安特尔对糖尿病患者阴茎勃起功能障碍的影响

目的:探讨安特尔治疗糖尿病患者阴茎勃起功能障碍的效果。方法:将80例阴茎勃起功能障碍、且经万艾可治疗无效的2型糖尿病患者,随机分为两组。安万组:40 例,在用万艾可治疗的同时加用安特尔(120mg/d);维万组:40例,在用万艾可治疗的同时加用维生素E(30 mg/d)。两组均治疗1 个月,观察患者治疗前后血清睾酮水平、IIEF 5评分和阴茎海绵体血流量的变化。结果:安万组较治疗前血清睾酮明显升高(P<0.01),IIEF 5评分显著提高(P<0.05),阴茎海绵体血流量明显增加(P<0.05);其中30例(75%)患者性交时阴茎能满意地勃起;未出现任何不良反应。维万组治疗前后上述指标无明显变化(均P>0.05)。结论:安特尔能显著改善经用万艾可治疗无效的糖尿病患者的阴茎勃起功能,且安全性好。     

阴茎勃起功能障碍研究的三大突破与研究趋势

近年来,阴茎勃起功能障碍（ｅｒｅｃｔｉｌｅｄｙｓｆｕｃ－ｔｉｏｎ,ＥＤ）已越来越受到人们的重视,其发病率随年龄的增高而增加,是一种年龄依赖性疾病。回顾近２０年来的治疗进展,发现以罂粟碱注入阴茎海绵体、经尿道使用前列地尔（ＭＵＳＥ）以及口服昔多芬为治疗...     

阴茎勃起功能障碍患者血液流变学分析

目的 探讨阴茎勃起功能障碍（ED）患者血液流变学参数的临床意义。方法 对43例ED患者和20例阴茎勃起正常对照者血液流变学参数进行对照分析。结果 ED组全血低切粘度（η10）、血浆粘度（ηp）、红细胞聚集指数（CE）、全血还原粘度（ηw）、血沉方程K值（K）明显高于对照组（P＜0．05）,内分泌性ED组红细胞刚性指数（IP）明显高 于心理性、动脉性、静脉性ED组（P＜0．05）,心理性EC组红细胞压积（HCT）明显高于内分泌性、静脉性、动脉性组（P＜0．05） ,差别均有显著性意义。结论 ED患者血液呈高粘滞性,降低血液粘稠度可能有助于患者勃起功能的改善。     

海绵体神经损伤与阴茎勃起功能障碍

阴茎勃起功能障碍 (ＥＤ)是盆腔肿瘤手术治疗后的常见并发症 ,如传统的前列腺癌根治术、膀胱全切术、经腹会阴联合径路的直肠癌根治术 ,术后ＥＤ可高达 10 0 % [1] 。通常认为这是术中损伤支配阴茎勃起的海绵体神经所致。现对海绵体神经解剖学、生理学、医源性海绵体神经损伤所     

120例阴茎勃起功能障碍病因分析

通过120例阴茎勃起功能障碍(ED)患者的观察并分析其病因,结果表明心理性ED78例(65.0％),血管性ED22例(18.3％),内分泌性ED15例(12.5％),神经性ED5例(4.2％)。并对不同病因的ED进行了讨论。     

阴茎勃起功能障碍140例临床分析

目的：分析阴茎勃起功能障碍（ＥＤ）患者的临床特点。方法：对１４０例年龄为２５￣７４岁ＥＤ患者的临床资料进行总结。器质性ＥＤ５６例,混合性ＥＤ６２例,心理性ＥＤ２２例,器质性与混合性ＥＤ占８２．９％。按年龄将患者分为＜５０岁组及≥５０岁组。结合勃起功能国际部卷表计算勃起功能积分（ＥＦ积分）比较两组病程、伴随疾病及勃起功能障碍程度的差异。结果：＜５０岁组６１例,其中轻度３１例,中度１９例,重度１１例;     

阴茎勃起功能障碍的基因治疗

近 2 0年来 ,随着勃起神经递质 (ＮＯ等 )和海绵体平滑肌功能等有关阴茎勃起机制研究的巨大进展 ,出现了许多治疗阴茎勃起功能障碍的方法 ,如西地那非等药物口服、血管活性药物海绵体注射、阴茎血管手术及阴茎假体置入等。上述方法治疗勃起功能障碍取得了较好疗效 ,但同时存在一些不良反应、并发症及禁忌证。因而 ,未来治疗勃起功能障碍的方法应该在具备良好疗效的同时 ,有更少的副反应和禁忌证。基因治疗的初步研究显示了美好的前景。一、基因治疗与基因治疗载体(一 )基因治疗基因治疗的目标是将遗传物质导入靶细胞内 ,恢复细胞的正常功能 …     

阴茎勃起功能障碍的基因治疗

近２０年来，人们对于阳萎的病理生理学、诊断及治疗水平的认识有了很大进步，如阴茎中一氧化氮（ＮＯ）及其合酶（ＮＯＳ）的发现［１］、海绵体内注射（ＩＣＩ）、负压装置和阴茎假体的改良、尿道前列地尔（ａｌｐｒｏｓｔａｄｉｌ）栓剂［２］的应用等。特别是最近开发的口服药昔多芬（ｓｉｌｄｎａｆｉｌ，ｖｉａｇｒａ）已成为男科医生治疗阳萎的有效药物［３］。但是目前所有的治疗方法都有一定的局限性或副作用。因此应用分子生物学技术进一步深入研究阴茎勃起的病理生理学，以探讨阳萎基因治疗的方法和途径很有必要。近来分子生物学…     

广西南宁、玉林地区阴茎勃起功能障碍发病率调查报告

目的 探讨阴茎勃起功能障碍的发病率。方法 对广西南宁、玉林地区5504例人群随机进行问卷勃起功能障碍调查。结果 30岁以上壮族人群阴茎勃起功能障碍发病率高于汉族人群,统计学差别有显著意义（P＜0．01）。40岁以上人群勃起功能障碍发病率与其他年龄段相比显著升高,差别有显著意义（P＜0．01）。40岁－和50岁－年龄段发病率高于20岁－和30岁－年龄段（P＜0．01）。而40岁－和50岁－年龄段、20岁－和30岁－年龄段之间差别无显著性意义（P＞0．05）。结论 勃起功能障碍发病率在40岁以前并未随年龄增高而增加,40岁以后则逐渐增加。壮族发病率高于汉族。勃起功能障碍在人群中有较高的发病率。     

糖尿病性勃起功能障碍的血流动力学研究

目的　探索糖尿病性ED相关的血管和血流动力学的变化。方法　从 1996 .9～ 2 0 0 2 .1,入选 2 2例糖尿病性ED及 35例心因性ED患者进行对照 ,两组患者均采用罂粟碱 酚妥拉明 (30mg/1mg)行阴茎海绵体内注射 ,并运用双功能多普勒超声诊断仪 ,对患者的阴茎海绵体的动静脉血管形态和血流动力学进行检查。结果　 2 2例糖尿病性ED和 35例心因性ED患者的SPV平均值分别为 2 0 .0 6± 7.15cm/s和 35 .82± 9.4 1cm/s,Ad平均值两者分别为 0 .78± 0 .2 5cm和 1.0 1± 0 .4 2cm ,RI平均值分别为 0 .72± 0 .2 8和 0 .98± 0 .31,均存在统计学上的差异。而EDV平均值分别为 8.82± 0 .35cm/s和 5 .5 1± 0 .4 2cm/s ,Vd的平均值分别为 1.0 5± 0 .32mm和 1.2 1±0 .4 5mm ,DDVF的平均值分别为 2 8.81± 6 .32cm/s和 2 5 .74± 7.5 8cm/s ,不存在差异性。糖尿病性ED患者超声显示海绵体动脉壁增厚 ,僵硬。结论　糖尿病性ED主要造成阴茎海绵体动脉管壁粥样硬化 ,影响动脉供血 ,并导致静脉闭合功能减退     

Determination of serum testosterone in experimental diabetes with erectile dysfunction

To study the mechanisms of erectile dysfunction (ED) in ex-perimental diabetic (DM) rats, streptozotocin (STZ) was injectedintraperitoneally into Sprague-Dewley rats to make experimentalmodels of DM. Rats showing apparent ED after apomorphine injec-tion were selected for the experiment. Penile erections were studiedon the 6th, 8th and 12th week after injection of apomorphine. Theconcentration of LH, FSH and testosterone (T) were examined andmicrostructure of testes were observed. Results indicated that theserum T was decreased significantly with marked changes in testicu-lar histology; the degree of both was closely related to the durationof DM. The concentration of LH did not change on the early days,but decreased significantly later in the course. FSH concentrationswere not changed. As conclusions, penile erection and synthesis oftestosterone are affected seriously by DM, and the decrease of Tconcentration may be one of the most important mechanisms.(Chin J Androl 2000; 4: 227 - 230)     

2型糖尿病伴勃起功能障碍的相关发病因素探讨

目的:探讨中青年2型糖尿病(T2DM)患者伴发勃起功能障碍(ED)与血管、神经和雄激素等因素的关系,为ED早期防治提供临床依据。方法:53例50岁以下男性T2DM患者按国际勃起功能指数-5(IIEF-5)评分分为ED组(IIEF评分≤21,n=28)和非ED组(NED组)(IIEF评分≥22,n=28),测定两组血脂、血糖、血清总睾酮(TT)、性激素结合蛋白(SHBG)、硫酸脱氢表雄酮(DHEA-S)、计算法游离睾酮(cFT)等指标,检查两组视网膜病变(DR)、大血管病变和周围神经病变(DPN)等并发症,比较两组各指标及并发症的差异。结果:两组年龄、糖尿病病程、体重指数、血压、血脂、血糖水平具有可比性(P>0.05),ED组DR发生率(39.3%)高于NED组(4.0%)(P<0.05),两组TT、DHEA-S、cFT水平及大血管病变和DPN发生率差异均无统计学意义(P>0.05)。结论:T2DM患者伴ED发生与DR关系密切,对合并DR的T2DM患者尤应早期关注其勃起功能。     

糖尿病性阴茎勃起功能障碍大鼠模型球海绵体肌和坐骨耻骨肌重量及显微结构的研究

ＳＤ大鼠注射链脲佐菌素制造糖尿病（ＤＭ）动物模型后,注射阿朴吗啡观察６周、８周及１２周大鼠队茎勃起情况,筛选ＭＤ性阴茎勃起功能障碍（ＥＤ）大鼠模型,研究其海绵体肌及坐骨耻骨肌重量及显微结构的改变,并测定其血清睾酮浓度,以探讨ＤＭ性ＥＤ的发病机理。结果：ＤＭ性ＥＤ大鼠模型球海绵体肌和坐骨耻骨肌重量及血清睾酮浓度显著降低;显策结构发生明显病理性改变,且上述变化与ＤＭ病程密切相关。揭示ＤＭ严重影响阴茎勃     

Glutathione levels in patients with erectile dysfunction, with or without diabetes mellitus

The reduced form of glutathione (GSH) is the most important cell antioxidant and is also an essential cofactor for nitric oxide (NO) synthase that synthesizes NO from l-arginine. Reduced levels of GSH, due both to a hyperglycaemia-induced increase of free radical production and to a decrease of NADPH levels [like in diabetes mellitus (DM)], can hamper the endothelial cell functions. This condition may play an important role in the aetiology of some clinical signs, like erectile dysfunction (ED). The aim of this study was to test the hypothesis that GSH concentration is reduced in patients with ED and type 2 diabetes mellitus. We studied 111 male patients with ED: 64 with diabetes (ED/DM) and 47 without diabetes (ED/wDM); 20 patients with diabetes but without ED (DM) and 26 male normal subjects as a control group (C). The GSH red blood cell concentration was significantly lower in ED than in C (X +/- SD; 1782.12 +/- 518.02 vs. 2269.20 +/- 231.56 mumol/L, p < 0.001). In particular, GSH was significantly reduced in ED/DM vs. ED/wDM (1670.74 +/- 437.68 vs. 1930.63 +/- 581.01 micromol/L, p < 0.01). In DM, GSH was significantly lower than in C and significantly higher than in ED/DM (2084.20 +/- 118.14 vs. 2269.20 +/- 231.56 and vs. 1670.74 +/- 437.68 micromol/L, p < 0.002 and p < 0.001 respectively). GSH showed a negative correlation with fasting glucose concentrations (r = -0.34, p < 0.01) and with the duration of DM (r = -0.25, p < 0.05). A GSH depletion can lead to a reduction of NO synthesis, thus impairing vasodilation in the corpora cavernosa.     

Inhibition of inducible nitric oxide synthase improved erectile dysfunction in rats with type 1 diabetes

Diabetes mellitus (DM), which is closely related to microvascular dysfunction, is a risk factor for erectile dysfunction (ED). Furthermore, the upregulation of inducible nitric oxide synthase (iNOS) is associated with systemic vascular dysfunction in rats with diabetes. The purpose of this study was to investigate the role of iNOS in diabetes mellitus erectile dysfunction (DMED). First, we developed a type 1 DM rat model using streptozotocin and selected those that developed DMED. Then, we injected these rats with the 1400W, an iNOS inhibitor, for 10 weeks and subsequently assessed their ED. Lastly, we performed various molecular studies and histopathological analyses of penile tissues collected from these rats after the experiments. Through the histopathological studies, we also found that the treatment restored the ratios of the smooth muscle to collagen fibres, delayed the development of microvascular injury and alleviated the oxidative stress caused by hyperglycaemia. Based on these results, we confirmed that upregulation of iNOS leads to microvascular dysfunction in patients with ED. Overall, we found that inhibition of iNOS displayed beneficial effects in the treatment of ED, suggesting that its mechanism should be further explored.     

Chronic alcoholism associated with diabetes impairs erectile function in rats

OBJECTIVE

To investigate the effects of chronic ethanol consumption and diabetes on nitric oxide (NO)‐mediated relaxation of cavernosal smooth muscle (CSM).

MATERIAL AND METHODS

Male Wistar rats were divided into four groups: control, isocaloric, diabetic and ethanol‐diabetic. The CSMs were mounted in organ chambers for measurement of isometric tension. Contraction of the strips was induced by electrical field stimulation (EFS, 1–32 Hz) and phenylephrine. We also evaluated the effect of ethanol consumption on the relaxation induced by acetylcholine (ACh; 0.01–1000 µmol/L), sodium nitroprusside (SNP, 0.01–1000 µmol/L) or EFS (1–32 Hz) in strips pre‐contracted with phenylephrine (10 µmol/L). Immunoexpression of endothelial NO synthase (eNOS) and inducible NOS (iNOS) was also accessed.

RESULTS

The endothelium‐dependent relaxation induced by ACh was decreased in CSM from ethanol‐diabetic rats when compared with the controls, with a mean (sem ) of 21 (4) vs 37 (2)%. Similarly, the potency and maximal responses induced by SNP were reduced in the ethanol‐diabetic [3.97 (0.38) and 85 (1)%, respectively] and diabetic groups [3.78 (0.56) and 81 (2)%, respectively] when compared with the controls [5.3 (0.22) and 90 (3)%, respectively] and isocaloric [5.3 (0.19) and 92 (1)%, respectively] groups. Noradrenergic nerve‐mediated contractions of CSM in response to EFS were increased in rats from ethanol‐diabetic and diabetic groups when compared with the control and isocaloric groups. Conversely, there were no differences in EFS‐induced relaxation among the groups. The immunostaining assays showed overexpression of eNOS and iNOS in the CSM from diabetic and ethanol‐diabetic rats when compared with the control and isocaloric rats.

CONCLUSION

There was an impairment of relaxation of CSM from ethanol‐diabetic and diabetic rats that involved a decrease in the NO‐cyclic guanosine monophosphate signalling pathway by endothelium‐dependent mechanisms accompanied by a change in the CSM contractile sensitivity.     

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.     

糖尿病性勃起功能障碍相关因素分析

目的 研究糖尿病性勃起功能障碍(ED)的发病情况及其影响ED程度的相关因素。 方法 调查90例男性2型糖尿病病人的性功能状态、年龄、糖尿病病程、测量血压,同时测定其糖化血红蛋白(HbA1C)血脂等指标。结果 糖尿病病人中ED患病率为75.6%(68/90),患病率随年龄的增加而增加,在非ED组与不同程度ED组之间,年龄存在非常显著差异(P<0.01),DM病程、HbA1C存在显著差异(P<0.05)结论 糖尿病病人ED患病率高,糖尿病性ED的程度随年龄、DM病程、HbA1C的增加而加重,长期良好的血糖控制有助于延缓糖尿病性ED的加重。     

糖尿病性勃起功能障碍的超声研究

目的 应用彩色多普勒超声血流显像(CDFI)技术探讨动脉在糖尿病性勃起功能障碍(ED)中的作用.方法 23例糖尿病性ED患者和30例非糖尿病ED患者经阴茎海绵体注射前列地尔注射液(主要成分为PGE1)10 μg诱导勃起后,行CDFI检查双侧海绵体动脉血流动力学指标,包括收缩期最大流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)及内径(R).结果 PSV和R这两项指标在糖尿病性ED和非糖尿病ED患者中存在差异具有统计学意义,EDV和RI在两组患者中的差异没有统计学意义.糖尿病性ED患者中的动脉性ED明显多于非糖尿病性ED.结论 动脉供血不足在糖尿病性勃起功能障碍发病机制中起着重要作用.阴茎海绵体注射血管活性药物后CDFI对血管性ED检查是一种微创而准确的方法.     

胰岛素对糖尿病大鼠阴茎内nNOS神经纤维的影响

目的探讨糖尿病性阴茎勃起功能障碍（ED）的发病机制及胰岛素的治疗作用。方法注射链脲佐菌素建立糖尿病（DM）大鼠模型，胰岛素治疗组于成模后注射胰岛素。7周和12周后注射阿扑吗啡（APO）进行大鼠阴茎勃起功能实验，取大鼠阴茎和血浆，用ABC免疫组织化学法观察nNOS神经纤维的变化。测定血浆NOS活性。结果（1）与对照组相比，DM组大鼠阴茎勃起次数明显减少;胰岛素治疗后症状缓解;（2）与对照组相比，DM组血浆NOS活性明显增高;DM组血浆NOS活性与病程延长呈负相关;与DM组比较，胰岛素治疗组血浆NOS活性明显降低;（3）与对照组相比，DM组阴茎内nNOS阳性神经纤维明显减少;与DM组比较，胰岛素治疗组nNOS阳性神经纤维表达增加。结论糖尿病性ED阴茎内nNOS阳性纤维的数量及光密度随DM病程的延长而下降;早期给予胰岛素治疗可预防糖尿病大鼠ED的出现及阴茎内nNOS含量的下降。