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。     

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。     

血脂异常对男性勃起功能影响的流行病学研究

目的 探讨血脂异常对男性勃起功能的影响.方法 于清晨空腹采集外周血标本,测定血清总胆固醇(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项有异常的我院患者中随机选取200例男性患者,4项结果均正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,分析血脂异常对男性勃起功能的影响.结果 血脂异常者勃起功能障碍(ED)的发病率为47%,血脂正常者ED的发病率为30%,两者的发病率差异有统计学意义(P=0.005).其中,40～59岁人群ED的发病率在两组问有统计学差异.Logistic回归分析发现年龄、HDL、TC/HDL、冠心病、焦虑或抑郁、良性前列腺增生和长期服用影响勃起的药物史与ED的发病有关,除HDL为保护因素,其余均为危险因素.结论 高血脂是影响男性勃起功能的一个重要因素,尤其对40～59岁的中年男性的勃起功能影响最明显.HDL水平的下降和TC/HDL比值的上升是ED的重要的危险因素.     

多发性硬化与勃起功能障碍

多发性硬化是一种中枢神经系统慢性炎症性脱髓鞘疾病。一氧化氮、离子通道、细胞因子及睾酮在多发性硬化中起着重要作用。多发性硬化所致阴茎勃起功能障碍(ED)可能与这些因素有关,同时多发性硬化引起的周围神经损伤也参与了ED。通过对这些物质、神经及其功能的深入研究,可为ED的治疗提供理论依据。     

大鼠勃起功能障碍模型的研究进展

勃起功能障碍(erectile dysfunction,ED)是指男性持续不能达到和/或维持足够的勃起以完成满意的性生活.阴茎勃起是一个受多系统调节的复杂过程,正常的阴茎勃起依赖于正常的性心理反应,正常的生理结构,正常的神经、内分泌和血管功能.任何一个环节的异常都可能导致勃起功能障碍.由于影响阴茎勃起的因素较多,研究者们针对不同的病因设计了不同的大鼠ED模型,根据ED的临床分类将大鼠ED模型叙述如下.     

干细胞治疗阴茎勃起功能障碍的研究进展

阴茎勃起功能障碍(ED)是指男性反复或者持续性的难以达到和维持充分的阴茎勃起,无法完成性交或满意性活动的病理现象。海绵体神经(CN)损伤引起的勃起神经反射中断,是患者出现ED的直接原因,此外,CN损伤后,阴茎海绵体组织平滑肌细胞和内皮细胞凋亡增加,海绵体平滑肌纤维数量减少加重了ED的发生。因此,尽早干预CN损伤的病理过程,促进CN再生是治疗CN损伤性ED的关键。近年来,干细胞在ED治疗中的应用日益成为临床研究热点。现对胚胎干细胞(ESC)、间充质干细胞(MSCs)、肌源性干细胞(MDSCs)、脂肪干细胞(ADSCs)在ED治疗中的研究综述如下。     

在阴茎勃起中一氧化氮合酶的作用及调节机制研究进展

正阴茎勃起功能障碍(erectile dysfunction,ED)是指阴茎不能达到和(或)维持足够的勃起以获得满意的性生活,并且时间持续3个月以上者~([1]),已逐渐成为困扰全球男性的重要疾病之一。近年来,对阴茎勃起的基础研究取得了很大的突破,其中一氧化氮-环鸟苷磷酸(NO/cGMP)通路是目前与阴茎勃起相关最为经典、研究最为深入的分子信号通路,以NO/cGMP通路调控作用为基础的5型磷酸二酯酶(phosphodiesterase type 5,PDE5)抑制剂药物治疗     

阴茎勃起功能障碍基础研究新动向

阴茎勃起功能障碍(ED)是指阴茎不能达到或维持充分勃起,以完成满意的性交。据文献报道,全球约有一亿多ED患者,40～70岁的男性中,约有52％的男性有不同程度的阴茎勃起功能障碍。因此,ED是一种影响男性健康的常见疾病。近20年来,人们对ED的发病基础作了大量的研究,通过利用各种ED动物模型,筛选安全有效的、增强阴茎海绵体平滑肌松弛作用的药物,为ED的治疗提供了光明的前景。其中一氧化氮-环磷酸鸟苷(NO-cGMP)通路、离子通道、细胞间通讯、基因治疗是近年来研究的新热点,本文将较详细阐述ED基础研究最新动向。     

RigiScan阴茎硬度测量仪在勃起功能障碍评估中的研究进展

阴茎勃起功能障碍(ED)是男性最常见疾病之一,RigiScan阴茎硬度测量仪是评估ED的重要检测工具,其应用对ED的诊断和病因鉴别发挥重要作用。随着RigiScan的广泛应用,越来越多的临床研究正深入探索其在ED具体病因诊断和治疗效果评估中的价值。本文将全面综述RigiScan在ED诊断与评估中的研究进展。     

重组人生长激素治疗阴茎勃起功能障碍(附30例报告)

阴茎勃起功能障碍(ED)的发生率随着年龄的增长而增加。人们一直在努力寻找治疗ED方便和长期有效的方法。研究表明在继发性生长激素缺乏患者中补充重组人生长激素(rhGH)可以改善男性性功能。我们应用rhGH治疗ED30例，初步观察其有效性和安全性。     

The predictive value of red cell distribution width on erectile dysfunction

Red cell distribution width (RDW), one of the biomarkers used to measure vascular ageing, is known to correspond with cardiovascular diseases. As coronary artery disease and erectile dysfunction (ED) are both caused by the same shared pathophysiology, in this study, we compared the RDW values of men diagnosed with ED and those of healthy controls. Ninety‐nine patients who were diagnosed with ED were included in the study. The control group consists of 100 men who presented to our outpatient clinic. Patients' fasting blood glucose, triglyceride, total cholesterol and LDL cholesterol levels were significantly higher in men diagnosed with ED. While the mean RDW value was 13.49 ± 1.52 in men with ED, it was 12.91 ± 1.13 in the control group. When RDW values were compared between the two groups, the RDW values of men with ED were found to be statistically significantly higher. Multivariate analyses showed that only the patients' body mass index, fasting blood sugar, triglyceride (TG), low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol levels (HDL‐C), TG/HDL‐C ratio and RDW levels' relationship with ED was statistically significant. Although some studies have shown that RDW may be related to some diseases such as cardiovascular diseases and cancer, this appears to be the first study demonstrating a relationship between RDW and ED. RDW can be utilised as a predictor for the determination of the presence and monitoring of the severity of ED.     

Testosterone in men's health: a new role for an old hormone

Testosterone is an anabolic hormone with a wide range of beneficial effects on men's health. A considerable body of evidence suggests that testosterone (T) deficiency contributes to the onset and/or progression of type 2 diabetes mellitus (T2D), insulin resistance (IR), metabolic syndrome (MetS), cardiovascular disease (CVD), and erectile dysfunction (ED). Low testosterone precedes elevated fasting insulin, glucose, and hemoglobin A1c (HbA1C) values and may even predict the onset of diabetes. Low testosterone also produces adverse effects on cardiovascular health. Androgen deficiency is associated with increased levels of total cholesterol, low density lipoprotein (LDL), increased production of pro-inflammatory factors, increased thickness of the arterial wall, and contributes to endothelial dysfunction. Testosterone therapy of hypogonadal men improves insulin sensitivity, fasting glucose, and hemoglobin A1c levels. Testosterone supplementation restores arterial vaso-reactivity, reduces pro-inflammatory cytokines, total cholesterol, and triglyceride levels and improves endothelial function and high density lipoprotein (HDL) levels. The therapeutic role of testosterone in men's health, however, remains a hotly debated issue for a number of reasons, including the purported risk of prostate cancer. In view of the emerging evidence suggesting that androgen deficiency is a risk factor for MetS, T2D, IR, CVD, and ED, androgen replacement therapy in hypogonadal men may potentially reduce the risk for these pathologies.     

Visceral adiposity index is useful for evaluating obesity effect on erectile dysfunction

Studies show that erectile dysfunction (ED) is associated with obesity, and it has been shown that the possibility of developing sexual dysfunction in obese men is 30% higher compared to those with normal weight. Obesity is measured using various methods, for example waist circumference (WC) measurement or body mass index (BMI), but recently, visceral adiposity index (VAI) has also been utilised to better assess obesity and metabolic syndrome. In our study, the potential link between VAI and ED was investigated. The data of 176 patients who presented to the urology outpatient clinic with erection complaints were retrospectively screened. A control group was also established with 122 men without complaints of erectile dysfunction. The erectile functions of all participants were determined using the International Erectile Function Index‐5 (IIEF‐5) scoring. In addition, their serum fasting blood glucose, total testosterone (TT), triglyceride (TG), low‐density lipoprotein (LDL) cholesterol and high‐density lipoprotein (HDL) cholesterol levels were measured. The physical examination comprised the measurement of WC, height and weight, and BMI. The mean age of the participants was 58.7 ± 8.4 for the ED group and 57.1 ± 7.5 for the control group. The mean VAI was statistically significantly higher in the ED group (5.32 ± 2.77) compared to the control group (4.11 ± 1.93) (p < 0.001). Since VAI contains both physical and metabolic parameters, our findings suggest that it discloses the effects of WC, BMI, HDL and TG more clearly. VAI is considered useful for the assessment of the effect of obesity on ED patients.     

Hyperlipidemia impairs erectile function in rats by causing cavernosal fibrosis

Men with hyperlipidemia are more likely to have erectile dysfunction (ED) than those without hyperlipidemia, but the mechanisms are not fully understood. The aim of this study was to investigate the underlying mechanism of ED caused by hyperlipidemia. Fourteen 8‐week‐old Sprague–Dawley rats were randomly divided into two groups: a control group and a hyperlipidemia group (fed chow containing 4% cholesterol and 1% cholic acid). After 6 months, we assessed erectile function by performing cavernous nerve electrostimulation followed by intracavernosal pressure/mean arterial pressure measurements, as well as plasma lipid profile assessment in all rats. A transferase‐mediated nick end labeling (TUNEL) assay, immunohistochemical staining and Western blotting were performed to determine the levels of apoptosis, autophagy and fibrosis in the penile tissue. Compared with the control group, the hyperlipidemia group exhibited: (i) increased plasma lipid levels; (ii) decreased erectile function; (iii) a decreased smooth muscle/collagen ratio; (iv) increased fibrosis; (v) increased apoptosis and decreased autophagy. Overall, hyperlipidemia may attenuate erectile function in rats by causing of cavernosal fibrosis.     

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.     

Risk factors for the development and progression of dyslipidemia after heart transplantation

BACKGROUND: Hyperlipidemia is an important complication after organ transplantation and contributes to the development of posttransplant accelerated coronary artery diseases. METHODS: We have retrospectively evaluated the relative contribution of various risk factors associated with the development and progression of hyperlipidemia in 194 heart transplant recipients by the use of mixed effects multiple linear regression analysis. The demographic characteristics evaluated were primary diagnosis of ischemic heart disease (IHD), gender, and age. Postoperative characteristics included number of treated rejections, dosage of cyclosporine (CYA), tacrolimus (TAC), prednisolone and azathioprine, and concentration of serum creatinine and glucose. The effects of administration of antihypertensive agents, diuretics, and lipid lowering agents were also studied. RESULTS: The total cholesterol concentration increased significantly in the first 3 months posttransplant but gradually decreased thereafter. Total cholesterol and the ratio of low density lipoprotein (LDL) cholesterol to high density lipoprotein (HDL) cholesterol (LDL-C/HDL-C) increased to a greater extent in patients with IHD although female transplant recipients had a greater increase in the total cholesterol concentration. Each episode of rejection increased serum cholesterol by 0.306 mmol/liter (0.258, 0.355) [mean (95% C.I.)] and serum triglyceride by 0.164 mmol/liter (0.12, 0.209) although switching to TAC improved total cholesterol and LDL-C/HDL-C. Administration of frusemide, increased the total cholesterol and LDL-C/HDL-C whereas administration of bumetanide or metolazone increased the concentration of serum triglyceride. Serum glucose was associated with hypertriglyceridemia whereas serum creatinine was associated with increases in the total cholesterol, LDL-C/HDL-C and triglyceride. CONCLUSIONS: We have identified demographic and postoperative covariables that predispose heart transplant recipients to hyperlipidemia. Some of these risk factors, such as the effect of diuretics, have not been identified before in this group of patients and may be amenable to modification or closer control. TAC rather than CYA may be the immunosuppressive of choice for patients who are at greater risk of developing hyperlipidemia.     

The relationship between lipid profile and erectile dysfunction

The objective of this study is to investigate the relation between serum lipids (cholesterol, LDL, HDL, triglyceride (TG)) and erectile dysfunction (ED). The experimental methods involved comparison of 100 patients with organic ED (mean age of 43.59+/-10.51 y), with 100 healthy individuals (mean age of 43.72+/-9.76 y) regarding their lipid profile from January 2000 to June 2003 (cholesterol, TG, HDL, LDL). The results showed that there was a significant difference between mean plasma cholesterol and LDL levels in the individuals suffering from ED and the control group (P=0.04 and 0.02, respectively). The TG and HDL mean plasma level differences were not significant (P=0.583 and 0.299, respectively). Odds ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97. The R2 was 0.04 for both cholesterol and LDL. Applying linear regression, the coefficient for cholesterol and LDL reduced the International Index of Erectile Function questionnaire scores by -0.036 and -0.035. In conclusion, this study, the correlation of cholesterol and LDL levels with ED strongly supports the role of hyperlipidemia treatment in both the prevention and management of ED.     

Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation

PURPOSE: We determined that use of a statin drug to lower cholesterol would improve erectile function in men who have hypercholesterolemia as the only risk factor for erectile dysfunction (ED). MATERIALS AND METHODS: A total of 18 men were determined to have increased cholesterol as the only risk factor for ED by history, system review, physical examination and laboratory analysis. Nine of these men agreed to participate in the study. Organic ED was verified by abnormal nocturnal penile tumescence and rigidity testing with the RigiScan (UroHealth Systems, Inc., Laguna Niguel, California) and Sexual Health Inventory in Men questionnaire. Subjects were given atorvastatin with a goal decrease of total cholesterol to less than 200 mg/dl and low-density lipoprotein cholesterol to less than 120 mg/dl. RigiScan measurements were compared before and after treatment with atrovastatin. RESULTS: Mean age +/- SD was 49.7 +/- 7.4 years. Mean length of treatment with atrorvastatin was 3.7 +/- 2.1 months. Clinically 8 of the 9 men had improved erection adequate for penetration during sexual intercourse. Mean questionnaire scores improved from 14.2 to 20.7 (p <0.001). Mean total and low-density lipoprotein cholesterol decreased significantly after treatment (p <0.001). RigiScan measurements showed an increased average penile rigidity at the base (p <0.001) and tip (p <0.005) after treatment with atorvastatin. CONCLUSIONS: Erectile function improves in men with hypercholesterolemia as the only risk factor for ED when treated with atorvastatin. Treating hypercholesterolemia may improve ED, while promoting primary cardiac prevention.     

The lowering effect of probucol on plasma lipoprotein and proteinuria in puromycin aminonucleoside-induced nephrotic rats

Hyperlipidemia associated with nephrotic syndrome was treated with probucol and the changes in plasma lipoprotein lipid concentration and urinary protein excretion were examined in puromycin aminonucleoside-induced nephrotic rats. Rats made nephrotic exhibited severe hyperlipidemia with increases in all major lipoprotein fractions. Probucol treatment of nephrotic rats significantly lowered plasma triglyceride (TG), cholesterol (Ch) phospholipid (PL) and apoprotein B associated with very-low-density and low-density lipoprotein and Ch and PL in high-density lipoprotein (HDL). Malondialdehyde (MDA) associated with the lipoproteins was significantly elevated in nephrotic rats and probucol treatment also lowered MDA concentration in all major lipoproteins. In control rats probucol moderately, but significantly, reduced plasma TG and HDL-Ch concentrations. Proteinuria associated with nephrosis was decreased significantly by treatment with probucol. Probucol treatment did not affect blood urea nitrogen and plasma creatinine levels. A significant positive correlation existed between the amount of protein excreted in urine and the plasma lipid concentrations in all nephrotic rats, suggesting that the hypolipidemic effect of probucol may attenuate proteinuria associated with nephrosis. These results suggest that probucol may be a favorable treatment for hyperlipidemia associated with nephrotic syndrome.