组SEP1、SEP2和SEP5平均阳性回答率分别为70%、59%、52%,均显著高于B、C组(P均<0.05);12周后,3组IIEF-5评分分别增加(3.20±2.62)、(1.31±1.70)、(0.91±1.87)分,A组显著高于B、C组(P均<0.05)。结论:小剂量他达那非每日给药一次对骨盆骨折后ED有较好的康复作用,外伤后越早使用其疗效越好。     

血脂异常与男性勃起功能的相关性研究

目的:探讨血脂异常与男性勃起功能之间的相关关系。　方法:于清晨空腹采集外周血标本,使用生化分 析仪测定其中血清总胆固醇(TC)、总甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)的浓度。从上述 4项结果中至少1项有异常的患者中随机选取200例男性患者,用勃起功能障碍国际指数问卷表(IIEF 5)评估这 些患者的勃起功能,并用统计学方法分析两者之间的相关关系。　结果:血脂异常者勃起功能障碍(ED)的发病率 为47%。年龄、冠心病、空腹血糖水平升高、良性前列腺增生(BPH)、服药、高血压均与勃起功能评分之间呈负相 关,HDL与勃起功能评分之间呈正相关。年龄、冠心病、TC/HDL为ED的危险因素,HDL为保护因素,调整年龄因 素后,冠心病、TC/HDL、BPH均为危险因素,HDL是保护因素。　结论:高血脂是影响男性勃起功能的一个重要因 素。其中HDL水平的下降和TC/HDL比值的上升是ED的重要的危险因素。TC/HDL比值的检测和HDL水平的 检测都是预测ED发生的敏感指标。