伐地那非治疗糖尿病患者的勃起功能障碍

勃起功能障碍(erectile dysfunction，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。     

伐地那非治疗难治性勃起功能障碍的最新进展

5型磷酸二酯酶(phosphodiesterase 5,PDE5)在阴茎勃起功能中所起的作用越来越引起人们的关注。环磷酸鸟苷(cGMP)信号通路介导的一氧化氮平滑肌舒张效应是正常勃起功能的必要条件,这个信号通路的下调能引起勃起功能障碍(erectile dysfunction,ED)的许多病理状态,并导致一些慢性疾病的发生。本文回顾了伐地那非治疗ED患者的有效性和安全性。结果表明,伐地那非对于合并异常脂蛋白血症和高血压、糖尿病、抑郁症、前列腺切除术后、外伤性脊髓损伤、西地那非治疗无效、肾移植术后、慢性前列腺炎和早泄的ED患者安全有效,为这些难治性ED患者提供了一种合理的治疗选择。另外,伐地那非还能延长ED患者的勃起时间。     

伐地那非在肾移植伴勃起功能障碍患者中应用的有效性和安全性研究

目的:评估伐地那非在肾移植后伴阴茎勃起功能障碍(ED)患者中应用的有效性和安全性。方法:选取39例血浆肌酐值<2mg/dl的肾移植伴有ED患者进行为期4周随机、双盲的伐地那非研究,实验组20例,安慰剂组19例。应用勃起功能国际指数(IIEF)进行伐地那非有效性的评估;应用血清肌酐值,肌酐清除率和血液中免疫抑制剂环孢素浓度监测值评估伐地那非的安全性。结果:应用伐地那非治疗的ED患者评分从12.6±3.4改善到26.5±2.8(P<0.01)。肾功能和环孢素浓度在伐地那非治疗前后没有改变。有4例伐地那非组患者观察到不良反应,2例出现头痛,1例出现心悸伴颜面潮红,还有1例出现消化不良。结论:本研究证实伐地那非对肾移植伴ED患者勃起功能改善有效而且安全。     

舍曲林和伐地那非治疗合并勃起功能障碍的早泄患者的临床观察

目的:评价舍曲林和伐地那非治疗合并勃起功能障碍(ED)的早泄患者的临床疗效和安全性。方法:60例诊断为合并ED的早泄患者随机分为舍曲林组和伐地那非组,每组30例。舍曲林组每天服用舍曲林50 mg,疗程2个月。伐地那非组每次性生活前服用伐地那非10~20 mg,疗程2个月。以治疗前后IIEF-5评分的改变来评价ED治疗效果,以治疗前后阴道内射精潜伏期(IELT)的变化来评价早泄治疗效果。结果:伐地那非组勃起功能改善24例,有效率为80%;而舍曲林组仅8例勃起功能改善,有效率为27%,两者差异有显著性(P<0.05)。伐地那非组早泄改善20例,有效率为67%;而舍曲林组早泄改善12例,有效率为40%,两者差异有显著性(P<0.05)。两组患者中,勃起功能改善者的早泄治疗的有效率均显著高于勃起功能无改善者。两组的不良反应均为轻度,无停药者。结论:对合并ED的早泄患者,改善患者的勃起功能是关键。     

多剂量伐地那非治疗男性勃起功能障碍的临床研究

目的评估不同剂量新型磷酸二酯酶5（PED5）抑制剂伐地那非治疗男性勃起功能障碍（ED）的有效性和安全性。方法采用随机、双盲、安慰剂平行对照、3个药物剂量（5、10和20mg）的方法，对88例ED患者进行为期12周的临床研究。结果伐地那非5mg、10mg和20mg组均能改善患者国际勃起功能指数（IIEF）中勃起功能部分的得分、患者日记中插入和保持勃起的成功率，改善程度优于安慰剂组。伐地那非20mg组对IIEF问卷中勃起功能部分得分的改善优于伐地那非5mg组。伐地那非组不良事件的发生率高于安慰剂组，但多为轻中度，且可自行缓解。结论伐地那非是治疗男性勃起功能障碍的安全、有效药物。     

伐地那非的安全性和耐受性

本文回顾了伐地那非治疗勃起功能障碍(erectile dysfunction,ED)的安全性和耐受性,包括其总体安全性、心血管安全性和视觉安全性。临床试验和实际应用的实践经验证明,最常见的不良事件为头痛、颜面潮红和鼻充血,并且多为轻、中度和一过性。无论在一般ED人群中还是在难治性ED人群中,无论是短期还是长期应用,伐地那非均有良好的安全性和耐受性。     

伐地那非对肾阳虚、肾阴虚及肝气郁结型勃起功能障碍的疗效分析

目的:观察伐地那非对肾阳虚、肾阴虚及肝气郁结型勃起功能障碍(ED)的临床疗效。方法:将124例ED患者按中医辨证分为肾阳虚型ED(44例)、肾阴虚型ED(41例)、肝气郁结型ED(39例),所有患者每天服用伐地那非5 mg,总疗程为8周。结果:伐地那非能显著提高各型ED患者的勃起功能问卷-5(IIEF-5)和勃起质量表(EQS)评分,且各组间比较差别有统计学意义(P<0.01);伐地那非显著提高肾阳虚和肾阴虚型ED患者性交成功百分率(P<0.01),肝气郁结型ED在治疗后性交成功百分率也有明显提高(P<0.05);伐地那非还能显著提高各型ED患者阴茎勃起硬度,3组治疗后总体有效率分别为81.82%、73.17%、43.59%。结论:伐地那非对肾阳虚和肾阴虚型ED患者疗效优于肝气郁结型ED患者。     

口服伐地那非治疗勃起功能障碍疗效和安全性的临床研究

目的 :评价伐地那非对男性勃起功能障碍 (ED)患者的疗效和安全性。　方法 :应用随机、双盲、安慰剂平行对照、剂量固定 (5、1 0和 2 0mg)方法 ,对 88例ED患者进行 1 2周的临床研究。　结果 :5、1 0和 2 0mg伐地那非使ED患者达到和维持勃起的临床主要和次要指标均明显高于安慰剂 (P <0 .0 1 ) ;伐地那非各剂量组不良事件发生率高于安慰剂组 ,均为轻至中度 ,呈一过性。　结论 :伐地那非是治疗各种病因导致ED的安全、有效的药物。     

伐地那非治疗高血压患者勃起功能障碍的有效性和安全性

勃起功能障碍(erectile dysfunction,ED)在高血压患者中的发病率明显高于非高血压人群,由于担心联合用药会出现严重不良反应,医生往往不愿为该类患者处方治疗ED的药物。伐地那非是一种新型高选择性磷酸二酯酶5型抑制剂,它对心血管系统的安全性已被多项临床试验所证实。最近进行的一项大型临床研究表明,对于同时服用多种降压药的高血压合并ED患者,伐地那非能够显著改善患者的勃起功能,并且使用安全,尤其对于血压或心率等项指标均未见临床意义的改变。     

伐地那非联合阿昔莫司治疗糖尿病性勃起功能障碍的疗效探讨

目的 探讨伐地那非联合阿昔莫司治疗糖尿病性勃起功能障碍(ED)的疗效.方法 180例在我院泌尿外科门诊治疗的2型糖尿病性ED患者,随机分为试验组和对照组各90例,两组患者均用常规方法控制血糖,试验组患者给予伐地那非联合阿昔莫司,对照组仅用伐地那非;用国际勃起功能障碍指数问卷(IIEF-5)评估治疗前后的疗效,同时记录夫妻对性生活的满意程度和不良反应.结果 所有患者均顺利完成治疗,试验组和对照组治疗后IIEF-5评分分别为20.2±4.1和15.9±4.4(F=12.48,P＜0.01),总有效率分别为78.9％和70.0％(x2 =9.02,P=0.03);试验组血脂下降程度大于对照组(P＜0.05);夫妻性生活满意率试验组和对照组分别为73.3％、63.3％,组间比较差异无统计学意义(x2=4.49,P=0.11);两组不良反应发生率分别为27.8％和24.4％,差异无统计学意义(x2=0.26,P=0.61).结论 伐地那非联合阿昔莫司治疗糖尿病性ED的疗效优于单纯伐地那非,但长期使用的安全性需要更多研究支持.     

上海市1582例中老年男子勃起功能障碍流行病学调查

为调查我国中老年男性人群勃起功能障碍的患病率及其高危因素.本文用描述流行病学方法,采用多阶段抽样方法在城市一般人群中抽取上海市区40岁以上的男性居民1582例,完成勃起功能障碍自答问卷.结果1582例中ED患病率为73.1%,且随其年龄增长而上升,60岁以上者上升幅度尤为明显.影响ED患病率的有关因素是年龄、心理性、器质性疾病等.其中,内分泌疾病(糖尿病),心血管病变、泌尿生殖器官疾病患者中,ED发病率较高.经济收入状况与ED患病率有显著相关性,而教育文化程度与ED患病率无相关性.     

细胞凋亡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和多发病。目前,对于引起ED的机制了解尚不深入。越来越多的研究发现勃起组织的过度凋亡是引起ED的重要机制之一。多数ED的危险因素均可以引起阴茎勃起组织的过度凋亡,从而影响勃起功能。本文就细胞凋亡的机制、凋亡在ED中的作用及凋亡与ED的危险因素糖尿病、高脂血症、海绵体神经损伤和衰老之间的关系作一综述。     

万艾可治疗老年糖尿病性勃起功能障碍疗效分析

目的:观察万艾可治疗我国老年糖尿病性勃起功能障碍患者的临床安全性和疗效。方法:用国际勃起功能问卷的勃起功能评分、性生活日记的问题2及问题3和总体评价问卷评估452例患者服用万艾可前后勃起功能状况。结果:服药后,患者的国际勃起功能问卷的勃起功能评分提高程度、性生活日记问题2和问题3作肯定回答的患者百分率,以及总体评价问卷回答百分率均显著高于基线值,统计学分析差异有极显著性(P<0.01)。结论:万艾可显著改善糖尿病性勃起功能障碍患者的勃起能力,提高性生活质量。     

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.     

Testosterone and erectile dysfunction

Aging is associated with a decline in several important health factors in men, including libido. Serum testosterone concentrations also decrease with age, and many age-related clinical features are closely associated with androgen deficiency, including erectile function (ED). Approximately 70% of ED is of organic origin, with the major risk factors being diabetes mellitus, hypercholesterolemia, smoking and chronic medical illnesses. These are also established risk factors for atherosclerosis, which is the predominant predisposing factor of vasculogenic ED. The introduction of phosphodiasterase-5 (PDE-5) inhibitors for the treatment of ED made a significant impact both in terms of clinical efficacy, and increasing the awareness of the condition. In spite of this, some patients fail to respond to PDE-5 inhibitors alone. Both animal and clinical studies indicate that testosterone therapy improves both erectile function and the response to PDE-5 inhibitors in patients with ED and hypogonadism. Indeed, interventional studies demonstrate that testosterone replacement therapy improves erectile function in hypogonadal men who have previously failed to respond to PDE-5 inhibitors alone. Furthermore, it has been demonstrated that the full therapeutic potential of PDE5 inhibitors will only become manifest in a eugonadal state. Recent studies have demonstrated a close relationship between testosterone and ED and suggest that testosterone therapy may be a valuable option for an increasing number of affected men. European guidelines recommend that all men presenting with ED should have their testosterone concentrations measured.     

Obesity, low testosterone levels and erectile dysfunction

Obesity is an important risk factor for many common diseases including cardiovascular disease (CVD), type 2 diabetes, cancer and erectile dysfunction (ED). Adipose tissues produce a number of adipokines and cytokines, which affect endothelial and metabolic function resulting in insulin resistance and the metabolic syndrome (risks factors for CVD). Both ED and metabolic syndrome improve with a reduction in body mass index (BMI). The relationships among obesity, metabolic syndrome, ED, sex hormone-binding globulin (SHBG) and serum total and free testosterone levels are complex and often confusing to the physician. It is known that BMI is inversely proportional to serum total testosterone concentrations; low serum SHBG levels in obesity contribute to the low serum total testosterone. Recent studies show that BMI is also inversely proportional to free testosterone concentration. The characteristic low serum testosterone concentrations observed in obese men are also present in men with the metabolic syndrome and type 2 diabetes mellitus. A small proportion of men with ED have hypogonadism; however, the proportion increases if these men are obese with manifestations of the metabolic syndrome or type 2 diabetes mellitus. ED is a common symptom in patients with type 2 diabetes who also have low testosterone levels. This review describes the relationships between low serum testosterone concentrations and ED in obese patients and those with metabolic syndrome and type 2 diabetes mellitus.     

Lifestyle and metabolic approaches to maximizing erectile and vascular health

Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.     

伐地那非在难治性ED人群中的应用

本文回顾了高选择性口服磷酸二酯酶5(PDE5)抑制剂伐地那非在各种难治性ED人群的疗效和安全性。结果表明,伐地那非对于合并糖尿病、抑郁症、前列腺切除术后、外伤性脊髓损伤性、以及西地那非治疗无效的ED患者安全有效,为这些难治性ED人群提供了一种合理的治疗选择。     

Serum testosterone levels in diabetic men with and without erectile dysfunction

Diabetes mellitus is a common chronic disease, affecting 0.5–2% worldwide. The Massachusetts Male Aging Study reported that up to 75% of men with diabetes have a lifetime risk of developing ED. Type 2 diabetes is associated with low total serum testosterone (TT) identified in several cross‐sectional studies and systemic analyses. There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality. In this retrospective study, we sought to evaluate the effect of associated co‐morbidities on serum total testosterone (TT) level in men with type 2 diabetes DM, either with or without erectile dysfunction (ED). Three hundred and ninety‐one patients were evaluated for erectile function using an abridged, five‐item version of the International Index of Erectile Function‐5. Measurements of TT, fasting lipid profile, blood sugar and glycated haemoglobin (HbA1c) were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Hypogonadism was found in 126 cases (33.2%), and normal TT was observed in 254 (66.8%). ED was detected in 119 cases in the hypogonadal group (94.4%) as compared to 155/254 (61.0%) in eugonadal group, P = 0.0001. TT was lower in diabetic men with ED as compared to those with normal erectile function (EF), 392.4 ± 314.9 versus 524.3 ± 140.2 ng dl^?1, respectively, P < 0.0001. After exclusion of patients with hypertension and dyslipidaemia, 185 men were evaluated, and there was no difference in the mean TT level among men with ED 490.6 ± 498.2 ng dl^?1 versus normal EF 540.6 ± 133.4 ng dl^?1 although, HbA1c remained lower in men with normal erectile function. Receiver operating characteristic (ROC) curve of TT in men without associated co‐morbidities showed that EF was compromised at TT = 403.5 ng dl^?1 or less. Sensitivity of 63.3% and a specificity of 94.0% were detected. At this level, ED was found in 33/38 (86.8%) men with TT 403.5 ng dl^?1, whereas ED was observed in 57/147 (38.8%) men with TT ≥ 403.5 ng dl^?1 (P < 0.0001). We propose a cut‐off value of 403.5 ng dl^?1 of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED. Further prospective controlled trials are recommended.     

Daily use of sildenafil improves endothelial function in men with type 2 diabetes

Diminished vascular endothelial function results in decreased vasodilator capacity and is associated with erectile dysfunction (ED) in patients afflicted with type 2 diabetes. The current study was designed to evaluate whether daily use of sildenafil could alter endothelial function and improve penile rigidity in a group of patients with diabetic ED. A double-blind, placebo-controlled, prospective trial was conducted with 24 men with type 2 diabetes who were randomized into 2 groups: one receiving daily sildenafil (50 mg, n = 12) and the other placebo (n = 12) for 10 weeks. Erectile function was captured subjectively using the International Index of Erectile Function (IIEF-5), and endothelial function was objectively monitored via brachial artery flow-mediated dilation. Among the placebo and sildenafil groups, there were no significant differences in average patient age, time from type 2 diabetes diagnosis, duration of ED, or baseline IIEF-5 scores. Past medical histories, including smoking, alcohol consumption, hypertension, and hyperlipidemia, were also similar. At the conclusion of the 10-week trial, patients who received daily sildenafil had significantly improved erectile rigidity as captured by IIEF-5 (P < .001) and increased endothelial function via brachial artery flow-mediated dilation (P < .01). Endothelial function in men with type 2 diabetes was enhanced with daily sildenafil. Improved erectile rigidity and enhanced vascular circulation was noted after 10 weeks of daily sildenafil use.