勃起功能障碍同病异证患者血清性激素水平及其与常见临床参数关系的研究
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摘要
目的探讨维吾尔医学(维医)异常胆液质型(ASap)勃起功能障碍(ED)、异常血液质型ED(AKanED)、异常黏液质型ED(APhl-ED)、异常黑胆质型ED(ASav-ED)患者血清性激素水平及其与常见临床参数的关系。方法在维医体液辨证分型的基础上选取国际勃起功能指数5项(IIEF-5)评分<22分的阳痿患者77例,其中38例APhl-ED患者(APhl-ED组)、15例ASav-ED患者(ASav-ED组)、13例AKan-ED患者(AKan-ED组)、11例ASap-ED患者(ASap-ED组)和21例正常健康人(N组),收集常见临床资料,采用电化学发光免疫分析法检测血清性激素水平,并分析其与常见临床参数的关系。结果APhl-ED组睾酮(T)水平显著降低(P<0.05),AKan-ED和APhl-ED组雌二醇(E2)水平均显著增高(P<0.05),ASap-ED、AKan-ED、APhl-ED和ASav-ED组促黄体生成素(LH)水平显著增高(P<0.05),APhl-ED和ASav-ED组催乳素(PRL)水平显著增高(P<0.05),ASav-ED组卵泡刺激素(FSH)显著增高(P<0.05)。性激素水平与常见临床参数分析发现,在年龄≥40y、腰围≥90cm、IIEF-5<12分、MSF-4<9分的ED患者血清中T水平显著降低(P<0.05);IIEF-5<12分、MSF-4评分<9分的ED患者血清中E2和LH水平均显著增高(P<0.05)。结论性腺轴功能改变在ED发生、发展过程中发挥着关键性的作用,为不同证型ED的共性机制之一,而其具体的内分泌改变则因证型不同可能有所差异。
Objective To study the expression of sexual hormones in ED with different syndromes(abnormal phlegmatic,abnormal savda,abnormal sapra and abnormal kan)of Uyghur medicine and their association with clinicopathogical parameters.Methods On the basis of syndrome differentiation of Uygur Medicine,77 cases of impotence patients with the international erectile function index 5(IIEF-5)score< 22 were selected,including 38 APhl-ED,15 ASav-ED,11 ASap-ED,13 AKan-ED patients and 21 normal healthy persons(N group).The clinical data were collected and the serum sex hormones were detected by electrochemiluminescence immunoassay,and the relationship between the sex hormones and the clinical parameters was analyzed.Results Testosterone(T)level reduced in APhl-ED group(P <0.05),Estradiol(E2)level increased in APhl-ED and AKan-ED group(P <0.05);Luteinizing hormone(LH)level increased in ASap-ED,AKan-ED,APhl-ED and ASav-ED group(P <0.05);Prolactin(PRL)level increased in APhl-ED and ASav-ED group(P <0.05);FSH level increased in ASav-ED group(P <0.05).T level dereased in patients with age≥40y,waist≥90cm,IIEF-5<12and MSF-4<9(P <0.05);E2and LH level significantly increased in patients with IIEF-5<12and MSF-4<9(P <0.05).Conclusion Neuroendocrine disorder,especially the function of gonad axis changes in ED development plays a key role,as one of the common mechanism of different syndrome types of ED,and its specific endocrine change due to different syndromes may vary.Clinical pathological parameters change of ED patients with different syndrome not only accords with theory of Uyghur body fluids,also are important factors of different syndromes of ED.
Objective To study the expression of sexual hormones in ED with different syndromes(abnormal phlegmatic,abnormal savda,abnormal sapra and abnormal kan)of Uyghur medicine and their association with clinicopathogical parameters.Methods On the basis of syndrome differentiation of Uygur Medicine,77 cases of impotence patients with the international erectile function index 5(IIEF-5)score< 22 were selected,including 38 APhl-ED,15 ASav-ED,11 ASap-ED,13 AKan-ED patients and 21 normal healthy persons(N group).The clinical data were collected and the serum sex hormones were detected by electrochemiluminescence immunoassay,and the relationship between the sex hormones and the clinical parameters was analyzed.Results Testosterone(T)level reduced in APhl-ED group(P <0.05),Estradiol(E2)level increased in APhl-ED and AKan-ED group(P <0.05);Luteinizing hormone(LH)level increased in ASap-ED,AKan-ED,APhl-ED and ASav-ED group(P <0.05);Prolactin(PRL)level increased in APhl-ED and ASav-ED group(P <0.05);FSH level increased in ASav-ED group(P <0.05).T level dereased in patients with age≥40y,waist≥90cm,IIEF-5<12and MSF-4<9(P <0.05);E2and LH level significantly increased in patients with IIEF-5<12and MSF-4<9(P <0.05).Conclusion Neuroendocrine disorder,especially the function of gonad axis changes in ED development plays a key role,as one of the common mechanism of different syndrome types of ED,and its specific endocrine change due to different syndromes may vary.Clinical pathological parameters change of ED patients with different syndrome not only accords with theory of Uyghur body fluids,also are important factors of different syndromes of ED.
引文
[1]中国医学百科全书编辑委员会.中国医学百科全书:维吾尔医学分册[M].上海:上海科学技术出版社,2005:120-124.
[2]AYTA I A,MCKINLAY J B,KRANE R J.The likely worldwide increase in erectile dysfunction between 1995and 2025and some possible policy consequence[J].BJU Int,1999,84(1):50-56.
[3]艾力阿吉·库尔班尼亚孜米琪.维吾尔医治疗阳痿[M].乌鲁木齐:新疆人民卫生出版社,2006:31-96.
[4]阿地力江·伊明,潘建春,哈木拉提·吾甫尔,等.几种不同方法建立维医异常黏液阳痿病证模型的研究[J].新疆医科大学学报,2010,33(11):1275-1280.
[5]阿地力江·伊明,范强,哈木拉提·吾甫尔,等.维医异常黏液质阳痿病证动物模型的建立与反证[J].中国男科学杂志,2011,25(9):3-9.
[6]阿地力江·伊明,范强,哈木拉提·吾甫尔,等.维医异常黏液质证候与阳痿病证大鼠性行为学改变的研究[J].中国男科学杂志,2011,25(9):20-23.
[7]阿地力江·伊明,潘建春,哈木拉提·吾甫尔,等.维医异常黏液质证侯与阳痿病证大鼠模型生殖激素的改变及其生物学意义[J].新疆医科大学学报,2012,35(11):1438-1444.
[8]张盼盼,刘凤霞,阿地力江·伊明,等.异常黏液质型阳痿病证大鼠性腺轴改变的形态学研究[J].中国男科学杂志,2014,28(7):8-13.
[9]哈木拉提·吾甫尔,阿不都热依木·玉苏甫.维吾尔医气质、体液论及其现代研究[M].乌鲁木齐:新疆科学技术出版社,2003:14-15.
[10]雅森·米吉提.维吾尔医学体液辩证分型及其相关疾病[J].新疆医科大学学报,2010,33(6):612-613.
[11]毛俊彪.PKB/Akt信号通路与阴茎勃起功能的关系[J].中国男科学杂志,2011,25(11):67-69.
[12]乔梁,辛钟成.阴茎勃起相关基因的研究进展[J].中华男科学,2002,8(5):363-366.
[13]SAGHIER E O E,Shebl S E,Fawzy O A,et al.Androgen deficiency and erectile dysfunction in patients with type 2diabetes[J].Clin Med Insights Endocrinol Diabetes,2015(8):55-62.
[14]LEE W C,KIM M T,KO K T,et al.Relationship between serum testosterone and cardiovascular disease risk determined using the framingham risk score in male patients with sexual dysfunction[J].World J Mens Health,2014,32(3):139-144.
[15]CUNNINGHAM G R,STEPHENS SHIELDS A J,ROSEN R C,et al.Association of sex hormones with sexual function,vitality,and physical function of symptomatic older men with low testosterone levels at baseline in the testosterone trials[J].J Clin Endocrinol Metab,2015,100(3):1146-1155.
[16]沈周俊,陈昭典.男性性功能障碍一氧2氮合成酶变化的研究进展[J].临床泌尿外科杂志2000,15(10):478-479.
[17]EL SAKKA A I.Impact of the association between elevated oestradiol and low testosterone levels on erectile dysfunction severity[J].Asian J Androl,2013,15(4):492-496.
[18]KATAOKA T,HOTTA Y,OHNO M,et al.Limited effect of testosterone treatment for erectile dysfunction caused by high-estrogen levels in rats[J].Int J Impot Res,2013,25(6):201-205.
[19]VIGNOZZI L,FILIPPI S,COMEGLIO P,et al.Estrogen mediates metabolic syndrome-induced erectile dysfunction:a study in the rabbit[J].J Sex Med,2014,11(12):2890-2902.
[2]AYTA I A,MCKINLAY J B,KRANE R J.The likely worldwide increase in erectile dysfunction between 1995and 2025and some possible policy consequence[J].BJU Int,1999,84(1):50-56.
[3]艾力阿吉·库尔班尼亚孜米琪.维吾尔医治疗阳痿[M].乌鲁木齐:新疆人民卫生出版社,2006:31-96.
[4]阿地力江·伊明,潘建春,哈木拉提·吾甫尔,等.几种不同方法建立维医异常黏液阳痿病证模型的研究[J].新疆医科大学学报,2010,33(11):1275-1280.
[5]阿地力江·伊明,范强,哈木拉提·吾甫尔,等.维医异常黏液质阳痿病证动物模型的建立与反证[J].中国男科学杂志,2011,25(9):3-9.
[6]阿地力江·伊明,范强,哈木拉提·吾甫尔,等.维医异常黏液质证候与阳痿病证大鼠性行为学改变的研究[J].中国男科学杂志,2011,25(9):20-23.
[7]阿地力江·伊明,潘建春,哈木拉提·吾甫尔,等.维医异常黏液质证侯与阳痿病证大鼠模型生殖激素的改变及其生物学意义[J].新疆医科大学学报,2012,35(11):1438-1444.
[8]张盼盼,刘凤霞,阿地力江·伊明,等.异常黏液质型阳痿病证大鼠性腺轴改变的形态学研究[J].中国男科学杂志,2014,28(7):8-13.
[9]哈木拉提·吾甫尔,阿不都热依木·玉苏甫.维吾尔医气质、体液论及其现代研究[M].乌鲁木齐:新疆科学技术出版社,2003:14-15.
[10]雅森·米吉提.维吾尔医学体液辩证分型及其相关疾病[J].新疆医科大学学报,2010,33(6):612-613.
[11]毛俊彪.PKB/Akt信号通路与阴茎勃起功能的关系[J].中国男科学杂志,2011,25(11):67-69.
[12]乔梁,辛钟成.阴茎勃起相关基因的研究进展[J].中华男科学,2002,8(5):363-366.
[13]SAGHIER E O E,Shebl S E,Fawzy O A,et al.Androgen deficiency and erectile dysfunction in patients with type 2diabetes[J].Clin Med Insights Endocrinol Diabetes,2015(8):55-62.
[14]LEE W C,KIM M T,KO K T,et al.Relationship between serum testosterone and cardiovascular disease risk determined using the framingham risk score in male patients with sexual dysfunction[J].World J Mens Health,2014,32(3):139-144.
[15]CUNNINGHAM G R,STEPHENS SHIELDS A J,ROSEN R C,et al.Association of sex hormones with sexual function,vitality,and physical function of symptomatic older men with low testosterone levels at baseline in the testosterone trials[J].J Clin Endocrinol Metab,2015,100(3):1146-1155.
[16]沈周俊,陈昭典.男性性功能障碍一氧2氮合成酶变化的研究进展[J].临床泌尿外科杂志2000,15(10):478-479.
[17]EL SAKKA A I.Impact of the association between elevated oestradiol and low testosterone levels on erectile dysfunction severity[J].Asian J Androl,2013,15(4):492-496.
[18]KATAOKA T,HOTTA Y,OHNO M,et al.Limited effect of testosterone treatment for erectile dysfunction caused by high-estrogen levels in rats[J].Int J Impot Res,2013,25(6):201-205.
[19]VIGNOZZI L,FILIPPI S,COMEGLIO P,et al.Estrogen mediates metabolic syndrome-induced erectile dysfunction:a study in the rabbit[J].J Sex Med,2014,11(12):2890-2902.