江苏省3551例中老年男性健康调查

目的:了解我省中老年男性健康的基本情况。方法:对苏南、苏北、苏中随机收集3551例46~69岁的男性进行常规体检;按照勃起功能国际指数(IIEF-5)、老年男性雄激素部分缺乏(PADAM)自我评估表等进行询问。实验室检测肝肾功能和血糖、血脂指标;用放射免疫法测定血清睾酮和游离睾酮;B超检查前列腺体积及残余尿情况。结果:各年龄组B超检查的前列腺体积有明显差异(P<0.05)。各年龄组之间睾酮的差异无显著性(P>0.05),而游离睾酮随着年龄的增加而降低,有明显差异,在有更年期症状者中随着年龄的增加下降更为明显(P<0.05)。勃起功能障碍(ED)和PADAM的发病率与年龄的增加显著相关(P<0.001)。结论:男性在中老年期随着年龄的增加,体能、性功能水平下降,前列腺体积增大,ED、PADAM发病率明显增加。     

对勃起功能障碍患者血清游离睾酮及睾酮分泌指数的初步研究

目的：通过观察勃起功能障碍（ED）患者的血清游离睾酮（FT）、睾酮分泌指数（TSI）的变化，探讨两者在ED内分泌病因中的诊断价值。方法：120例ED患者及30例正常婚检者均来自于江苏省中医院男科门诊和病房，分别进行勃起功能国际指数（IIEF）问卷中勃起功能评分和性欲评分，采用化学发光法（CLIA）检测血清总睾酮（rI，r）、黄体生成素（LH），放射免疫检测法（RIA）检测游离睾酮（FT），并计算睾酮分泌指数（TSI）。结果：120例ED患者中低于TT、FT参考值的患者分别占5％、15．8％；TT在不同年龄组ED患者中随年龄下降但无统计学差异，FT、TSI在不同年龄组ED患者中随年龄下降且有统计学差异。TT随IIEF评分的变化缺乏规律，而FT、TSI随IIEF评分降低且有统计学差异。TT、FT、TSI在ED患者不同性欲评分组无统计学差异。结论：FT在ED伴有性腺功能减退的诊断价值优于TT，FT，FT、TSI是评估ED严重程度的重要参数。     

对诊断PADAM的血清游离睾酮界限值的初探

目的探寻诊断中老年男子部分雄激素缺乏综合征(PADAM)血清游离睾酮(FT)的界限值。方法根据60例45岁以上健康男性完成伊斯坦布尔症状量表(ISS)与视听性刺激(AVSS)时阴茎勃起监测结果进行分组,计算AVSS勃起功能正常组推算的游离睾酮(CFT)值的参考范围。结果AVSS勃起功能正常组CFT的中位数为0．37(0．20～0．52)nmol/L,异常组的中位数为0．25(0．12～0．40)nmol/L,z=2．25,P＜0．05,差别有显著性意义。两组性功能症状的差别也有极显著性意义(P＜0．01)。CFT的界限值是0．20nmol/L。结论研究用ISS和AVSS勃起功能正常对象的血清FT值,可为诊断PADAM建立界限值。     

中老年男性血清睾酮、游离睾酮、双氢睾酮和性激素结合球蛋白含量的变化

目的 观察中老年男性血清睾酮(T)、游离睾酮(FT)、双氢睾酮(DUT)和性激素结合球蛋白(SHBG)的浓度,研究雄激素与增龄的关系。方法 129例45岁以上健康男性,可能有影响雄激素分泌的疾病和药物者已除外。按年龄分为4组。采用酶标免疫法测定T、FT、DHT和SHBG血清浓度。数据用SPSS软件包分析处理。结果 各年龄组之间,T的差别有显著性意义(P<0.05);而FT、DHT和SHBG的差别都具有非常显著性意义(P<0.01)。除了T(P>0.05),增龄与血清FT、DHT和SHBG浓度均明显相关(P<0.01)。结论 男性在中老年期随着年龄的增长,血清T浓度变化不明显,而FT和DHT浓度明显下降,SHBG浓度则明显上升。     

对勃起功能障碍患者血清游离睾酮及睾酮分泌指数的初步研究

目的:通过观察勃起功能障碍(ED)患者的血清游离睾酮(FT)、睾酮分泌指数(TSI)的变化,探讨两者在ED内分泌病因中的诊断价值。方法:120例ED患者及30例正常婚检者均来自于江苏省中医院男科门诊和病房,分别进行勃起功能国际指数(IIEF)问卷中勃起功能评分和性欲评分,采用化学发光法(CLIA)检测血清总睾酮(TT)、黄体生成素(LH),放射免疫检测法(RIA)检测游离睾酮(FT),并计算睾酮分泌指数(TSI)。结果:120例ED患者中低于TT、FT参考值的患者分别占5%、15.8%;TT在不同年龄组ED患者中随年龄下降但无统计学差异,FT、TSI在不同年龄组ED患者中随年龄下降且有统计学差异。TT随IIEF评分的变化缺乏规律,而FT、TSI随IIEF评分降低且有统计学差异。TT、FT、TSI在ED患者不同性欲评分组无统计学差异。结论:FT在ED伴有性腺功能减退的诊断价值优于TT,FT、TSI是评估ED严重程度的重要参数。     

结合计算法和单一酶免法测定血清游离睾酮结果比较

目的　探寻测定血清游离睾酮 (FT)浓度的准确方法。　方法　 12 9例 45岁以上健康男性 ,按年龄分为 4组 ,收集血清标本 -40℃冻存。酶标免疫方法同批测定FT ,同时测定总睾酮 (T)和性激素结合球蛋白 (SHBG)并代入Vermeulen公式计算 :FT =T -2 3 .43FTSHBG -(T -2 3 .43FT) × 10 - 9mol/L。对两种方法测定结果进行统计学比较。　结果　 12 9例标本中酶免法FT为 (46.69± 2 1.79)pmol/L ,计算法为 (3 96.3 0± 3 17.0 4)pmol/L ,t =13 .0 1,P <0 .0 1,差异有非常显著性意义。两种方法测定FT浓度各年龄组间差异均有非常显著性意义 (P <0 .0 1) ;与年龄相关分析差异均有非常显著性意义 (P <0 .0 1) ,相关程度计算法大于酶免法。FT/T平均百分数酶免法为 0 .2 3 % ,计算法为 1.42 %。　结论　结合计算法检测FT浓度较酶免法更科学、正确 ,更适用于老年男子部分性雄激素缺乏综合征 (PADAM )的诊断     

对诊断PADAM的游离睾酮指数的评估

目的 评价诊断中老年男子部分雄激素缺乏综合征（PADAM）的游离睾酮指数（FTI）.方法 对129例45岁以上健康男性的FTI进行年龄相关分析.以推算的游离睾酮（CFT）值为依据,对FTI进行有效性检验.结果 男子在中老年期FTI与增龄呈明显的负相关.FTI敏感性97.78%,特异性58.33%.结论 计算简单的FTI可用于PADAM病人的筛选和随访,尤其对70岁以上男子是血清FT较为有效的参数.     

154例中青年男性器质性勃起功能障碍患者与代谢综合征关联分析

目的:探讨中青年男性勃起功能障碍(erectile dysfunction,ED)与代谢综合征(metabolic syndrome,MS)及睾酮水平的相关性。方法:2012年2月至2014年1月,调查门诊154例20~59岁男性器质性ED患者与103例性生活正常男性的一般情况、腰围、血压、空腹血糖、总甘油三酯、高密度脂蛋白、血清总睾酮、国际勃起功能评分5项以及勃起功能指标,比较ED组与非ED组,以及ED患者中MS者与非MS者各项指标差别。结果:中青年ED组MS患病率显著高于非ED组MS患病率(P0.05),ED组与非ED组腹围、血压、腹围、空腹血糖、高密度脂蛋白及总睾酮均有有显著性差异(P0.05)。ED组中MS者与非MS者勃起功能各项指标及总睾酮有显著性差异(P0.05)。多元logistic回归分析MS各项指标及总睾酮与ED相关性分析,发现腰围与ED密切相关(P0.01)。结论:中青年ED患者并发MS患病率较正常人群明显增高,ED患者中并发MS者睾酮水平较低、勃起功能较差。中心性肥胖与中青年ED密切相关。     

中老年男性勃起功能障碍与代谢综合征关联性分析

目的:探讨中老年男性勃起功能障碍(erectile dysfunction,ED)与代谢综合征(metabolic syndrome,MS)及血清睾酮(testosterone,T)之间的相关性,并分析影响ED发生的危险因素。方法:连续收集150例2017年5月～2020年5月确诊ED的门诊男性患者与150例性生活正常体检男性的一般情况、体格检查指标、代谢综合征相关生化指标、勃起硬度分级(erectile Hardness Score,EHS)及国际勃起功能5项评分(international index of erectile function 5,IIEF-5)。对比ED组与非ED组、ED并发MS组与未并发MS组各项指标差异及相关性。结果:ED组MS患病率明显高于非ED组(40.7%vs. 12.7%,P0.01)。两者在中心型肥胖指标(体重、腰围、BMI)、甘油三酯(TG)、空腹血糖(FBG)、血清睾酮(T)、舒张压(DBP)、高密度脂蛋白(HDL)差异明显(P≤0.01)。其次,ED并发MS组在EHS、IIEF-5评分上表现均差于未并发MS组(P0.01)。多元Logistic回归分析显示FBG、TG及T水平与ED发生密切相关(P0.01)。结论:ED患者中MS患病率较正常人群明显升高,ED并发MS患者病情严重程度差于未并发MS患者,MS指标中空腹血糖、甘油三酯及睾酮可能构成ED发生的主要危险因素。     

十一酸睾酮胶丸联合PDE5抑制剂治疗40岁以上ED患者的临床疗效观察

<正>通常40岁前后男性的血清睾酮开始下降[1],而勃起功能障碍(erectile dysfunction,ED)在40岁以上男性中发生率也随年龄增加而显著升高[2],这是否表示在40岁以上的男性中ED发生率和血清睾酮水平存在明显的相关性。Khler等[3]在门诊中发现33%的ED患者血清总睾酮低于     

万艾可联合安特尔治疗老年男性勃起功能障碍的前瞻性、随机对照研究

目的 验证万艾可联合安特尔治疗老年男性勃起功能障碍的安全性、有效性。方法 采用前瞻性、随机对照研究方法将60名ED患者分为两个对照组和一个研究组。分别观察、记录治疗前、后1、2、3个月时的IIEF、部分雄激素缺乏(PADAM)症状评分及性激素等变化。结果 IIEF、PADAM评分及有关性激素的变化表明研究组疗效显著优于对照组。结论 联合用药因同时纠正了合并存在的低睾酮水平而显著提高了疗效。对反复服用万艾可无效的老年患者，需进一步评估有无PADAM存在。     

The Aging Male's Symptoms (AMS) scale in Japanese men attending an infertility clinic

There is a gradual decline in testosterone and free testosterone with age. Physical and psychological changes can occur due to this decline of androgens--a syndrome known as "partial androgen decline in the aging male" (PADAM). Male infertility and erectile dysfunction (ED) can also be caused by androgen deficiency. Thus, male infertility, ED and PADAM are interrelated. We evaluated the prevalence of PADAM symptoms in 215 infertile patients in an infertility clinic using the Aging Males Symptom (AMS) scale. Results of the evaluation of 301 men, (30-39 years old) using the same scale, who were part of a multiphasic health screening program, served as controls. The total score of the infertile patients was lower than that of the controls. Especially, the scores of the psychological and somatic subscales were significantly lower in infertile patients (P=0.009, P=0.012, respectively). Thirty three (15.3%) of the 215 infertile patients had ED. Although the score of sexual subscale was higher in the ED patients than in the controls, the scores of the psychological and somatic subscales were not significantly different from those in the controls. In conclusion, PADAM symptoms in Japanese infertile patients were not severe. Moreover, general function was better preserved in the infertile patients than in the controls. The psychological and somatic functions of ED patients were also well preserved.     

Medical management of erectile dysfunction in aging males： is it too late to treat？

Erectile dysfunction （ED） is a common disorder among aging males. However, most aging males refuse to seek medical help and believe that ED is an irreversible event in the aging process. The purpose of this study was to describe the current medical management of ED in aging males and to examine whether it is too late to treat this disorder in these elderly men. From 2007 to 2008, 4507 patients diagnosed with ED were gathered from 46 centers in China; 4241 completed the study, 3837 of whom were treated with sildenafil. The 3837 patients were divided into five groups based on age （group A： 20-30 years; group B： 31-40 years; group C： 41-50 years; group D： 51-60 years; and group E： 〉60 years）. After comparing pre- and posttreatment International Index of Erectile Function-Erectile Function domain （IIEF-EF） questionnaires, Erection Hardness Scale （EHS）, and IIEF Q13 （＂How satisfied have you been with your overall sex life？＂）, we discovered that the aging males had worse erectile function, erection hardness, and sexual satisfaction than the younger males （P〈 0.001）. After treatment, the improvement rates in the IIEF-EF, EHS, and IIEF Q13 scores were 107.0%, 83.1%, and 116.5%, respectively. The magnitude of these changes demonstrated significant differences among groups （P 〈 0.001）. Accordingly, aging males are likely to benefit more from medical treatment. We propose that aging males should be informed that age is not a limiting factor for medical ED management, and it is never too late to treat.     

Bioavailable Testosterone With Age and Erectile Dysfunction

PurposeSymptoms of partial androgen deficiency of the aging male (PADAM), such as sexual dysfunction and depression, are receiving increased attention. Currently bioavailable testosterone (BT) is considered the most reliable marker for establishing the presence of hypogonadism. We clarified the relationship between BT and other hormones with respect to patient age and PADAM symptoms.Materials and MethodsA total of 130 patients who visited our special clinics for sexual function were included in this study. Endocrinological profiles were evaluated as appropriate, and sexual dysfunction and depression as symptoms of PADAM were assessed by a self-reported questionnaire. The relationship between age and several measures of testosterone, between BT and other hormonal measures, and between BT and PADAM symptoms were analyzed.ResultsAlthough serum total testosterone did not decrease with age, sex hormone binding globulin increased significantly. BT and free testosterone decreased significantly, and total and free testosterone correlated significantly with BT. The International Index of Erectile Function-5 score for erectile function increased significantly with increases in BT. However, the relationship between the depression score and BT was not significant.ConclusionsWe consider that BT is a useful marker for diagnosing and treating patients with PADAM because BT correlates significantly with age and International Index of Erectile Function-5 scores. We emphasize that measuring serum testosterone is necessary in aging males.     

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。     

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.     

浙江省一农村社区迟发性性腺功能减退症的调查研究

目的:调查乡村中老年男性迟发性性腺功能减退症(LOH)的流行病学情况。方法:2012年4～10月在浙江省嘉兴市嘉善县魏塘乡村采用年龄分层抽样选取996例40～80岁的中老年男性进行中老年男子雄激素缺乏(ADAM)、老年男子症状(AMS)和国际勃起功能问卷-5(IIEF-5)调查,同时测定血清中总睾酮(TT)、性激素结合球蛋白(SHBG)及白蛋白(ALB)水平,Vermeulen公式计算游离睾酮(cFT)及生物可利用睾酮(Bio-T)水平,超声检测前列腺、睾丸体积。结果:研究对象年龄(56.22±8.82)岁,ADAM及AMS筛查LOH的患病率分别为62.86%和23.05%;ED阳性率为68.83%,SHBG、LH、cFT及Bio-T筛查LOH各组之间存在统计学差异。结论:浙江省嘉善县魏塘乡村中老年男性LOH筛查率较国内其他报告(特别是大中城市)LOH筛查率低,ED患病率接近。城乡中老年LOH患病率有差别,值得进一步研究。