Aversa A, Rossi F, Francomano D, Bruzziches R, Bertone C, Santiemma V, Spera G
Chair of Internal Medicine, Department of Medical Pathophysiology, Sapienza University of Rome, Rome, Italy.
Int J Impot Res. 2008 Nov-Dec;20(6):566-73. doi: 10.1038/ijir.2008.43.
Aim of the study was to evaluate whether endothelial dysfunction is a marker of erectile dysfunction (ED) in recreational drug abuse. Sixty-four non-consecutive men complaining of ED from at least 3 months were included. All patients underwent detailed history about recreational drug abuse and were then submitted to dynamic penile duplex ultrasound (PDU). According to pharmaco-stimulated peak systolic velocity (PSV) cutoff at 35 cm s(-1), patients were divided into two groups: organic (O; n=30) and non-organic (NO; n=34) ED. All subjects and 7 healthy age-matched subjects as controls, underwent veno-occlusive plethysmography (VOP) for the evaluation of endothelium-dependent dilatation of brachial arteries. Blood pressure, total and free testosterone, prolactin, estradiol, low-density lipoprotein and high-density lipoprotein cholesterol were also evaluated; patients were classified with regard to insulin resistance through the HOMA-IR index. Cannabis smoking was more frequent in O-ED vs NO-ED (78% vs 3%, P<0.001) in the absence of any concomitant risk factor or comorbidity for ED. VOP studies revealed impaired endothelium-dependent vasodilatation in O-ED but not in NO-ED and controls (12+/-6 vs 32+/-4 and 34+/-5 ml min(-1), respectively; P=0.003). Overall patients showed a direct relationship between HOMA-IR and PSV (r(2)=0.47, P<0.0001), which was maintained in men with organic ED (r(2)=0.62, P<0.0001). In cannabis consumers, a direct relationship between HOMA-IR and VOP was also found (r(2)=0.74, P<0.0001). Receiver-operating characteristic (ROC) curve analysis revealed that VOP values below 17.22 ml min(-1) were suggestive for vasculogenic ED. We conclude that early endothelial damage may be induced by chronic cannabis use (and endocannabinoid system activation); insulin resistance may be the hallmark of early endothelial dysfunction and may concur to determine vascular ED in the absence of obesity. Further studies are warranted to establish a direct relationship between cannabis abuse, onset of insulin resistance and development of vascular ED.
本研究的目的是评估内皮功能障碍是否为娱乐性药物滥用所致勃起功能障碍（ED）的一个标志物。纳入了64名非连续性的男性，他们主诉ED至少3个月。所有患者均接受了关于娱乐性药物滥用的详细病史询问，然后接受动态阴茎双功超声（PDU）检查。根据药物刺激后的收缩期峰值流速（PSV）截断值35 cm/s，患者被分为两组：器质性（O组；n = 30）和非器质性（NO组；n = 34）ED。所有受试者以及7名年龄匹配的健康受试者作为对照，接受静脉闭塞体积描记法（VOP）以评估肱动脉的内皮依赖性扩张。还评估了血压、总睾酮和游离睾酮、催乳素、雌二醇、低密度脂蛋白和高密度脂蛋白胆固醇；通过HOMA-IR指数对患者的胰岛素抵抗进行分类。在没有任何ED相关伴随危险因素或合并症的情况下，O组ED患者中吸食大麻的情况比NO组ED患者更常见（78%对3%，P<0.001）。VOP研究显示，O组ED患者存在内皮依赖性血管舒张受损，而NO组ED患者和对照组则无（分别为12±6与32±4和34±5 ml/min，P = 0.003）。总体患者中，HOMA-IR与PSV之间存在直接关系（r² = 0.47，P<0.0001），在器质性ED男性中这种关系依然存在（r² = 0.62，P<0.0001）。在吸食大麻者中，还发现HOMA-IR与VOP之间存在直接关系（r² = 0.74，P<0.0001）。受试者操作特征（ROC）曲线分析显示，VOP值低于17.22 ml/min提示血管源性ED。我们得出结论，长期吸食大麻（以及内源性大麻素系统激活）可能会导致早期内皮损伤；胰岛素抵抗可能是早期内皮功能障碍的标志，并且在无肥胖的情况下可能共同导致血管性ED。有必要进一步研究以确定大麻滥用、胰岛素抵抗的发生与血管性ED发展之间的直接关系。
