Corona Giovanni, Mannucci Edoardo, Schulman Claude, Petrone Luisa, Mansani Riccardo, Cilotti Antonio, Balercia Giancarlo, Chiarini Valerio, Forti Gianni, Maggi Mario
Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Eur Urol. 2006 Sep;50(3):595-604; discussion 604. doi: 10.1016/j.eururo.2006.02.053. Epub 2006 Mar 13.
The association of low testosterone level and erectile dysfunction (ED) with metabolic syndrome (MS) is receiving increasing attention. The present study determined the psychobiologic characteristics of sexual dysfunction (SD) associated with MS (as defined by the National Cholesterol Education Program's Adult Treatment Panel III criteria) in a series of 803 consecutive male outpatients.
Several hormonal, biochemical, and instrumental (penile Doppler ultrasound [PDU]) parameters were studied, along with general psychopathology scores (Middlesex Hospital Questionnaire modified [MHQ]). The Structured Interview on Erectile Dysfunction (SIEDY) was also applied.
Among the 236 patients (29.4%) diagnosed as having a MS, 96.5% reported ED, 39.6% hypoactive sexual desire (HSD), 22.7% premature ejaculation, and 4.8% delayed ejaculation. Patients with MS were characterised by greater subjective (as assessed by SIEDY) and objective (as assessed by PDU) ED and by greater somatised anxiety than the rest of the sample. The prevalence of overt hypogonadism (total testosterone <8 nM) was significantly higher in patients with MS. Among MS components, waist circumference and hyperglycaemia were the best predictors of hypogonadism. Hypogonadal patients with MS showed higher gonadotropin and lower free testosterone levels, suggesting a primary hypogonadism. Among patients with MS, hypogonadism was present in 11.9% and 3.8% in the rest of the sample (p<0.0001) and was associated with typical hypogonadism-related symptoms, such as hypoactive sexual desire, low frequency of sexual intercourse, and depressive symptoms.
Our data suggest that MS is associated with a more severe ED and induces somatisation. Furthermore, MS is associated with a higher prevalence of hypogonadism in patients with SD. The presence of hypogonadism can further exacerbate the MS-associated sexual dysfunction, adding the typical hypogonadism-related symptoms (including HSD, 66.7%). Recognising MS associated with hypogonadism is important for both sexual and general health and its serious potential associated risks.
低睾酮水平及勃起功能障碍（ED）与代谢综合征（MS）之间的关联正受到越来越多的关注。本研究确定了一系列连续803名男性门诊患者中与MS相关的性功能障碍（SD）（根据美国国家胆固醇教育计划成人治疗小组第三次报告标准定义）的心理生物学特征。
研究了若干激素、生化及器械检查（阴茎多普勒超声[PDU]）参数，以及一般精神病理学评分（改良的米德尔塞克斯医院问卷[MHQ]）。还应用了勃起功能障碍结构化访谈（SIEDY）。
在236名（29.4%）被诊断患有MS的患者中，96.5%报告有ED，39.6%性欲减退（HSD），22.7%早泄，4.8%射精延迟。与样本中的其他患者相比，MS患者的主观ED（通过SIEDY评估）和客观ED（通过PDU评估）更严重，躯体化焦虑也更严重。明显性腺功能减退（总睾酮<8 nM）的患病率在MS患者中显著更高。在MS的各项组成成分中，腰围和高血糖是性腺功能减退的最佳预测指标。患有MS的性腺功能减退患者促性腺激素水平较高，游离睾酮水平较低，提示原发性性腺功能减退。在MS患者中，性腺功能减退的发生率为11.9%，样本中的其他患者为3.8%（p<0.0001），且与典型的性腺功能减退相关症状有关，如性欲减退、性交频率低和抑郁症状。
我们的数据表明，MS与更严重的ED相关，并会引发躯体化。此外，MS与SD患者中性腺功能减退的较高患病率相关。性腺功能减退的存在会进一步加重与MS相关的性功能障碍，并增加典型的性腺功能减退相关症状（包括HSD，66.7%）。认识到与性腺功能减退相关的MS对性功能和整体健康及其严重的潜在相关风险都很重要。
