Moore Charles R, Wang Run
Department of Urology, University of Texas Health Science Center and MD Anderson Cancer Center, 6431 Fannin Street, Suite 6.018, Houston, Texas 77030, USA.
Asian J Androl. 2006 Nov;8(6):675-84. doi: 10.1111/j.1745-7262.2006.00223.x. Epub 2006 Aug 4.
The pathophysiology of diabetes is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction (ED) in diabetic patients includes elevated advanced glycation end-products (AGEs) and increased levels of oxygen free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate (cGMP)-dependent kinase-1 (PKG-1). The treatment of diabetic ED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of the disease. The peripherally acting oral phosphodiesterase type 5 (PDE5) inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional treatment as a non-invasive treatment option. Local administration of vasoactive medication via urethral suppository or intracorporal injection can be effective with minimal side-effects. Patients with irreversible damage of the erectile mechanism are candidates for penile implantation. Future strategies in the evolution of the treatment of ED are aimed at correcting or treating the underlying mechanisms of ED. With an appropriate vector, researchers have been able to transfect diabetic animals with agents such as neurotrophic factors and nitric oxide synthase (NOS). Further studies in gene therapy are needed to fully ascertain its safety and utility in humans.
糖尿病的病理生理学是多因素的，没有单一病因处于主导地位。糖尿病患者勃起功能障碍（ED）的潜在机制包括晚期糖基化终末产物（AGEs）升高和氧自由基水平增加、一氧化氮（NO）合成受损、内皮素B受体结合位点增加和超微结构改变、RhoA/Rho激酶途径上调、NO依赖性选择性氮能神经变性以及环磷酸鸟苷（cGMP）依赖性激酶-1（PKG-1）受损。糖尿病性ED的治疗是多模式的。治疗潜在的高血糖症和合并症对于预防或阻止疾病进展至关重要。外周作用的口服5型磷酸二酯酶（PDE5）抑制剂是糖尿病患者ED口服药物治疗的主要手段。真空勃起装置作为一种非侵入性治疗选择是额外的治疗方法。通过尿道栓剂或海绵体内注射局部给予血管活性药物可能有效且副作用最小。勃起机制存在不可逆损伤的患者是阴茎植入的候选者。ED治疗发展的未来策略旨在纠正或治疗ED的潜在机制。借助合适的载体，研究人员已能够用神经营养因子和一氧化氮合酶（NOS）等药物转染糖尿病动物。需要进一步开展基因治疗研究以充分确定其在人类中的安全性和实用性。
