男性高血压患者血压晨峰与勃起功能障碍的关系  

Relationship Between Morning Blood Pressure Surge and Erectile Dysfunction in Male Hypertensive Patients

作　　者：夏大胜[1] 何强[1] 王丽[1] 毛大庆 杨雁君 夏伟[1] 李超[1] 卢成志[1] XIA Dasheng;HE Qiang;WANG Li;MAO Daqing;YANG Yanjun;XIA Wei;LI Chao;LU Chengzhi(Department of Cardiology,First Central Hospital of Tianjin,Tianjin(300192),China)

机构地区：[1]天津市第一中心医院心内科,300192 [2]南开大学医学院 [3]天津市南开区体育中心街社区卫生服务中心

出　　处：《中国循环杂志》2022年第1期63-68,共6页Chinese Circulation Journal

摘　　要：目的:探讨男性高血压患者血压晨峰与勃起功能障碍(ED)、一氧化氮(NO)、内皮一氧化氮合酶(eNOS)的关系。方法:选择2017年1月至2020年12月在天津市第一中心医院心内科门诊就诊和住院的40~60岁男性原发性高血压患者200例为研究对象,根据24 h动态血压监测结果,收缩压晨峰值≥35 mmHg(1 mmHg=0.133 kPa)及<35mmHg的患者分别归入晨峰组(n=90)和非晨峰组(n=110)。采用RigiScan阴茎硬度测量仪监测夜间阴茎勃起硬度、阴茎尖部胀大率、阴茎根部胀大率、阴茎勃起时间及勃起次数;连续监测2个晚上,至少1次勃起事件阴茎头端勃起硬度≥60%,持续时间≥10 min,认为勃起功能正常,其中一项异常定义为ED。用酶联免疫法测定血清NO、eNOS水平;评估血压晨峰与ED以及血清NO、eNOS水平的关系。结果:晨峰组ED患病率明显高于非晨峰组(57.8%vs.28.2%,P<0.001)。晨峰组患者的血清NO水平[(60.53±4.00)μmol/L vs.(62.78±3.79)μmol/L]、eNOS水平[(20.16±2.91)μmol/L vs.(21.59±2.43)μmol/L]、最佳勃起硬度[(61.47±9.56)%vs.(77.25±14.46)%]、平均勃起硬度[(58.97±8.62)%vs.(73.05±13.94)%]、阴茎尖部胀大率[(32.57±6.76)%vs.(43.25±7.82)%]、阴茎根部胀大率[(35.47±6.29)%vs.(42.27±7.04)%]、平均勃起时间[(10.71±2.92)min vs.(15.82±5.20)min]均低于非晨峰组(P均<0.001),但阴茎勃起次数与非晨峰组的差异无统计学意义(P=0.059)。Spearson相关分析显示,高血压患者的收缩压晨峰值、舒张压晨峰值与血清NO、eNOS水平及最佳勃起硬度、平均勃起硬度、阴茎尖部胀大率、阴茎根部胀大率、平均勃起时间均呈负相关(P均<0.001),与阴茎勃起次数均无显著关联(P均>0.05)。多元Logistic回归分析显示,高血压患者的血压晨峰与ED发生风险呈独立正相关(OR=2.179,95%CI:1.392~4.168,P=0.019)。结论:在男性高血压患者中,血压晨峰加重内皮损害,是ED的独立影响因素。Objectives:To explore the relationship between morning blood pressure surge(MBPS)and erectile dysfunction,nitric oxide(NO),endothelial nitric oxide synthase(eNOS)in male hypertensive patients.Methods:A total of 200 male hypertensive patients aged 40-60 yeas,who visited our department between January 2017 and December 2020,were included in the study.The subjects were categorized into MBPS group(morning systolic blood pressure surge≥35 mmHg,1 mmHg=0.133 kPa,n=90)and non-MBPS group(morning systolic blood pressure surge<35 mmHg,n=110).Penile erection stiffness,rate of penile apex enlargement,rate of penile root enlargement,erection time and erection frequency were recorded with nocturnal penile tumescence.ED was defined as penile tip rigidity<60%or tumescence time<10 minutes based on the best erectile episode over two consecutive nights assessment by nocturnal penile tumescence.Serum NO and eNOS levels were determined by enzyme-linked immunosorbent assay(ELISA).Results:The prevalence of ED was significantly higher in MBPS group than in non-MBPS group(57.8%vs.28.2%,P<0.001).The serum level of NO([60.53±4.00]μmol/L vs.[62.78±3.79]μmol/L)and eNOS([20.16±2.91]μmol/L vs.[21.59±2.43]μmol/L),maximum erection stiffness([61.47±9.56]%vs.[77.25±14.46]%),average erection stiffness([58.97±8.62]%vs.[73.05±13.94]%),rate of penile apex enlargement([32.57±6.76]%vs.[43.25±7.82]%),rate of penile root enlargement([35.47±6.29]%vs.[42.27±7.04]%),average erection time([10.71±2.92]min vs.[15.82±5.20]min)were significantly lower in MBPS group than in non-MBPS group(all P<0.001).Erection frequency was similar between the two groups(P=0.059).Spearson correlation analysis demonstrated that morning systolic blood pressure surge,morning diastolic blood pressure surge were significantly negatively correlated with serum NO,eNOS levels and maximum erection stiffness,average erection stiffness,rate of penile apex enlargement,rate of penile root enlargement,average erection time(all P<0.001),and were not significantly correlated wi

关 键 词：高血压 血压晨峰 内皮 勃起功能障碍 

分 类 号：R54[医药卫生—心血管疾病]