目的:调查年龄的影响,各种荷尔蒙水平,勃起功能障碍(ED)患者阴茎海绵体血管功能的生化指标。方法:回顾性分析2020年1月至2023年8月在北京大学第三医院生殖医学中心行彩色多普勒超声(CDDU)和海绵体内注射试验(ICI)的男性ED患者的临床资料。使用SPSS29.0对数据进行管理和处理,并进行多变量Logistic回归分析。
结果:共纳入700例ED患者,380例ICI结果为阴性,320例呈阳性。在研究中,84例患者收缩期峰值流速(PSV)<25cm/s,616例PSV≥25cm/s;202例患者舒张末期流速(EDV)>5cm/s,498例EDV≤5cm/s。264例患者有异常的PSV和/或EDV结果,436对两者都有正常结果。血管性ED患者的雌激素水平明显降低(t=-3.546,P<0.001)。睾酮水平降低(t=-2.089,P=0.037),与非血管性ED相比,高血糖发生率更高(χ2=12.772,P=0.002)。动脉性ED患者年龄较大(t=3.953,P<0.001),高血糖发生率较高(χ2=9.518,P=0.009),与非动脉ED患者相比,雌激素/睾酮比率更高(t=2.330,P=0.020)。混合动静脉ED患者年龄较高(t=3.567,P<0.001),睾酮水平降低(t=-2.288,P=0.022),高血糖发生率较高(χ2=12.877,P=0.002),与正常结果相比,雌激素/睾酮比率更大(t=2.096,P=0.037)。多因素Logistic回归分析显示,雌激素水平升高是血管ED的保护因素(OR=1.009,95CI:1.004-1.014),血糖≥7.0mmol/L是危险因素(OR=0.381,95CI:0.219~0.661)。高龄是动脉性ED的危险因素(OR=0.960,95CI:0.938-0.982)。此外,年龄较大(OR=0.976,95CI:0.958-0.993)和葡萄糖水平为5.6-6.9mmol/L(OR=0.591,95CI:0.399-0.876)也是混合动静脉ED的危险因素.
结论:高血糖和衰老可能损害阴茎海绵体血管功能,而较高水平的雌激素可能对其有保护作用。
OBJECTIVE: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted.
RESULTS: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels (t=-3.546, P < 0.001), lower testosterone levels (t=-2.089, P=0.037), and a higher rate of hyperglycemia (χ2=12.772, P=0.002) compared with those with non-vascular ED. The patients with arterial ED were older (t=3.953, P < 0.001), had a higher rate of hyperglycemia (χ2=9.518, P=0.009), and a higher estrogen/testosterone ratio (t=2.330, P=0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age (t=3.567, P < 0.001), lower testosterone levels (t=-2.288, P=0.022), a higher rate of hyperglycemia (χ2=12.877, P=0.002), and a larger estrogen/testosterone ratio (t=2.096, P=0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED (OR=1.009, 95%CI: 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor (OR=0.381, 95%CI: 0.219-0.661). Older age was a risk factor for arterial ED (OR=0.960, 95%CI: 0.938-0.982). Additionally, older age (OR=0.976, 95%CI: 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L (OR=0.591, 95%CI: 0.399-0.876) were also risk factors for mixed arterio-venous ED.
CONCLUSIONS: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.