摘要
目的:探讨小剂量PDE5抑制剂对ED伴亚临床代谢综合征(SCMS)患者代谢参数、勃起功能的影响。方法:2017年4月至2018年5月在男科就诊的ED患者132例,平均年龄34.5岁(21~61岁),根据相关诊断标准分为3组:单纯ED组40例(A组),ED伴SCMS组34例(B组),ED伴MS组58例(C组),分别接受他达拉非(希爱力)5 mg每日睡前口服,3个月治疗,停药后各组再随访3个月;治疗期间给予所有患者指导建议:采取健康饮食方式,改变不良生活习惯,鼓励其参加定期定时的体育锻炼,保持心理平衡;在治疗前后及停药后3个月记录各组患者IIEF-5评分,以及腹围、血压、血糖、甘油三酯(TG)、高密度脂蛋白(HDL)的变化。结果:A、C组内不同时相间相比IIEF-5评分均有统计学差异(P<0.01),B组治疗后IIEF-5评分显著高于治疗前、停药后3个月[(19.71±2.40)分vs(10.21±3.92)分和(16.29±2.41)分,P<0.01]。停药后3个月的腹围A组[(78.10±6.00)cm]显著小于B组[(84.15±8.17)cm]和C组[(91.53±11.49)cm],P<0.01;停药后3个月C组HDL[(0.96±0.15)mmol/L]显著低于A组[(1.27±0.14)mmol/L]和B组[(1.16±0.21)mmol/L],P<0.01;收缩压:A组内不同时相间比较无统计学差异(P>0.05),B组停药后(131.85±13.26)同治疗后(133.38±14.26)相比(P>0.05),治疗前、治疗后相比与治疗前与停药后相比均(P<0.05),C组前后两两比较(P<0.01);舒张压:A组内两两比较无统计学差异(P>0.05),B组停药后[(74.65±9.90)mmHg]、治疗后[(75.62±10.70)mmHg]同治疗前[(78.00±11.42)mmHg]比较有显著差异(P<0.05),C组停药后[(82.40±10.09)mmHg]、治疗后[(82.19±10.36)mmHg]同治疗前[(86.71±12.32)mmHg]相比有统计学差异(P<0.05);空腹血糖在3组内,除B组内停药后[(5.36±0.40)mmol/L]同治疗后[(5.34±0.60)mmol/L]无显著差异(P>0.05),余各组内不同时间段比较均具有统计学差异(P<0.05);TG在不同组内,除B组内治疗前[(1.80±0.98)mmol/L]与治疗后[(1.64±1.19)mmol/L]无统计学差异(P>0.05),余各组内不同时相比较均具有统计学差异(P<0.05)。结论:对ED伴有SCMS患者而言,采取小剂量长效PDE5抑制剂周期性治疗,给予健康教育、生活方式改善等干预,其病情得到一定逆转,提高了勃起功能,其绝大多数代谢参数得到不同程度改善。
Objective: To investigate the effects of low-dose PDE5 inhibitors on metabolic parameters and erectile function in ED patients with subclinical metabolic syndrome(SCMS). Methods: Totally, 132 ED patients, aged 21-61(mean 34.5) years, were treated in the Andrology Clinic of the First Hospital of Wenzhou Medical University from April 2017 to May 2018. According to the diagnostic criteria, we divided the patients into groups A(simple ED, n = 40), B(ED with SCMS, n = 34) and C(ED with MS, n = 58) to receive 3 months of oral administration of tadalafil at 5 mg qd at bedtime, and followed them up for 3 months after drug withdrawal. During the treatment, we advised the patients to keep a healthy diet, change bad habits, participate in regular physical exercise, and maintain psychological balance. Before and right after medication and at 3 months after drug withdrawal, we recorded the changes in the IIEF-5 scores, abdominal circumference, blood pressure and levels of fasting blood sugar(FBS), triglyceride(TG) and high-density lipoprotein(HDL) of the patients. Results: The IIEF-5 scores showed statistically significant differences at different time points between groups A and C(P < 0.01), remarkably higher right after treatment than before treatment and at 3 months after drug withdrawal in group B(19.71 ± 2.40 vs 10.21 ± 3.92 and 16.29 ± 2.41, P < 0.01). At 3 months after drug withdrawal, the abdominal circumference was significantly smaller in group A than in B and C([78.10 ± 6.00] vs [84.15 ± 8.17] and [91.53 ± 11.49] cm, P < 0.01) and the HDL level lower in group C than in A and B([0.96 ± 0.15] vs [1.27 ± 0.14] and [1.16 ± 0.2]] mmol/L, P < 0.01). Systolic blood pressure exhibited statistically significant differences between any two time points in group C(P < 0.05 or P < 0.01) but not in group A(P > 0.05) or B(P > 0.05). Diastolic blood pressure was markedly lower in group B right after medication and at 3 months after drug withdrawal than before treatment([75.62 ± 10.70] and [74.65 ± 9.90] vs [78.00 ± 11.42] mmHg, P < 0.05), and so was it in group C([82.19 ± 10.36] and [82.40 ± 10.09] vs [86.71 ± 12.32] mmHg, P < 0.05), but manifested no significant difference between any two time points in group A(P > 0.05). There were statistically significant differences in the FBS level among different time points in groups A and C(P < 0.05) but not in B between post-treatment and 3 months after drug withdrawal([5.34 ± 0.60] vs [5.36 ± 0.40] mmol/L, P > 0.05), and so were there in the TG level among different time points in groups A and C(P < 0.05) but not in B between pre-and post-treatment([1.80 ± 0.98] vs [1.64 ± 1.19] mmol/L, P > 0.05). Conclusion: Periodic administration of low-dose sustained-release PDE5 inhibitors with health education and lifestyle guidance may reverse ED with SCMS and improve most of the related metabolic parameters.
作者
武志刚
周超烽
萧云备
王勤泉
蔡健
李澄棣
商学军
WU Zhi-gang;ZHOU Chao-feng;XIAO Yun-bei;WANG Qin-quan;CAI Jian;LI Cheng-di;SHANG Xue-jun(Department of Urology and Andrology,The First Hospital Affiliated to Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;Department of Andrology,General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2019年第6期522-528,共7页
National Journal of Andrology
基金
浙江省卫计委项目(2015KYB240)
温州市科技局项目(Y20160340)~~
