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。     

血清游离睾酮在勃起功能障碍患者中检测价值的初步探讨

目的:通过观察勃起功能障碍(ED)患者中血清计算游离睾酮(cFT)、睾酮分泌指数(TSI)及游离睾酮指数(FTI)的变化情况,探讨cFT、TSI、FTI在ED伴雄激素缺乏诊断中的价值。方法:详细询问病史,填写国际勃起功能指数问卷(IIEF-5),完成夜间阴茎勃起功能检测(NPT),根据病史及NPT检查结果纳入实验组及对照组,检测150例NPT结果异常以"ED"为主诉的ED患者及25例NPT结果正常的健康婚检者中血清总睾酮(TT)、黄体生成素(LH)、性激素结合球蛋白(SHBG)和血清白蛋白(ALB),通过公式计算cFT、生物可利用睾酮(Bio-T)、TSI、FTI。以cFT≤0.3 nmol/L、TSI≤2.8、FTI≤0.4为参考截点值,以TT≤11.5 nmol/L为诊断雄激素缺乏的标准,计算出cFT、TSI、FTI的漏诊率、误诊率及符合率。结果:以TT≤11.5 nmol/L为评估标准,诊断20~40岁ED患者雄激素缺乏的符合率分别为cFT 90.8%、TSI 85.8%、FTI 80.8%;诊断20~40岁ED患者雄激素缺乏的漏诊率分别为cFT 4.0%、TSI 33.3%、FTI 44.0%;诊断20~40岁ED患者雄激素缺乏的误诊率分别为cFT 10.5%、TSI9.4%、FTI 12.6%。Kappa值分别为:cFT 0.755、TSI 0.564、FTI 0.427,P均0.05。TT在不同年龄组ED患者中随年龄下降但无统计学差异,cFT、Bio-T、TSI、FTI在不同年龄组ED患者中随年龄下降且具有统计学差异;20~40岁ED患者血清TT、cFT、Bio-T、TSI、FTI在不同IIEF评分组的差别无统计学差异。结论:cFT对20~40岁ED患者伴有雄激素缺乏的检测价值优于TT、TSI及FTI。     

仪征市282例中老年男性PADAM和ED发病情况调查

目的研究本市中老年男性部分睾酮缺乏（PADAM）和勃起功能障碍（ED）的发生情况及相关影响因素。方法282例46-69周岁男性，按年龄分为3组，采用国际勃起功能指数（IIEF-5）和PADAM症状评分表进行问卷调查，测定血清睾酮（T）、游离睾酮（FT）。数据用SPSS软件包处理。结果3个年龄组之间T均数无明显差异（P〉0．05），而FT均数有非常显著性差异（P〈0．005）；ED、PADAM发病率有非常显著性差异（P〈0．001，P〈0．005）；PADAM组ED发病率高于对照组（P〈0.005）。结论中老年男性随着年龄的增长血清T变化不明显，FT下降明显，ED和PADAM发病率均明显升高，PADAM的发病率与FT下降关系密切，中老年男性ED的发病与年龄、内分泌关系密切。     

西地那非联合睾酮凝胶有效治疗单独睾酮治疗失败的性腺功能减退ED患者

合并勃起功能障碍（ED）的性腺功能减退患者单独使用睾酮治疗失败后，加用西地那非是否能改善其疗效呢？Greenstein A等人对此进行了评估性研究。入选了49例性腺功能减退患者（平均年龄60．7岁），平均治疗随访时间为20．2个月。主要疗效评估指标有血清总睾酮、生物可利用睾酮、前列腺特异性抗原（PSA）、国际勃起功能指数问卷（IIEF）及总体疗效问卷（GAQ）。     

血浆睾酮水平测定在评价男性性欲减退中的临床意义

为了研究勃起功能障碍患者的血浆睾酮水平与性欲之间的关系，作者回顾性研究了１９９７年４月～１９９８年１月间１８０例勃起功能障碍患者的临床资料。性欲状况用《简要性功能调查问卷》进行评价，同时测定了血浆总睾酮及游离睾酮水平。其中，资料完整者１０８例，年龄３３～７９岁，平均（５９－５±１０．２）岁。按性欲强弱分为３组：性欲减退者５５例（５０－９％），性欲适中者３８例（３５－２％），性欲高亢者１３例（１３－９％）。３组间的平均性欲、性焦虑及总性功能评分差异有显著性（Ｐ＜０－００１）。３组平均血浆总睾酮水平…     

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。     

西地那非有效改善应用促红细胞生成素和(或)睾酮无效的透析患者的勃起功能

男性透析患者中勃起功能障碍(ED)是非常普遍的问题。Tas等进行了一项研究,以评价重组人促红细胞生成素(Epo)、睾酮(T)或者两者的联合应用治疗血透患者的勃起功能障碍的疗效,最后对联合疗法无反应的患者用西地那非治疗并评估疗效。入选的23例患者被分成两组。使用国际勃起功能指数问卷(IIEF)评价勃起功能和治疗效果。患者先接受12周的Epo或者T治疗,稍后两组患者一起再接受另外12周的联合治疗。联合治疗后两组患者的IIEF评分都有显著增加,且评分的变化相似。经过联合治疗后,16例IIEF评分仍小于26分的患者接受西地那非和Epo联合治疗,同…     

糖尿病并勃起功能障碍的中西医结合治疗

目的：观察糖尿病并勃起功能障碍的中西医结合治疗临床疗效。方法：将120名患者随机分为两组,观察组使用万艾可加中药治疗,对照组使用万艾可治疗。分别记录治疗前及治疗后3个月时的国际勃起功能指数评分（IIEF）及睾酮（T）的变化。结果：观察组IIEF评分及T的变化显著优于对照组（P〈0．05）。结论：通过辨证论治,利用中药偏性,施以六味地黄汤加减进行中西医结合治疗,可较好地改善患者睾酮水平及IIEF指数。     

小剂量十一酸睾酮联合他达拉非治疗LOH伴ED的临床研究

目的:观察小剂量十一酸睾酮联合他达拉非治疗迟发性性腺功能低下(LOH)伴勃起功能障碍(ED)患者的临床疗效。方法:符合纳入标准的90例LOH伴ED患者随机分为对照组(他达拉非治疗)、联合组(小剂量十一酸睾酮+他达拉非治疗),分别比较组内和组间治疗前后的LOH症状、IIEF-5评分、SEP评分、总睾酮(TT)、游离睾酮(FT)、PSA、前列腺体积等变化。结果:联合组治疗后IIEF-5评分、SEP评分、TT、FT分别为(20.6±3.8)分、(4.02±1.08)分、(15.4±3.4)nmol/L、(0.391±0.062)nmol/L,均显著高于治疗前[(15.7±3.9)分、(1.49±0.82)分、(10.1±1.2)nmol/L、(0.200±0.045)nmol/L,P均<0.01],且改善明显优于对照组治疗后[(8.6±3.6)分、(3.50±1.21)分、(10.2±1.2)nmol/L、(0.210±0.051)nmol/L,P均<0.01]。结论:小剂量十一酸睾酮联合他达拉非治疗LOH伴ED患者疗效确切,未见明显的补充雄激素带来的不良反应。     

血清游离睾酮水平和睾酮分泌指数随年龄老化而降低

目的:调查健康成年男性血清雄激素水平随年龄老化而发生的变化,寻找部分性缺乏的雄激素界限值。方法:在北京、上海、西安和重庆四城市调查健康成年男性1 080人,年龄20岁以上,测定体重指数(BM I)、腰臀比(WHR)、黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(T)、游离睾酮(cFT)、性激素结合球蛋白(SHBG)、雌二醇(E2)、游离睾酮指数(FTI)和睾酮分泌指数(TSI)。结果:cFT、TSI和FTI随年龄的老化而逐渐下降,并与年龄和促性腺激素水平呈负相关;T没有明显变化。cFT、TSI和FTI的变化规律是一致的,40~49岁轻度下降,50岁以后下降的幅度加大,并维持相对稳定约20年,70岁以后又有进一步的下降。以20~39岁的10%位数为切点,部分性雄激素缺乏的界限值为cFT 0.3 nmol/L,TSI 2.8 nmol/IU,FTI 0.4。由cFT界限值计算的男性部分性雄激素缺乏的患病率为:40~49岁13.0%,50~59岁31.8%,60~69岁30.1%,≥70岁46.7%。结论:健康男性在40岁以后血清cFT、TSI、FTI水平随年龄老化而下降,而T没有明显变化。TSI随年龄而下降的规律与cFT非常接近,可以作为一个临床指标使用。由于TSI是根据临床常规检测的T和LH计算,因而可以免去复杂的非常规检测,降低费用,使用方便,比需要检测SHBG才能计算出来的FTI具有更大的优越性。     

Effects of Testosterone, Progesterone and Testosterone plus Progesterone on Rat Testicular Lipids

The effects of testosterone, progesterone or testosterone plus progesterone on testicular lipids of pubertal rats are presented. The hormones were administered for 1 day as well as 7 days continuously to study both short and long term effects. Testosterone induced marked depletion of glycerides in short and long term treatments. It elicited a significant increase in phospholipids only in long term treatment. Progesterone brought about marked increase in esterified cholesterol with a congenital fall in free cholesterol. It had no significant effect on testicular glycerides and phospholipids Testosterone plus progesterone administration caused marked increase in phospholipids with a fall in glyceride levels even in short term treatment. There was a marked increase in esterified cholesterol with a concurrent fall in free cholesterol level. Thus, testosterone plus progesterone treatment brought out marked changes in phospholipids, glycerides and cholesterol fractions.
These hormonal treatments did not have any significant effect on testicular weight in short as well as long term studies.     

Plasma Testosterone Values in Hypospadiacs

The plasma testosterone values were determined by radioimmunoassay in a group of 42 patients with a severe form of hypospadia, in one case of epispadia, in a control group of 69 boys with an adequate development of sex organs, and in 48 well fertile men. It was found that the beginning of pubescence started in both groups at the same age but that already from 13 years onwards the level of male sex hormone in the blood was lower in hypospadiacs than in the individuals of the control group. The difference is statistically significant in the subgroups from 19 years of age onwards. It is assumed that the function of gonads was insufficient in these patients not only in the period of intrauterine life, but that it often remains reduced even in puberty and adulthood.

Zusammenfassung

Bei 42 Männern mit einer schweren Hypospadie, einem Fall von Epispadie und in einer Kontrollgruppe von 69 Jugendlichen mit adaequater Entwicklung der Geschlechts-organe sowie 48 fertilen Männern wurde Plasma-Testosteron mittels RIA bestimmt. Es wird festgestellt, daß der Eintritt der Reifezeit in beiden Gruppen in der gleichen Alters-stufe beginnt, daß aber schon vom 13. Lebensjahr an fortschreitend die Werte der männ-lichen Geschlechtshormone im Blut bei den Hypospadie-Patienten niedriger liegen als bei der Kontrollgruppe. Es wird angenommen, daß die Funktion der Keimdrüsen bei diesen Patienten nicht nur während der Intrauterinphase insuffizient war, sondern daß das ebenso für die Reifezeit als auch für die Erwachsenenphase gilt.     

Testosterone treatment of hypogonadal men participating in competitive sports

Testosterone has a steeply dose-dependent effect on muscle mass and strength irrespective of gonadal status. So, for reasons of fairness, people who engage in competitive sports should not administer exogenous testosterone raising their blood testosterone levels beyond the range of normal. There is a ban on exogenous androgens for men and women in sports, but an exception has been made for men with androgen deficiency due to pituitary or testicular disease. Men who receive testosterone administration for the indication hypogonadism have an interest in the use of testosterone preparations generating blood testosterone levels within the normal range of healthy, eugonadal men. On the grounds of a positive correlation between blood testosterone concentrations muscle and volume/strength, they are best served with a parenteral testosterone preparation, rather than transdermal testosterone, but they should not run the risk of being excluded from competition because of supraphysiological testosterone levels. The latter is a realistic risk with the traditional parenteral testosterone esters. The new parenteral testosterone undecanoate preparation offers much better perspectives. Its pharmacokinetics have been investigated in detail and there is a fair degree of predictability of resulting blood testosterone levels with use of this preparation.     

Testosterone and metabolic syndrome

Controversies surround the usefulness of identifying patients with the metabolic syndrome (MetS). Many of the components are accepted risk factors for cardiovascular disease (CVD). Although the MetS as defined includes many men with insulin resistance, insulin resistance is not universal. The low total testosterone (TT) and sex hormone binding globulin (SHBG) levels in these men are best explained by the hyperinsulinism and increased inflammatory cytokines that accompany obesity and increased waist circumference. It is informative that low SHBG levels predict future development of the MetS. Evidence is strong relating low TT levels to CVD in men with and without the MetS; however, the relationship may not be causal. The recommendations of the International Diabetes Federation for managing the MetS include cardiovascular risk assessment, lifestyle changes in diet, exercise, weight reduction and treatment of individual components of the MetS. Unfortunately, it is uncommon to see patients with the MetS lose and maintain a 10% weight loss. Recent reports showing testosterone treatment induced dramatic changes in weight, waist circumference, insulin sensitivity, hemoglobin A1c levels and improvements in each of the components of the MetS are intriguing. While some observational studies have reported that testosterone replacement therapy increases cardiovascular events, the Food and Drug Administration in the United States has reviewed these reports and found them to be seriously flawed. Large, randomized, placebo-controlled trials are needed to provide more definitive data regarding the efficacy and safety of this treatment in middle and older men with the MetS and low TT levels.     

Testosterone and Testosterone Binding Globulin (TeBG) in Young Men during Prolonged Stress

The effect of prolonged physical and psychological stress on the testicular function was studied in 8 students (age 22–25 years) of the Norwegian Academy of War during a combat course of 5 days' duration. The average urinary excretion of free cortisol and 17-ketogenic steroids was 81 and 129% higher than the respective control values one week after the course. Plasma cortisol levels increased from 21.7 μg/100 ml at 8 a. m. before the course to 24.6 ( P < 0.05), and serum HGH rose from undetectable levels, < 0.08 ng/ml, to an average value of 12.9 ng/ml ± 3.7 (SD) at 8 a. m. during the course.
A marked suppressive effect on plasma testosterone levels from 5.6 ng/ml ± 1.4 to 0.9 ± 0.5, and no adjustment to stress was observed over a 5 day period. TeBG increased gradually from 26.9 nmol/l ± 9.9 to 52.7 ± 17.7 on day 6, followed by a slow decrease without reaching control values on day 12, suggesting that the decreased plasma testosterone levels probably reflect reduced production and not increased metabolism of testosterone. LH fluctuated during the course, but was significantly higher in the morning immediately following the end of the course than at the start ( P < 0.02). It is postulated that the effect of stress on the plasma testosterone levels is mediated via an action both on the hypothalamus-pituitary level and on the testis.