从维生素D与5-羟色胺关系探讨巴戟天治疗早泄机制
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摘要
早泄是临床常见的性功能障碍,是指射精发生在男性的愿望之前,对射精缺乏合理的随意控制,患病率在20%~30%之间,严重影响患者及其伴侣的生活质量,甚至导致抑郁、焦虑等精神疾病。本文通过文献研究发现,低水平5-HT (5-hydroxytryptamine,5-HT)是早泄发病机制之一,临床常以提升下丘脑5-HT水平作为治疗靶点,在帕罗西汀等药物作用机制中扮演重要角色。维生素D缺乏会导致5-HT水平降低,与早泄具有密切联系。巴戟天具有补肾阳、强筋骨等功效,临床用于肾虚阳痿、遗精早泄等疾病,具有调节5-HT的作用。因此,课题组提出巴戟天可能通过维生素D受体、调控5-HT水平从而达到改善早泄的治疗目的,且无5-HT再摄取抑制剂共同的不良反应。
Premature ejaculation which refers to ejaculation lacking of autonomous control occurs before the male's desire,is a common clinical sexual dysfunction. The prevalence rate is between 20% to 30%. It can cause the depression,the anxiety and so on mental illness which influences patient and partner's life quality seriously. Vitamin D deficiency can lead to the decrease of serotonin which is the pathogenic factor of premature ejaculation. Paroxetine and other drugs playing a positive role in the treatment of premature ejaculation can often be used to elevate the level of hypothalamus 5-ht as the therapeutic target. Vitamin D deficiency is closely associated with premature ejaculation. Ba ji tian has the effect of tonifying Shen Yang,strong bones. And it is clinically used for kidney deficiency impotence,premature ejaculation and other diseases. It may be able to regulate the level of 5-HT by activating the Vitamin D receptor,plays a therapeutic role for premature ejaculation without any common adverse reactions.
Premature ejaculation which refers to ejaculation lacking of autonomous control occurs before the male's desire,is a common clinical sexual dysfunction. The prevalence rate is between 20% to 30%. It can cause the depression,the anxiety and so on mental illness which influences patient and partner's life quality seriously. Vitamin D deficiency can lead to the decrease of serotonin which is the pathogenic factor of premature ejaculation. Paroxetine and other drugs playing a positive role in the treatment of premature ejaculation can often be used to elevate the level of hypothalamus 5-ht as the therapeutic target. Vitamin D deficiency is closely associated with premature ejaculation. Ba ji tian has the effect of tonifying Shen Yang,strong bones. And it is clinically used for kidney deficiency impotence,premature ejaculation and other diseases. It may be able to regulate the level of 5-HT by activating the Vitamin D receptor,plays a therapeutic role for premature ejaculation without any common adverse reactions.
引文
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[14] PILZ S,FRISCH S,KOERTKE H,et al. Effect of vitamin D supplementation on testosterone levels in men[J]. Hormone and Metabolic Research,2011,43(3):223.
[15] JENSEN M B, LIEBEN L, NIELSEN J E, et al.Characterization of the testicular, epididymal and endocrine phenotypes in the Leuven Vdr-deficient mouse model:targeting estrogen signalling[J]. Molecular and cellular endocrinology,2013,377(1-2):93-102.
[16] PATRICK R P,AMES B N. Vitamin D hormone regulates serotonin synthesis. Part 1:relevance for autism[J]. FASEB journal:official publication of the Federation of American Societies for Experimental Biology,2014,28(6):2398-413.
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[21]王中,刘东波.自拟固精汤联合帕罗西汀治疗早泄的临床观察[J].中国男科学杂志,2018,32(1):53-54.
[22]杨阿民,陈国宏.肾藏精理论在早泄治疗中的运用[J].中国中医基础医学杂志,2010,16(4):327-327.
[23]王雪侠,张向前.巴戟天醇提物对D-半乳糖致衰老大鼠免疫功能的影响[J].中国医药导报,2013,10(4):17-19.
[24]麻柔,谢仁敷,廖军鲜.成对和单味中药对造血细胞的作用[J].中国中西医结合杂志,1984,4(9):533-535.
[25]刘汝银,岳宗进,包德明.巴戟天多糖对骨质疏松模型大鼠5-HT、VEGF与体内矿物质含量影响研究[J].中国生化药物杂志,2015,35(4):59-62.
[26]王雪芹,张鸿燕,舒良,等.巴戟天寡糖胶囊治疗轻、中度抑郁症的疗效和安全性[J].中国新药杂志,2009,18(9):802-805.
[27]杨黎辉,闫福曼,陈朝凤,等.中药巴戟天提取物药理作用研究进展[J].中医药学报,2005,33(2):6-8.
[28]贾新转,魏兰,王咏梅.维生素D及其受体与雄性生殖[J].中国男科学杂志,2015,29(3):62-65.
[29]王瑞鹤.补肾阳中药的现代药理作用研究[J].湖北中医药大学学报,2011,13(4):63-66.
[30]肖凤霞,林励.巴戟天补肾壮阳作用的初步研究[J].食品与药品,2006,8(5):45-46.
[31]江敏,李又空.盐酸达泊西汀治疗早泄患者对焦虑抑郁情绪的影响[J].中国性科学,2018(1):24-27.
[32]陶林,王春华.抗抑郁剂治疗早泄的研究进展[J].中国男科学杂志,2000,14(3):209-212.
[33]陈云志,张军平,秦钟.维生素D内分泌系统与中医肾藏象学说关联的理论探讨[J].中华中医药学刊,2010,28(12):2621-2623.
[2] CASTIGLIONE F,ALBERSEN M,HEDLUND P,et al. Current Pharmacological Management of Premature Ejaculation:A Systematic Review and Meta-analysis[J]. European Urology,2015,69(5):904-916.
[3] PORSTA H,ROSEN R C,GAYNOR L,et al. The Premature Ejaculation Prevalence and Attitudes(PEPA)Survey:Prevalence,Comorbidities,and Professional Help-Seeking[J].European Urology,2007,51(3):816-823.
[4] ALTHOF S E,ABDO C H,DEAN J,et al. International Society for Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation[J]. Journal of Sexual Medicine,2010,7(9):2947.
[5]王晓峰,朱积川,邓春华.中国男科疾病诊断治疗指南[M].北京:人民卫生出版社,2013:208-210.
[6]龙皓,姜睿.维生素D缺乏导致勃起功能障碍机制的研究进展[J].中国男科学杂志,2016,30(4):66-68.
[7]蔡海荣,黄翔,章晓蓉.早泄与血中单胺类神经递质关系的相关性研究[J].中国现代医生,2018,56(7):20-23.
[8] OZTURK MI,KOCA O,TUKEN M,et al. Hormonal evaluation in premature ejaculation[J]. Urologia Internationalis,2012,88(4):454-458.
[9]周勇,汤坤龙,王宝龙,等.血浆瘦素及5-羟色胺与早泄的关系[J].中华内分泌外科杂志,2013,7(2):160-164.
[10]罗兵,龙家才,李炜,等.帕罗西汀治疗原发性早泄后血浆5-羟色胺浓度的变化[J].国际检验医学杂志,2015,(14):2056-2058.
[11] HSIEH JT,LIU SP,CHANG HC,et al. The activation of peripheral 5-HT1A receptors can inhibit seminal vesicle contraction:An in vivo animal study[J]. Urology,2011,78(2):376-379.
[12]朱晨露,李淑湘,魏佳玲,等.男性不育患者血清维生素D的变化及意义[J].中华男科学杂志,2014,20(8):751-754.
[13] WANG N,HAN B,LI Q,et al. Vitamin D is associated with testosterone and hypogonadism in Chinese men:Results from a cross-sectional SPECT-China study[J]. Reproductive Biology and Endocrinology,2015,13(1):74.
[14] PILZ S,FRISCH S,KOERTKE H,et al. Effect of vitamin D supplementation on testosterone levels in men[J]. Hormone and Metabolic Research,2011,43(3):223.
[15] JENSEN M B, LIEBEN L, NIELSEN J E, et al.Characterization of the testicular, epididymal and endocrine phenotypes in the Leuven Vdr-deficient mouse model:targeting estrogen signalling[J]. Molecular and cellular endocrinology,2013,377(1-2):93-102.
[16] PATRICK R P,AMES B N. Vitamin D hormone regulates serotonin synthesis. Part 1:relevance for autism[J]. FASEB journal:official publication of the Federation of American Societies for Experimental Biology,2014,28(6):2398-413.
[17] PARTONEN T. Vitamin D and serotonin in winter[J]. Medical hypotheses,1998,51(3):267-268.
[18] PATRICK R P,AMES B N. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action,part 2:relevance for ADHD,bipolar disorder,schizophrenia,and impulsive behavior[J]. FASEB journal:official publication of the Federation of American Societies for Experimental Biology,2015,29(6):2207-2222.
[19] CASTIGLIONE F,ALBERSEN M,HEDLUND P,et al. Current Pharmacological Management of Premature Ejaculation:A Systematic Review and Meta-analysis[J]. European urology,2016,69(5):904-916.
[20]秦国政.中医男科学[M].北京:中国中医药出版社,2012:158-170.
[21]王中,刘东波.自拟固精汤联合帕罗西汀治疗早泄的临床观察[J].中国男科学杂志,2018,32(1):53-54.
[22]杨阿民,陈国宏.肾藏精理论在早泄治疗中的运用[J].中国中医基础医学杂志,2010,16(4):327-327.
[23]王雪侠,张向前.巴戟天醇提物对D-半乳糖致衰老大鼠免疫功能的影响[J].中国医药导报,2013,10(4):17-19.
[24]麻柔,谢仁敷,廖军鲜.成对和单味中药对造血细胞的作用[J].中国中西医结合杂志,1984,4(9):533-535.
[25]刘汝银,岳宗进,包德明.巴戟天多糖对骨质疏松模型大鼠5-HT、VEGF与体内矿物质含量影响研究[J].中国生化药物杂志,2015,35(4):59-62.
[26]王雪芹,张鸿燕,舒良,等.巴戟天寡糖胶囊治疗轻、中度抑郁症的疗效和安全性[J].中国新药杂志,2009,18(9):802-805.
[27]杨黎辉,闫福曼,陈朝凤,等.中药巴戟天提取物药理作用研究进展[J].中医药学报,2005,33(2):6-8.
[28]贾新转,魏兰,王咏梅.维生素D及其受体与雄性生殖[J].中国男科学杂志,2015,29(3):62-65.
[29]王瑞鹤.补肾阳中药的现代药理作用研究[J].湖北中医药大学学报,2011,13(4):63-66.
[30]肖凤霞,林励.巴戟天补肾壮阳作用的初步研究[J].食品与药品,2006,8(5):45-46.
[31]江敏,李又空.盐酸达泊西汀治疗早泄患者对焦虑抑郁情绪的影响[J].中国性科学,2018(1):24-27.
[32]陶林,王春华.抗抑郁剂治疗早泄的研究进展[J].中国男科学杂志,2000,14(3):209-212.
[33]陈云志,张军平,秦钟.维生素D内分泌系统与中医肾藏象学说关联的理论探讨[J].中华中医药学刊,2010,28(12):2621-2623.