老年男性272名勃起功能障碍患病情况调查

目的 了解老年男性勃起功能障碍患病情况，为临床诊治勃起功能障碍提供依据。方法 采用国际勃起功能指数评分的简化版中(IIEF-5)问卷调查性生活史，并回顾相关既往史、用药史和生活方式。结果 272名老年男性勃起功能障碍总患病率是89．7％，其中60～岁组是75．9％、70～岁组是78．6％、80～88岁组是100．0％；此次调查的老年男性中95．1％的高血压病患者伴发勃起功能障碍。结论 老年男性勃起功能障碍的患病率与年龄增长和高血压有关。     

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...     

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.     

2型糖尿病男性患者性功能及性激素水平的临床研究

目的 探讨T2DM男性患者性激素水平变化及其相关因素.方法 选取T2DM男性患者100例,记录年龄、身高、体重和病程,检测FPG、HbA1c和性激素水平.采用国际勃起功能指数-5（IIEF-5）量表评估性功能状况.结果 患者IIEF-5评分较发病前降低[（15.40±7.41）vs（23.41±1.65）,P＜0.01].无勃起功能障碍（ED）患者与轻、中、重度ED患者相比,其睾酮水平总体比较差异有统计学意义（P＜0.01）.卵泡刺激素和黄体生成素水平总体比较差异有统计学意义（P＜0.05）.结论 T2DM男性患者性功能障碍可能与糖尿病症状同时出现,部分患者以性功能障碍为糖尿病首发症状.睾酮、黄体生成素和卵泡刺激素水平与性功能障碍程度、血糖控制水平等存在一定的相关性.     

超声刀、电刀行保留盆神经TME对男性性功能影响的比较

目的比较采用超声刀、电刀行保留盆神经直肠癌全系膜切除术(TME)对男性直肠癌患者术后性功能的影响。方法 64例接受保留盆神经TME的男性患者,30例使用超声刀手术(观察组),34例使用传统电刀手术(对照组)。统计并比较两组患者术后勃起功能障碍和射精功能障碍发生情况。结果观察组和对照组患者术后勃起功能障碍发生率分别为16.7%和35.2%,射精功能障碍发生率分别为20.0%和38.2%,两组勃起功能障碍和射精功能障碍发生率相比P均<0.05。结论与传统电刀手术相比,使用超声刀行保留盆神经TME可明显降低男性术后性功能障碍的发生率。     

慢性病毒性肝炎及肝硬化合并高血压患病率分析

目的 了解慢性病毒性肝炎及肝硬化合并高血压的患病情况,为应用中医药治疗乙肝提供辨证思路.方法 对2007年我院住院的慢性肝病患者中合并高血压病患者进行统计分析.结果 男性、女性乙肝患者合并高血压患病率分别为4.75%、5.44%,男性、女性丙肝患者合并高血压患病率分别为23.64%、21.25%.乙肝组的高血压患病率低于正常组.结论 高血压是慢性乙型肝炎、肝硬化的重要影响因素.     

慢性肝病患者睡眠障碍的研究进展

睡眠障碍是慢性肝病患者的常见表现,60%～80%患者的主观睡眠较差,影响健康相关生活质量。多种慢性肝病如非酒精性脂肪肝疾病、慢性病毒性肝炎及原发性胆汁性胆管炎等患者均可存在不同类型的睡眠障碍,包括失眠、睡眠效率降低、睡眠潜伏期延长、快眼动睡眠时间减少、不宁腿综合征及白天过度嗜睡等。目前对慢性肝病睡眠障碍的治疗选择有限,且针对慢性肝病的治疗也可导致睡眠障碍。本文主要对慢性肝病患者睡眠障碍的研究进展进行综述。     

饮酒量与男性2型糖尿病患者勃起功能障碍的相关性研究

目的探讨饮酒量与男性2型糖尿病患者勃起功能障碍(ED)的相关性。方法对2007年4月至2010年1月在沈阳军区总医院内分泌科住院的400例男性2型糖尿病患者进行问卷调查,采用勃起功能国际指数(IIEF-5)评分问卷对其勃起功能进行评分,按照患者饮酒量进行分组。比较大量饮酒组、适量饮酒组、不饮酒组的基础信息和勃起功能。结果三组糖尿病患者中年龄、空腹血糖、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)、血压、雌激素、睾酮比较差异无统计学意义,三组糖尿病患者糖尿病病程、血管和神经并发症方面比较差异亦无统计学意义。大量饮酒组中ED患病率为83.42%,适量饮酒组中ED患病率为51.11%,不饮酒组中ED患病率为53.70%;大量饮酒组与适量饮酒组比较差异有统计学意义,大量饮酒组与不饮酒组比较差异有统计学意义,而适量饮酒组与不饮酒组比较差异无统计学意义。结论酒精的大量摄入可能是男性2型糖尿病患者ED患病率增加的一个重要因素。     

代谢综合征与慢性乙型病毒性肝炎及非酒精性脂肪性肝病患者肝纤维化程度的相关性研究

目的 比较慢性乙型病毒性肝炎患者和非酒精性脂肪性肝病患者代谢综合征患病率,以及代谢综合征对慢性乙型病毒性肝炎患者和非酒精性脂肪性肝病患者肝纤维化进展的影响.方法 对2008年1月至2009年6月在我院就诊的136例慢性乙型病毒性肝炎患者和110例非酒精性脂肪性肝病患者进行回顾性分析,调查其代谢综合征的患病率,测定肝功能及病毒学指标,进行肝脏病理学检查.采用t检验和X~2检验进行统计学分析.结果 代谢综合征总的患病率为28.5%,非酒精性脂肪性肝病患者代谢综合征患病率显著高于慢性乙型病毒性肝炎患者(分别为49.1%和11.8%).肝纤维化分期为S_(0～1)、S_(2～4)的慢性乙型病毒性肝炎患者代谢综合征的患病率分别为3.1%和19.7%(P＜0.01),代谢综合征、体重指数、天门冬氨酸转氨酶、γ-谷氨酰转肽酶及炎症程度均与其肝纤维化程度相关.在非酒精性脂肪性肝病患者中,非酒精性脂肪性肝炎患者代谢综合征患者率高于非酒精性脂肪肝(分别为55.4%和40.0%);纤维化分期为S_(0～1)、S_(2～4)的患者代谢综合征的患病率分别为36.2%和70.7%(P＜0.01);代谢综合征、丙氨酸转氨酶、天门冬氨酸转氨酶、γ-谷氨酰转肽酶及明显炎症均与其肝纤维化严重程度相关.结论 非酒精性脂肪性肝病患者代谢综合征的患病率高于慢性乙型病毒性肝炎患者,这两类患者代谢综合征与肝纤维化程度相关.     

性激素与肝脏

慢性肝病时男性患者女性化和性功能低下,以及妇女应用避孕药物后发生肝脏肿瘤,致使临床医师对性激素与肝脏的关系日益关注。本文仅就肝脏在固醇类性激素的代谢过程中的作用,肝脏疾患时这些激素的变化以及性激素对肝脏的影响等方面的研究现状综述如下。     

Sexual Dysfunction in Men with COPD: Impact on Quality of Life and Survival

Background

Most patients with chronic obstructive pulmonary disease (COPD) are middle-aged or older, and by definition all have a chronic illness. Aging and chronic illness decrease sexual interest, sexual function, and testosterone levels. To date, researchers have not simultaneously explored prevalence, risk factors, and impact of sexual dysfunctions on quality of life and survival in men with COPD. We tested three hypotheses: First, sexual dysfunctions, including erectile dysfunction, are highly prevalent and impact negatively the quality of life of those with COPD. Second, gonadal state is a predictor of erectile dysfunction. Third, erectile dysfunction, a potential maker of systemic atherosclerosis, is a risk factor for mortality in men with COPD.

Methods

In this prospective study, sexuality was assessed in 90 men with moderate-to-severe COPD (40 hypogonadal) by questionnaire. Testosterone levels, comorbidities, dyspnea, depressive symptoms, and survival (4.8?years median follow-up) were recorded.

Results

Seventy-four percent of patients had at least one sexual dysfunction, with erectile dysfunction being the most common (72?%). Most were dissatisfied with their current and expected sexual function. Severity of COPD was equivalent in patients with and without erectile dysfunction. Low testosterone, depressive symptoms, and presence of partner were independently associated with erectile dysfunction. Severity of lung disease and comorbidities, but not erectile dysfunction, were independently associated with mortality (p?=?0.006).

Conclusions

Sexual dysfunctions, including erectile dysfunction, were highly prevalent and had a negative impact on quality of life in men with COPD. In addition, gonadal state was an independent predictor of erectile dysfunction. Finally, erectile dysfunction was not associated with all-cause mortality.     

Prevalence and risk factors for erectile dysfunction in the US

Purpose

To assess the prevalence of erectile dysfunction and to quantify associations between putative risk factors and erectile dysfunction in the US adult male population.

Methods

Cross-sectional analysis of data from 2126 adult male participants in the 2001-2002 National Health and Nutrition Examination Survey (NHANES). Erectile dysfunction assessed by a single question during a self-paced, computer-assisted self-interview. These data are nationally representative of the noninstitutionalized adult male population in the US.

Results

The overall prevalence of erectile dysfunction in men aged ≥20 years was 18.4% (95% confidence interval [CI], 16.2-20.7), suggesting that erectile dysfunction affects 18 million men (95% CI, 16-20) in the US. The prevalence of erectile dysfunction was highly positively related to age but was also particularly high among men with one or more cardiovascular risk factors, men with hypertension, and men with a history of cardiovascular disease, even after age adjustment. Among men with diabetes, the crude prevalence of erectile dysfunction was 51.3% (95% CI, 41.9-60.7). In multivariable analyses, erectile dysfunction was significantly and independently associated with diabetes, lower attained education, and lack of physical activity.

Conclusions

The high prevalence of erectile dysfunction among men with diabetes and hypertension suggests that screening for erectile dysfunction in these patients may be warranted. Physical activity and other measures for the prevention of cardiovascular disease and diabetes may prevent decrease in erectile function.     

Coronary flow velocity reserve reduction is comparable in patients with erectile dysfunction and in patients with impaired fasting glucose or well-regulated diabetes mellitus.

BACKGROUND: There is growing evidence that erectile dysfunction is a sentinel for future coronary artery disease. Recently published studies have shown signs of impaired coronary endothelial function in patients with erectile dysfunction, without clinical cardiovascular disease and diabetes. We evaluated the magnitude of coronary vasodilatory dysfunction in men with erectile dysfunction, as compared with men with impaired glucose metabolism (impaired fasting glucose or diabetes) and healthy controls. METHODS: We investigated men aged 68-73 years with erectile dysfunction (n=12), age-matched men with impaired glucose metabolism, who all proved to have erectile dysfunction (n=15), and age-matched male controls (n=12). Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Coronary flow velocity reserve in the left anterior descending artery was examined using Doppler ultrasound and intravenous adenosine provocation. RESULTS: Coronary flow velocities at rest did not differ between the three groups, but maximum coronary flow velocity was significantly lower in the erectile dysfunction group (P=0.004) and in the impaired glucose metabolism group (P=0.019), as compared with controls. There was no difference between the erectile dysfunction and impaired glucose metabolism groups. Coronary flow velocity reserve was reduced in the erectile dysfunction group (P=0.026) compared to controls, but was similar compared to the impaired glucose metabolism group. In multivariate analysis including all groups, erectile dysfunction score was the only independent predictor of reduced coronary flow velocity reserve (P=0.020). CONCLUSIONS: The magnitude of early coronary endothelial and smooth muscle cell dysfunction in otherwise healthy men with erectile dysfunction was comparable to that of patients with impaired glucose metabolism: a well known risk factor for coronary artery disease.     

Sexual functions in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse.     

Erectile dysfunction in patients with chronic hepatitis C virus infection

Background and study aimsHepatitis C virus (HCV) infection is a major public health problem worldwide and in Egypt. Several studies have suggested that chronic HCV infection may be associated with erectile dysfunction (ED) in men. The aim of our study was to detect the prevalence of ED among male patients with chronic HCV infection.Patients and methodsThe study included 150 male patients with chronic HCV infection (124 patients with chronic hepatitis and 26 patients with HCV-associated liver cirrhosis). The Child–Pugh score was used to assess the severity of cirrhosis. An Arabic validated version of the five-item International Index of Erectile Function (IIEF-5) was used to detect the presence and severity of ED.ResultsThe patients’ age ranged from 20 to 80 years with mean age ± standard deviation (SD; 50 ± 17.19) years. The prevalence of ED among patients with chronic HCV infection was found to be 29.3%. The prevalence was significantly higher in cirrhotic as compared to chronic hepatitis patients (p < 0.001) and the average ED score was significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. There was a highly significant relation between the severity of ED and the severity of liver disease. There was a significant negative correlation between serum bilirubin and ED score and a significant positive correlation between serum albumin and ED score in patients with liver cirrhosis.ConclusionAbout 30% of patients with chronic HCV infection were found to have ED; so, given the high prevalence of HCV infection in Egypt, chronic HCV infection may be considered in the differential diagnosis of ED. There was a highly significant relation between the severity of ED and the severity of liver disease and the majority of patients with liver cirrhosis proved to be suffering from ED, which may be related to the associated hypoalbuminaemia.     

Erectile dysfunction in cirrhosis is impacted by liver dysfunction,portal hypertension,diabetes and arterial hypertension

Background

Although several risk factors for erectile dysfunction may be present in patients with cirrhosis, data on the actual prevalence and cause of erectile dysfunction is limited. The International Index of Erectile Function‐5 (IIEF‐5) is a well‐validated survey to determine the presence and severity of erectile dysfunction in men. We assessed (i) the prevalence and severity of erectile dysfunction, and (ii) risk factors for erectile dysfunction in patients with cirrhosis.

Methods

In this prospective study, erectile dysfunction was defined as: absent (>21 IIEF‐5‐points), mild (12‐21) and severe (5‐11). Patients with overt hepatic encephalopathy, active alcohol abuse, extrahepatic malignancy, previous urologic surgery, previous liver transplantation and severe cardiac conditions were excluded.

Results

Among n = 151 screened patients, n = 41 met exclusion criteria and n = 30 were sexually inactive. Thus, a final number of n = 80 male patients with cirrhosis were included. Patient characteristics: age: 53 ± 9 years; model for end‐stage liver disease score (MELD): 12.7 ± 3.9; Child‐Pugh score (CPS) A: 30 (37.5%), B: 35 (43.8%), C: 15 (18.7%); alcohol: 38 (47.5%), viral: 25 (31.3%), alcohol/viral: 7 (8.8%) and others: 10 (12.5%). The presence of erectile dysfunction was found in 51 (63.8%) patients with 44 (55%) and 7 (8.8%) suffering from mild‐to‐moderate and moderate‐to‐severe erectile dysfunction. Mean MELD and hepatic venous pressure gradient (HVPG) were significantly higher in patients with erectile dysfunction (P = .021; P = .028). Child‐Pugh score C, MELD, creatinine, age, arterial hypertension, diabetes, low libido, low testosterone and high HVPG were associated with the presence of erectile dysfunction. Interestingly, beta‐blocker therapy was not associated with an increased risk. In multivariate models, arterial hypertension (OR: 6.36 [1.16‐34.85]; P = .033), diabetes (OR: 7.40 [1.31‐41.75]; P = .023), MELD (OR: 1.19 [1.03‐1.36]; P = .015) and increasing HVPG (n = 48; OR: 1.11 [1.002‐1.23]; P = .045) were independent risk factors for the presence of erectile dysfunction.

Conclusion

About two‐thirds of male patients with cirrhosis show erectile dysfunction. Severity of liver dysfunction, portal hypertension, arterial hypertension and diabetes were identified as risk factors for erectile dysfunction.     

Dupuytren's contracture, alcohol consumption, and chronic liver disease

This prospective study was undertaken to assess the prevalence of Dupuytren's contracture (DC) and its relationship with possible causes, especially alcohol consumption and chronic liver disease. Four hundred thirty-two consecutively hospitalized patients were examined for evidence of DC. They were divided into five groups based on the following clinical, biologic, and histologic criteria: alcoholic cirrhosis (89 patients), noncirrhotic alcoholic liver disease (55 patients), chronic alcoholism without liver disease (46 patients), nonalcoholic chronic liver disease (68 patients), and a control group (174 patients). The prevalence of DC in these five groups of patients was 32.5%, 22%, 28%, 6%, and 12%, respectively; the prevalence of DC was higher in patients with cirrhotic or noncirrhotic alcoholic liver disease (25.5%) than it was in patients with nonalcoholic liver disease (6%), but it was not significantly different in alcoholic patients with or without liver disease. The relationship between DC and age, sex, manual labor, previous hand injuries, diabetes mellitus, alcohol consumption, and cigarette smoking was assessed by univariate and logistic regression methods. Nine variables were significantly different in patients with or without DC: age, sex, manual labor, previous hand injuries, diabetes mellitus, daily alcohol consumption, duration of alcohol consumption, total alcohol consumption, and duration of cigarette smoking. In our patients, variables that could explain DC were, in decreasing order, age, total alcohol consumption, sex (male), and previous hand injuries. In alcoholic patients, these variables were age and previous hand injuries; in nonalcoholic patients, these variables were age and cigarette smoking. These results emphasize the high prevalence of DC in alcoholic patients and the absence of a correlation between DC and chronic liver disease. Age and alcohol consumption are the best explanatory variables of DC in hospitalized patients.     

Sexual dysfunction in men with alcoholic liver cirrhosis. A comparative study

Sexual dysfunction in men with alcoholic cirrhosis was investigated in young (less than 56 years) outpatients with steady female partners. Sixty-one per cent (11/18) claimed sexual dysfunction, with erectile dysfunction and/or reduced sexual desire being the most common symptoms. Comparing patients with (n = 11) and without (n = 7) sexual dysfunction, no significant differences were found concerning a number of pertinent clinical variables. This should be interpreted with caution, however, owing to the small number of patients in each group. The prevalence and type of sexual dysfunction were not significantly different comparing alcoholic cirrhotic men to chronic alcoholic men without overt liver disease (matched for duration of alcoholism, age and duration of partnership) and to insulin-dependent diabetic men (matched for age and duration of partnership). However, all groups had a significantly (p less than 0.025) raised prevalence of sexual dysfunction when compared to men without chronic disease (matched for age and duration of partnership).     

Association of erectile dysfunction with depression in patients with chronic viral hepatitis

AIM: To investigate the prevalence of erectile dysfunction(ED) and its association with depression in patients with chronic viral hepatitis.METHODS: This single center cross-sectional study was conducted from August 2013 through January 2014. All outpatients with chronic viral hepatitis in our liver clinic between 18 and 80 years of age were considered eligible for this study. The exclusion criteria included well-established causes of ED, such as diabetes, hypertension, hyperlipidemia, alcohol abuse, liver cirrhosis, ischemic heart disease, renal disease, neurologic disease, and malignancy. We also excluded the patients who had incompletely answered the questionnaires. ED was assessed using the validated Korean version of the International Index of Erectile Function(IIEF-5) scale. The Korean version of the self-administered Beck Depression Inventory(BDI) scale was used to assess depression in the patients. Demographic and medical data were obtained from the patients' medical records. Current or past history of psychiatric diagnosis and drug history including the use of an antiviral agent and an antidepressant were also recorded. RESULTS: A total of 727 patients met the initial eligibility criteria. Six hundred seventeen patients were excluded because their medical records contained one or more of the previously determined exclusion criteria. The remaining 110 patients were assessed based on the BDI and IIEF-5 questionnaires. Based on the IIEF-5 scale, the prevalence of ED among patients with chronic viral hepatitis was 40%. Compared with the non-ED group, patients in the ED group were older. The proportion of patients in the ED group who had a job or who were na?ve peg-interferon users was lower than that in patients in the non-ED group. Patients with ED had significantly lower scores on the IIEF-5 scale than patients without ED(11.75 ± 4.88 vs 21.33 ± 1.86, P = 0.000). Patients with ED rated significantly higher scores on the BDI scale compared with patients without ED(12.59 ± 7.08 vs 5.30 ± 4.00, P = 0.000). Also, the IIEF-5 scores were negatively correlated with age, employment, and BDI scores. In the multiple logistic regression analysis, age and depression were independently associated with erectile dysfunction(P =0.019 and 0.000,respectively).CONCLUSION:Patients with chronic viral hepatitis have a high prevalence of ED.Age and depression are independent factors for ED in male patients with chronic viral hepatitis.     

Negative stress echocardiographic study predicts excellent long-term prognosis in patients with erectile dysfunction

Background: Subjects with erectile dysfunction share common risk factors as those for coronary artery disease. However, there are no data on the role of stress echocardiography in assessing the prognosis of patients with erectile dysfunction. Hypothesis: We sought to determine the prognostic utility of negative stress echocardiography study in subjects with erectile dysfunction and compare it to similar subjects without erectile dysfunction. Methods: Between October 1996 and December 1997, 236 patients had negative stress echocardiograms. There were 28 patients with erectile dysfunction. There was a higher prevalence of diabetes in the erectile dysfunction group (64% vs. 35%, P=0.005). The prevalence of other risk factors was similar in the two groups. Follow-up was obtained for 233 patients for a mean duration of 25 months. Results: At the end of follow-up, there was no significant difference in the annualized occurrence of cardiac events between the two groups (4.6% vs. 4.3%, P=NS). Of note, none of the patients were prescribed sildenafil and none of the cardiac events were related to sexual activity. Conclusions: Our study shows that subjects with erectile dysfunction who have a negative stress echocardiographic study have a comparable event rate to similar subjects at high risk for cardiac events on long-term follow-up.