Mazo E B, Gamidov S I, Sotnikova E M
Ter Arkh. 2008;80(12):59-63.
To study effects of different treatments on erectile and endothelial functions in patients with erectile dysfunction (ED) and age-related hypogonadism (HG).
The study included 66 males with ED who had clinical and laboratory signs of HG. All the patients were examined using questionnaires (international index of erectile function, AMS), blood hormones tests. Endothelial function was assessed with postcompression tests on the cavernous arteries and blood homocystein assay. All the patients were divided into two matched groups. Group 1 (20 males, mean age 54.6 +/- 11.5 years) received androgens only, replacement therapy consisted of testosterone undecanoate (Nebido, Shering) 1000 mg each 10-12 weeks intramuscularly, interval between the first and second injection was 6 weeks. Group 2 (46 males, mean age 53.98 +/- 10.03 years) was given combined treatment (androgens and PDE 5 inhibitors), wardenafil (Levitra, Buer Shering Pharma) was used in a dose 20 mg. The treatment lasted 6 months.
AMS points decreased in group 1 from 38.3 +/- 0.29 to 29.2 +/- 0.32, in group 2--from 39.02 +/- 0.21 to 28.6 +/- 0.95, while testosterone rose from 9.86 +/- 0.4 to 17.77 +/- 0.42 and 9.35 +/- 0.25 to 17.21 +/- 0.63 nmol, respectively. Homocystein lowering was significantly more manifest in group 2. EF index in group 2 rose from 11.4 +/- 0.77 to 25.54 +/- 0.25 points versus 11.2 +/- 1.01 to 23.95 +/- 0.71 points in group 1, improvement of EF in group 2 occurred sooner. Endothelial function by diameter of the cavernous arteries differed after treatment in group 1 and 2 (19.55 +/- 2.88 to 39.2 +/- 0.84% and 19.51 +/- 1.28 to 48.5 +/- 1.76, respectively, p<0.001).
Combined therapy improves blood homocistein, acts faster and stronger on endothelial and erectile functions and can be recommended as first line for ED and HG patients.
研究不同治疗方法对勃起功能障碍（ED）合并年龄相关性性腺功能减退（HG）患者勃起功能和内皮功能的影响。
该研究纳入了66例患有ED且有HG临床和实验室体征的男性。所有患者均通过问卷调查（国际勃起功能指数、美国泌尿协会症状指数）、血液激素检测进行检查。通过海绵体动脉压迫后试验和血液同型半胱氨酸测定评估内皮功能。所有患者被分为两个匹配组。第1组（20例男性，平均年龄54.6±11.5岁）仅接受雄激素治疗，替代疗法为每10 - 12周肌肉注射1000mg十一酸睾酮（耐必多，先灵公司），第一次和第二次注射间隔为6周。第2组（46例男性，平均年龄53.98±10.03岁）接受联合治疗（雄激素和5型磷酸二酯酶抑制剂），使用西地那非（艾力达，拜耳先灵医药公司），剂量为20mg。治疗持续6个月。
第1组美国泌尿协会症状指数评分从38.3±0.29降至29.2±0.32，第2组从39.02±0.21降至28.6±0.95，而睾酮水平分别从9.86±0.4升至17.77±0.42以及从9.35±0.25升至17.21±0.63nmol。第2组同型半胱氨酸降低更为明显。第2组勃起功能指数从11.4±0.77升至25.54±0.25分，而第1组从11.2±1.01升至23.95±0.71分，第2组勃起功能改善更快。治疗后第1组和第2组海绵体动脉直径所反映的内皮功能存在差异（分别为19.55±2.88至39.2±0.84%以及19.51±1.28至48.5±1.76，p<0.001）。
联合治疗可改善血液同型半胱氨酸水平，对内皮功能和勃起功能的作用更快更强，可推荐作为ED和HG患者的一线治疗方法。
