Andersson K E
Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden.
Int J Impot Res. 2001 Aug;13 Suppl 3:S8-S17. doi: 10.1038/sj.ijir.3900718.
Despite considerable advances, both the central regulation of erection with processing of various stimuli, and the different steps involved in neurotransmission, impulse propagation and intracellular transduction of neural signals in penile smooth muscles, are still incompletely known. Centrally as well as peripherally, many transmitters and transmitter systems are involved. Dopamine, nitric oxide, oxytocin and ACTH/alpha-MSH, seem to have a facilitatory role, whereas serotonin may be either facilitatory or inhibitory, and enkephalins are inhibitory. Peripherally, the balance between contractant (eg noradrenaline, endothelins, angiotensins) and relaxant (eg NO, VIP and related peptides, prostanoids) factors controls the degree of contraction of the smooth muscle of the corpora cavernosa, and determines the functional state of the penis. Neurogenic NO is considered the most important factor for relaxation of penile vessels and corpus cavernosum. The roles of other putative transmitters/mediators and of various intracellular mechanisms, producing relaxation of vascular and corpus cavernosum smooth muscle, have not been established. For example, recent findings have suggested a role of Rho/Rho-kinase in the regulation of cavernosal tone, and that Rho-kinase antagonism could be a new potential principle for the treatment of erectile dysfunction. Further research in this area may be rewarding.
尽管取得了相当大的进展，但勃起的中枢调节以及各种刺激的处理过程，以及阴茎平滑肌中神经信号的神经传递、冲动传播和细胞内转导所涉及的不同步骤，仍未完全明确。在中枢和外周，许多递质和递质系统都参与其中。多巴胺、一氧化氮、催产素和促肾上腺皮质激素/α-黑素细胞刺激素似乎具有促进作用，而血清素可能具有促进或抑制作用，脑啡肽则具有抑制作用。在外周，收缩因子（如去甲肾上腺素、内皮素、血管紧张素）和舒张因子（如一氧化氮、血管活性肠肽及相关肽、前列腺素）之间的平衡控制着海绵体平滑肌的收缩程度，并决定阴茎的功能状态。神经源性一氧化氮被认为是阴茎血管和海绵体舒张的最重要因素。其他假定的递质/介质以及产生血管和海绵体平滑肌舒张的各种细胞内机制的作用尚未确定。例如，最近的研究结果表明Rho/Rho激酶在海绵体张力调节中起作用，并且Rho激酶拮抗作用可能是治疗勃起功能障碍的一个新的潜在原则。该领域的进一步研究可能会有收获。
