Aversa Antonio, Bruzziches Roberto, Pili Marcello, Spera Giovanni
Department of Medical Pathophysiology, University La Sapienza 00161 Rome Italy.
Curr Pharm Des. 2006;12(27):3467-84. doi: 10.2174/138161206778343046.
Erectile dysfunction (ED) has multifactor pathogenesis, with neurological, vascular, endocrinological and psychogenic components described. However, about 50-85% of ED population report the presence of one or more comorbidities i.e. hypertension, diabetes, cardiovascular disease, dyslipidemia which all impair endothelial function and, erection is a basically vascular event that necessitates an intact endothelium to occur. Hence, ED may be mostly considered as the clinical manifestation of a disease affecting penile circulation as a part of a generalized vascular disorder due to atherosclerosis. Orally active drugs, i.e. phosphodiesterase type-5 inhibitors (PDE5-i), are a group of on-demand drugs licensed for ED treatment and appear to offer advantages over past therapies in terms of ease of administration and cost, and they are now widely advocated as first-line therapy. The recent discovery that chronic not on-demand administration of these drugs may improve erectile and endothelial response in men previously unresponding to on-demand regimes, opens a new scenario in the treatment of men with ED and comorbidities. Finally, the recent approval of PDE5-i sildenafil for the treatment of pulmonary arterial hypertension represents the new challenge for these class of drugs. Aim of this article will be to provide an update on the pathophysiology of ED and how to use of different available PDE5-i in approaching sexual dysfunctional men, pointing out on their characteristic of efficacy and safety and different indications in special sub-populations.
勃起功能障碍（ED）具有多因素发病机制，涉及神经、血管、内分泌和心理等方面。然而，约50%-85%的ED患者报告存在一种或多种合并症，即高血压、糖尿病、心血管疾病、血脂异常，这些都会损害内皮功能，而勃起本质上是一个血管事件，需要完整的内皮才能发生。因此，ED大多可被视为由于动脉粥样硬化导致的全身性血管疾病中影响阴茎血液循环的一种疾病的临床表现。口服活性药物，即5型磷酸二酯酶抑制剂（PDE5-i），是一类经许可用于治疗ED的按需服用药物，在给药便利性和成本方面似乎比过去的疗法更具优势，现在它们被广泛倡导作为一线治疗方法。最近发现，对以前对按需治疗方案无反应的男性进行这些药物的长期非按需给药可能会改善勃起和内皮反应，这为ED合并症男性的治疗开辟了新的前景。最后，PDE5-i西地那非最近被批准用于治疗肺动脉高压，这对这类药物提出了新的挑战。本文的目的是提供ED病理生理学的最新信息，以及如何在治疗性功能障碍男性时使用不同的现有PDE5-i，指出它们的疗效和安全性特征以及在特殊亚人群中的不同适应症。
