Bocchio Massimo, Scarpelli Piero, Necozione Stefano, Pelliccione Fiore, Spartera Carlo, Francavilla Felice, Francavilla Sandro
Department of Internal Medicine, University of L'Aquila, L'Aquila, Italy.
Int J Androl. 2006 Aug;29(4):496-501. doi: 10.1111/j.1365-2605.2006.00688.x.
Assessment of cavernosal perfusion in men with erectile dysfunction (ED) relies on Doppler spectrum analysis of pharmachologically stimulated peak systolic velocity (sPSV) in cavernous arteries but its accuracy in identifying men affected by a cavernosal perfusion disorder correlated with atherosclerosis remains undefined. We estimated by B-mode ultrasound, the accuracy of sPSV of cavernous arteries to identify ED with an expected cavernosal perfusion disorder. This was predicted by an elevated intima-media thickness (IMT) of common carotid arteries, a reference methodology to estimate the degree of generalized atherosclerosis, in men exposed to vascular risk factors (VRFs). sPSV and IMT were evaluated in 269 men with ED, 49 had no VRFs, 100 were overweight with/or without hyperlipidaemia, 120 were affected by type 2 diabetes and/or essential hypertension. sPSV was significantly lower (p<0.05) in patients with VRFs associated with atherosclerosis (IMT>or=1 mm) (n=39) than in men with no VRFs and no atherosclerosis (n=49). sPSV correlated negatively with age (p<0.0001), with serum% of glycated haemoglobin (p=0.010) and with carotid artery IMT (p=0.013). An sPSV<or=30 cm/sec, the cut-off value which showed at receiver operating characteristic curve analysis the combined highest value of sensitivity and specificity, correctly identified only 57% of men in whom a cavernosal perfusion disorder was expected based on the presence of carotid artery IMT>or=1 mm combined to the exposure to VRFs. The ultrasonographic evaluation of sPSV had a very limited accuracy in discriminating ED with an expected cavernosal perfusion disorder, based on the presence of a generalized atherosclerosis in men with VRFs.
对勃起功能障碍（ED）男性的海绵体灌注评估依赖于对海绵体动脉药物刺激后的收缩期峰值速度（sPSV）进行多普勒频谱分析，但其在识别受与动脉粥样硬化相关的海绵体灌注障碍影响的男性方面的准确性仍不明确。我们通过B超估计海绵体动脉sPSV识别预期存在海绵体灌注障碍的ED的准确性。这是通过颈总动脉内膜中层厚度（IMT）升高来预测的，颈总动脉内膜中层厚度是估计暴露于血管危险因素（VRF）的男性全身动脉粥样硬化程度的参考方法。对269例ED男性进行了sPSV和IMT评估，其中49例无VRF，100例超重伴或不伴高脂血症，120例患有2型糖尿病和/或原发性高血压。与无VRF且无动脉粥样硬化的男性（n = 49）相比，与动脉粥样硬化相关的VRF患者（IMT≥1 mm）（n = 39）的sPSV显著降低（p<0.05）。sPSV与年龄呈负相关（p<0.0001），与糖化血红蛋白血清百分比呈负相关（p = 0.010），与颈动脉IMT呈负相关（p = 0.013）。sPSV≤30 cm/秒，这一在受试者工作特征曲线分析中显示出敏感性和特异性综合最高值的临界值，仅正确识别了57%的基于颈动脉IMT≥1 mm并暴露于VRF而预期存在海绵体灌注障碍的男性。基于VRF男性中存在全身动脉粥样硬化，sPSV的超声评估在鉴别预期存在海绵体灌注障碍的ED方面准确性非常有限。
