男性高血压患者血尿酸与勃起功能障碍及血管内皮损伤的关系#br#

摘要：目的　探讨男性高血压患者血清尿酸（UA）水平变化及其与勃起功能障碍（ED）和血管内皮损伤指标一氧化氮（NO）、内皮型一氧化氮合酶（eNOS）和内皮微粒（EMP）的关系。方法　选择新诊断男性高血压患者为研究对象，采用ED国际指数问卷表-5（IIEF-5）评估ED及其严重程度，100例伴ED患者（轻度31例、中度34例、重度35例）为ED组，100例年龄配对无ED的患者为对照组，尿酸酶法测定血清UA，酶联免疫法测定NO、eNOS，流式细胞技术测定血浆EMP水平。结果　重度ED组UA和EMP高于其他各组；而NO和eNOS低于其他各组，中度ED组UA和EMP高于轻度组及对照组；而NO和eNOS低于轻度组及对照组，轻度组UA和EMP高于对照组；而NO和eNOS低于对照组（P＜0.05）。相关分析表明高血压患者UA与NO、eNOS呈负相关，与EMP呈正相关（r分别为-0.589、-0.693和0.717，均P＜0.01）。多元逐步回归分析结果显示高血压患者UA、低密度脂蛋白胆固醇（LDL-C）、收缩压、糖尿病为EMP的影响因素，多元Logistic回归分析显示UA、舒张压、BMI及LDL-C为高血压患者ED的独立影响因素（P＜0.01），血清UA预测高血压伴ED的ROC曲线下面积为0.785（95%CI：0.717～0.852，P＜0.01）。以血清UA 384.5 µmol/L作为预测ED最佳阈值时，敏感度90%，特异度69%，阳性预测值74.8%，阴性预测值87.3%。结论　高血压合并ED患者血清UA水平增高，高尿酸血症可能通过损伤血管内皮功能促使高血压患者ED发生与发展。

The correlation between serum uric acid level with erectile dysfunction and vascular endothelial injury in male hypertensive patients

Abstract: Objective　To study the correlation between serum uric acid level with erectile dysfunction (ED) and vascular endothelial injury in male hypertensive patients. Methods　A total of 200 newly diagnosed hypertensive patients were included in the study. One hundred male hypertensive patients with ED were defined ED group (31 mild ED patients, 34 moderate ED patients and 35 severe ED patients) and 100 male hypertensive patients without ED who were matched in age were defined non-ED group according to international index of erectile function-5 (IIEF-5). Serum levels of uric acid were measured by uricase reagents. Serum nitric oxide (NO) and Endothelial nitric oxide synthase (eNOS) levels were tested by enzyme-linked immunosorbent assay. The level of plasma EMP was measured by flow cytometry. Results　Serum levels of uric acid and EMP were significantly increased in severe ED patients compared with those of moderate ED patients, mild ED patients and non-ED patients. These parameters were significantly increased in moderate ED patients compared with those of mild ED patients and non-ED patients. These parameters were significantly increased in mild ED patients compared with those of non-ED patients. While serum levels of NO and eNOS were markedly decreased in severe ED patients compared with those of moderate ED patients, mild ED patients and non-ED patients. Serum levels of NO and eNOS were markedly decreased in moderate ED patients compared with those of mild ED patients and non-ED patients (P＜0.05). Serum levels of NO and eNOS were markedly decreased in mild ED patients compared with those of non-ED patients (P＜0.05). There was a negative correlation between uric acid and NO as well as eNOS, and a positive correlation with EMP (P＜0.05) in all hypertensive patients. Uric acid was independently and positively associated with EMP in male hypertensive patients by stepwise multiple regression analysis. Logistic regresson analyses showed that serum uric acid level hadindependent relation with the occurrence of ED in hypertensive patients (P＜0.01). Area under receiver operating characteristic curve of uric acid to predict ED was 0.785 (95%CI: 0.717-0.852, P＜0.01). The optimal serum uric acid cut-point for predicting ED was 384.5 µmol/L, with a sensitivity of 90%, a specificity of 69%, a positive predictive value 74.8% and a negative predictive 87.3%. Conclusion　Hyperuricemia probably influences the occurrence and development of ED in male hypertension by promoting vascular endothelial injury. Key words:hypertension; erectile dysfunction; uric acid; endothelium, vascular;nitric oxide;nitric oxide synthase;endothelial microparticle