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.     

高催乳素血症勃起功能障碍的临床研究

催乳素 (Ｐｒｏｌａｃｔｉｎ ,ＰＲＬ)是垂体前叶分泌的一种多肽激素 ,与人类的生殖功能和性功能关系十分密切 ,ＰＲＬ的升高可以直接或间接地影响男子的性功能和生殖功能。 1998年 8月～ 1999年 3月 ,对来我所就诊的高催乳素血症伴有阴茎勃起功能障碍(ＥＤ)的 33例患者 ,进行了治疗前后卵泡刺激素(ＦＳＨ)、黄体生成素 (ＬＨ)、睾酮 (Ｔ)和雌二醇 (Ｅ2 )的测定及临床观察。材料和方法一、材　料1.受检对象　主诉阴茎勃起不坚、勃起困难或不能性交 ,经两次测定血清ＰＲＬ值 >30ｎｇ/ｍｌ的患者 33例 ,年龄 2 5～ 4 1岁 ,婚龄 1～ 16年 ,ＥＤ…     

前列腺癌治疗导致的勃起功能障碍

勃起功能障碍是治疗前列腺癌常见的副作用 ,发生率为 2 0 %～ 88%。对治疗前列腺癌导致勃起功能障碍的前瞻性评估并未阐明其发生时序和危险因子。一家医院内诊断为前列腺癌的 2 95 6例患者资料构成一前瞻性数据库 ,作者试图对前列腺癌治疗前后的勃起功能进行分析研究。 2 95 6例中有足够资料分析勃起功能者 80 2例 ,构成本研究的对象人群。分析治疗与勃起功能障碍间关系所应用的因子包括治疗方法 ,如根治性前列腺切除、外照射放疗、观察等待 ,以及种族、年龄、临床分期和肿瘤组织学分级。结果 :根治性前列腺切除和外照射治疗后保持勃起功能…     

大鼠糖尿病性勃起功能障碍模型的实验研究

目的 证实链脲佐菌素(STZ)单侧腹腔注射建立大鼠糖尿病性勃起功能障碍模型的可行性.方法 45只SD大鼠随机分为对照组(15只)和实验组(30只).实验组大鼠腹腔注射STZ 60mg/kg,对照组大鼠腹腔注射相应量的柠檬酸钠-柠檬酸缓冲液,3d后测血糖确定是否成模.此后,每周测血糖1次,8周后用阿朴吗啡(APO)80μg/kg颈部皮下注射,观察大鼠阴茎勃起情况.结果 实验组糖尿病成模率为93.3%(28/30),在成模后8周的观察期间大鼠的死亡率为7.1%(2/28).实验组血糖明显高于对照组(P<0.01),体重、阴茎勃起次数、阴茎勃起率则明显低于对照组,两组间差异有统计学意义(P<0.01).结论 STZ 60mg/kg单侧腹腔内注射能安全有效地建立大鼠糖尿病模型;颈部皮下注射APO 80μg/kg可有效地筛选出大鼠糖尿病勃起功能障碍.     

大鼠心因性勃起功能障碍模型制作

目的:建立心因性勃起功能障碍(ED)动物模型。方法:获得性交配经验的36只SD雄性大鼠随机分为正常组(n=12)、模型组(n=12)及去势组(n=12)。模型组大鼠每日悬空倒吊在水面上,并不断激惹。2周后观测与雌性大鼠合笼后的性活动状况,包括雄鼠的骑乘潜伏期和骑乘次数,插入潜伏期和插入次数以及雄鼠的射精潜伏期,并计数发生性活动的大鼠数,同时取大鼠血液作血液流变学指标检测。结果:与正常组大鼠相比,模型组大鼠骑乘潜伏期[(152.5±24.6)svs(42.4±9.6)s]、插入潜伏期[(437.0±67.7)svs(130.8±39.1)s]明显延长(P<0.01),射精潜伏期[(385.3±80.0)svs(547.3±69.4)s]明显缩短(P<0.05),骑乘次数[(38.3±6.1)次vs(38.5±5.4)次]无明显差别,插入次数[(9.2±1.7)次vs(20.3±3.1)次]明显减少(P<0.01),性活动的发生率(骑乘发生率为58.3%,插入发生率为33.3%,射精发生率为16.7%)明显降低(P<0.01);但模型大鼠与去势大鼠间的性活动能力无明显差别。模型组大鼠血液粘度、红细胞比容以及红细胞聚集指数均明显高于正常组及去势组大鼠(P<0.05),而正常组与去势组大鼠间无明显差异。结论:重复悬吊加激惹方法可引起大鼠的性动机和性活动能力明显减弱,显示运用此方法可制作理想的心因性ED大鼠模型。     

性传播疾病与勃起功能障碍

目的探讨勃起功能障碍（ED）与性传播疾病（STD）的关系。方法回顾性分析我院1995年1月至2005年1月4521例男性STD患者的临床资料，对发生ED患者的治疗前后情况进行比较并分析ED成因。结果治疗前3259例（72．1％）STD患者发生ED，STD高发年龄段在20-40岁，ED的严重程度与患者的年龄、病史、精神压力、并发症有密切关系（P〈0．01）。有357例ED患者的疗效不佳。结论STD患者长期未接受规范治疗，可能由于临床症状加重和心理因素共同作用引起ED；STD痊愈后，绝大多数患者的ED症状消失，但有部分患者由于心理或器质性原因，ED未得到明显改善。     

勃起功能障碍基因治疗研究进展

近年来基因治疗被尝试用于勃起功能障碍(ED)治疗的动物实验,许多研究发现基因治疗方案对各种类型的ED均有一定的治疗作用。特别是在左旋精氨酸-一氧化氮-环磷酸鸟苷通路、离子通道、勃起神经和海绵体血管内皮细胞的修复保护等方面的基因治疗研究显示,基因治疗ED有一定的疗效。但应用基因治疗来治疗ED患者,目前仍有较多的困难,暂时无法应用于临床。本综述旨在对该领域的最新研究进展做一个简单的介绍和展望。     

骨质疏松与勃起功能障碍风险相关性的Meta分析

目的采用Meta分析的方法,评估骨质疏松与勃起功能障碍(ED)之间风险相关性。方法检索PubMed、Cochrane Library、Embase、Web of Science、Springer Link、中国知网、万方等数据库,检索时间截止至2018年12月,数据提取由2名研究员独立进行,以避免错误或遗漏。任何分歧可通过小组商讨共识或咨询第3位研究员来解决。对纳入的研究采用Stata 12.0软件进行Meta数据分析。结果最终有4篇病例-对照研究文献符合此Meta分析的纳入标准。其中共纳入了4702例ED患者。Meta分析结果显示:各研究间不存在显著异质性(I2=46.4%,P=0.133)。因I2<50%,从而对该Meta分析采取固定效应模型。ED组骨质疏松的患者显著高于非ED组患者(P<0.05)。采用漏斗图法和Begg、Egger检验对对纳入研究的发表偏倚进行评估,最终未发现发表偏倚。敏感性分析采用逐次剔除法,合并效应值RR取值于1.48~1.61,剔除后的研究对结果影响不大,总合并效应值与其基本一致。结论通过研究发现ED患者合并骨质疏松的风险明显高于非ED患者,ED患者可能存在雄性激素与雌性激素水平的失平衡,而这种平衡被打破后,可能会让骨质疏松的发生率升高。这也侧面反映了性激素对于骨质疏松的重要性。     

慢性前列腺炎致勃起功能障碍的机制研究进展

勃起功能障碍(ereetile dysfunction,ED)是指阴茎不能达到或维持实现性交的勃起.ED对男性正常性生活具有巨大负面影响.一项调查研究显示很多人非常重视性生活[1]:42%的男性认为性生活非常重要,另外41%认为至少偶尔需要满意的性生活,仅17%的男性认为性生活是可有可无的.     

勃起功能障碍诊断方法探讨

目的:探讨ED的诊断方法。方法:对365例11个民族拟诊为血管性ED的患者分别采用阴茎海绵体注射试验、阴茎-肱动脉血压指数测定、阴茎彩色双功能超声、阴茎海绵体造影、阴茎数字减影血管造影及阴茎动、静脉血池显像等检查。结果:有365、204、168、228、142、136例患者分别接受了上述6种检查。诊断动脉性ED82例,静脉性ED132例,混合性ED57例,原因不明ED94例。不同民族间差异无统计学意义(P>0.05)。结论:ED是高度个性化疾病,针对ED患者不同情况采取相应的诊断方法有利于选择高效、经济、安全的治疗方法。     

药物性阴茎双功能超声在勃起功能障碍诊断中的应用

对１２４例勃起功能障碍（ＥＤ）者应用药物性阴茎双功能超声（ＰＰＤＵ）检查评估阴茎海绵体动脉功能和静脉关闭机制。结果显示：非血管性ＥＤ者８５例（６８５４％），动脉性ＥＤ者４例（３２３％），静脉性ＥＤ者３５例（２８２３％）。认为ＥＤ患者应常规行ＰＰＤＵ检查。     

Currenttreatm entfor erectile dysfunction and the future

国家级医学继续教育项目——生殖医学实用新技术培训班（卫继９９－０４－１３－００１）特邀国际阳痿研究学会主席，美国男性学杂志主编，国际阳痿研究杂志主编，美国乔治亚医学院泌尿外科主任Ｒｏｎａｌｄ Ｗ．Ｌｅｗ ｉｓ，ＭＤ讲授男性性功能障碍的现代治疗及未来展望，全文刊登于本刊，以餮读者。     

Testosterone deficiency and risk factors in the metabolic syndrome: implications for erectile dysfunction

The most common cause of erectile dysfunction (ED) is penile vascular insufficiency. This is usually part of a generalized endothelial dysfunction and is related to several conditions, including type 2 diabetes mellitus, hypertension, hyperlipidemia, and obesity. These conditions underlie the pathophysiology of metabolic syndrome (MetS). Hypogonadism, or testosterone deficiency (TD), is an integral component of the pathology underlying endothelial dysfunction and MetS, with insulin resistance (IR) at its core. Testosterone replacement therapy for TD has been shown to ameliorate some of the components of the MetS, improve IR, and may serve as treatment for decreasing cardiovascular and ED risk.     

Morphologic findings and blood flow parameters of penile vasculature in patients with erectile dysfunction

The objective was to study the risk factors in patients with erectile dysfunction in correlation with ultrasound findings of penile vasculature. Patients with erectile dysfunction were classified in four groups according to their risk factors. Group A (37 pts) who were heavy smokers, group B (40 pts) who suffered from diabetes mellitus, group C (30 pts) who suffered from hyperlipidemia and group D (40 pts) with no risk factors. The peak systolic velocity (PSV) was measured after the intracavernous injection of 10 mg alprostadile. Normal values were PSV>35 cm/s and endiastolic venous velocity<4 cm/s. It was found that the mean PSV in group A was 22.2±2.25 cm/s without venous leakage, in group B the mean PSV was 24.6±1.29 cm/s but there was a significant venous leakage (mean end-diastolic velocity 6.2±1.37 cm/s). Patients with hyperlipidemia (group C) had a mean PSV of 26.2±1.74 cm/s and insignificant venous leakage and patients in group D had a normal vascular profile. Patients with erectile dysfunction who are heavy smokers are predisposed to have penile arterial insufficiency, while diabetics have both arterial insufficiency and venous leakage.     

Pathogenetic aspects of erectile dysfunction in patients with the metabolic syndrome

BackgroundAlthough it is well known that the metabolic syndrome is a common cause of erectile dysfunction (ED) the pathogenesis of the latter in this group of patients is poorly understood. The present study aimed to improve our knowledge in this area.MethodsThe study included 385 men with ED (control group) who underwent a full evaluation, including laboratory and ultrasound assessment of endothelial function.ResultsThe full complex evaluation showed that arteriogenic impairment in the cavernosal circulation was the primary pathogenic factor for ED in patients with the metabolic syndrome. The ultrasound-assisted measurement of postocclusive changes in the diameter of the cavernosal arteries, which reflects the local endothelial function, was the most valuable method in the diagnosis of this form of ED. In addition, a considerable number of patients with the metabolic syndrome demonstrated both hormonal and neurological disorders which also contribute to the pathogenesis of ED in this cohort of men.ConclusionThe pathogenesis of ED in patients with the metabolic syndrome is multifactorial in nature: ED is primarily caused by arteriogenic disorders which are combined with neuropathic disorders in almost every second patient and with hormonal factors in every third one. In addition, psychomotor status has an impact on the development of ED in patients with metabolic syndrome.     

Prevalence of Peyronie's disease among patients with erectile dysfunction

PURPOSE: To assess the prevalence of Peyronie's disease (PD) among patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 1,440 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function (IIEF). All patients were also screened for socio-demographic data and risk factors for ED that included age, smoking, diabetes, hypertension, dyslipidemia, Ischemic Heart Disease (IHD), and psychological disorders. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Patients underwent routine laboratory investigation in addition to testosterone and prolactin assessment. RESULTS: Mean ages +/-SD were 54.1 +/- 6.9 (range 42-71) and 52.5 +/- 11.9 (range 20-84) years for patients with and without PD respectively. Of the patients, 11.8% had mild, 38.3% had moderate and 49.9% had severe ED. 7.9% of the patients had PD. Significant associations between PD and both the longer duration and the increased severity of ED were detected. There were also significant associations between PD and the following socio-demographic risk factors of ED: age, obesity, smoking, duration and number of cigarettes smoked per day. Concomitant diseases and medical comorbidities such as diabetes, dyslipidemia, psychological disorders and the presence of at least one risk factor were significantly associated with PD in patients with ED. CONCLUSIONS: Peyronie's disease was not rare among the study population. There were significant associations between ED risk factors and PD. Further studies are needed to investigate how much ED and PD influence each other.     

维持性血液透析患者勃起功能障碍的初步研究

目的 明确维持性血液透析（MHD）男性患者勃起障碍的发病率，及评价西地那非的疗效与副作用。方法 以国际勃起功能指数（IIEF）对22例HD男患者进行评分。勃起障碍者给予西地那非，每次从25mg/d开始，最高为100mg/d，治疗12周，对比治疗前后IIEF分值变化。结果 MHD勃起障碍发病率为72.73%。西地那非总有效率为87.5%。常见的副作用为头痛，面色潮红等。结论 西地那非对于正在接近血液透析治疗的肾衰患者安全性和有效性等同于其它人群。     

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。     

血管活性肠多肽基因转导增强阴茎勃起功能

目的 探讨阴茎海绵体勃起神经递质血管活性肠多肽(VIP)基因转导入糖尿病大鼠阴茎海绵体并表达多量VIP以增强勃起功能的可行性.方法 将构建的重组质粒pcDNA3/VIPcDNA注射入链尿佐菌素诱导的糖尿病大鼠阴茎海绵体,在注射3 d后测定阴茎海绵体内压(ICP),分别以正常空白、空白、单纯注射缓冲液和单纯注射pcDNA3载体对照.Dot blot法测定阴茎组织中VIP mRNA表达水平.结果 糖尿病大鼠阴茎海绵体注射重组质粒后3 d,电刺激海绵体神经,ICP较对照组明显升高(P＜0.05);阴茎组织VIP mRNA表达增多(P＜0.05).结论 成功将重组质粒pcDNA3/VIP cDNA转导入糖尿病阴茎海绵体,VIP mRNA表达增加能增强糖尿病大鼠阴茎海绵体的勃起功能.     

西地那非治疗勃起功能障碍的安全性和疗效的临床应用研究

目的：观察枸椽酸西地那非上市后实际临床应用中的安全性和有效性。方法：采用多中心、开放、非对照的方法，在全国36家医院对2101例因勃起功能障碍口服西地那非治疗的患者进行了观察随访。平均观察期65d(6-310d)。260例患者（12.4％）观察达6个月以上。结果；所观察到的各系统不良事件的特点和类型与说明书中所列及中国II期临床试验结果一致。未发现新的不良事件，不良事件发生率并不因服药期延长而升高。所有不良事件均为轻度至中度（以轻度为主），多数不需处理即可缓解，多于服药当天缓解。西地那非治疗勃起功能障碍的总有效率为82.3％。结论：西地那非治疗勃起功能障碍安全、有效、耐受性好。