阴茎海绵体注射试验对阴茎血管功能影响的回顾性研究  

Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function

作　　者：陈延 李况蒙 洪锴[1,2] 张树栋[1] 程建星 郑仲杰 唐文豪[1,2] 赵连明[1,2] 张海涛[1,2] 姜辉 林浩成[1,2] CHEN Yan;LI Kuangmeng;HONG Kai;ZHANG Shudong;CHENG Jianxing;ZHENG Zhongjie;TANG Wenhao;ZHAO Lianming;ZHANG Haitao;JIANG Hui;LIN Haocheng(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Reproductive Medicine Center,Peking University Third Hospital,Beijing 100191,China;Department of Ultrasound,Peking University Third Hospital,Beijing 100191,China;Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]北京大学第三医院生殖医学中心,北京100191 [3]北京大学第三医院超声医学科,北京100191 [4]北京大学第一医院泌尿外科,北京100034

出　　处：《北京大学学报（医学版）》2024年第4期680-686,共7页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(82371633);北京大学临床科学家计划专项-中央高校基本科研业务费(BMU2023PYJ H012)。

摘　　要：目的:探究勃起功能障碍(erectile dysfunction,ED)患者年龄、不同激素水平及生化指标对阴茎海绵体血管功能的影响。方法:回顾分析2020年1月至2023年8月于北京大学第三医院生殖医学中心男科进行彩色双频多普勒超声(color duplex Doppler ultrasonography,CDDU)联合阴茎海绵体注射试验(intracavernosal injection test,ICI)的ED患者的临床资料。使用SPSS 29.0建立数据库进行数据处理,采用多因素Logistic回归进行分析。结果:共纳入700例ED患者,其中ICI结果阴性380例,阳性320例;阴茎海绵体动脉收缩期速度(peak systolic velocity,PSV)<25 cm/s者84例,≥25 cm/s者616例;舒张末期速度(end diastolic velocity,EDV)>5 cm/s者202例,≤5 cm/s者498例;PSV和/或EDV结果异常者264例,PSV和EDV结果均正常者436例。血管性ED患者相较于非血管性ED患者雌二醇和睾酮水平更低(t=-3.546,P<0.001;t=-2.089,P=0.037),高血糖发生率更高(χ^(2)=12.772,P=0.002)。动脉性ED患者相较于非动脉性ED患者年龄更大(t=3.953,P<0.001),高血糖发生率更高(χ^(2)=9.518,P=0.009),雌二醇/睾酮比值更高(t=2.330,P=0.020)。动静脉混合性ED患者相较于均正常者的患者年龄更高(t=3.567,P<0.001),睾酮水平更低(t=-2.288,P=0.022),高血糖发生率更高(χ^(2)=12.877,P=0.002),雌二醇/睾酮比值更大(t=2.096,P=0.037)。多因素Logistic回归分析表明,雌二醇水平升高是血管性ED的保护因素(OR=1.009,95%CI:1.004~1.014),葡萄糖≥7.0 mmol/L是血管性ED的危险因素(OR=0.381,95%CI:0.219~0.661);年龄增长是动脉性ED的危险因素(OR=0.960,95%CI:0.938~0.982);年龄增长(OR=0.976,95%CI:0.958~0.993)、葡萄糖5.6~6.9 mmol/L(OR=0.591,95%CI:0.399~0.876)是动静脉混合性ED的危险因素。结论:高血糖和年龄增长可能使阴茎海绵体血管功能减退,而雌二醇水平升高可能对阴茎海绵体血管功能有保护作用。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(χ^(2)=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(χ^(2)=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(χ^(2)=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)wer

关 键 词：勃起功能障碍 彩色双频多普勒超声 阴茎海绵体注射 血管 危险因素 

分 类 号：R698.1[医药卫生—泌尿科学]