Department of Immunology, National Institute of Endocrinology, La Habana, Cuba.
J Sex Med. 2011 Jul;8(7):2017-30. doi: 10.1111/j.1743-6109.2011.02277.x. Epub 2011 May 6.
Erectile dysfunction (ED) is highly prevalent among type 2 diabetes mellitus patients (T2DM). Although a link among systemic inflammation, endothelial dysfunction, and ED is described in clinical situations mainly related with coronary heart disease (CHD) risk, evidences of this link in T2DM patients are rather limited.
To evaluate the association between endothelial dysfunction and balance of pro-/anti-inflammatory mediators with ED presence and severity in T2DM.
We conducted a cross-sectional study of 190 T2DM patients without symptomatic CHD, 150 out of them with ED and 40 without ED. Serum levels of E-selectin, intercellular adhesion molecule-1, tumor necrosis factor-α (TNF-α), and interleukin (IL)-10 were measured using specific enzyme-linked immunosorbent assays (ELISAs). ED presence and severity were tested by the five-item version of the International Index of Erectile Function questionnaire.
Differences in circulating levels of endothelial dysfunction (ICAM-1, E-selectin) and inflammatory/anti-inflammatory (TNF-α, IL-10, TNF-α : IL-10 ratio) markers between T2DM patients with and without ED, and assessment of biomarkers ED predictive value while adjusting for other known ED risk factors.
Patients with ED were older and had longer duration of diabetes than patients without ED. E-selectin serum levels were significantly increased, while IL-10 were lower in patients with ED; because TNF-α levels tend to be higher, TNF-α : IL-10 ratio was more elevated in ED patients. No significant differences of ICAM-1 levels were observed between study groups. Endothelial activation markers and TNF-α, as well as diabetes duration, were negatively correlated with erectile function. On multivariate analysis including age, duration of diabetes, insulin treatment, hypertension, insulin resistance, fair-to-poor glycemic control, and metabolic syndrome, increments in E-selectin levels and TNF-α : IL-10 ratio predicted independently ED presence, while IL-10 increases were associated with lower risk of ED in T2DM patients.
ED in T2DM patients without symptomatic CHD is associated with systemic endothelial dysfunction and a predominant, imbalanced low-grade inflammatory response.
勃起功能障碍（ED）在 2 型糖尿病患者（T2DM）中极为常见。尽管在主要与冠心病（CHD）风险相关的临床情况下描述了全身炎症、内皮功能障碍和 ED 之间的联系，但在 T2DM 患者中，这种联系的证据相当有限。
评估内皮功能障碍与促炎/抗炎介质平衡与 T2DM 患者 ED 存在和严重程度之间的关系。
我们对 190 名无症状 CHD 的 T2DM 患者进行了横断面研究，其中 150 名患者患有 ED，40 名患者无 ED。使用特定的酶联免疫吸附测定（ELISA）测量血清 E-选择素、细胞间黏附分子-1、肿瘤坏死因子-α（TNF-α）和白细胞介素（IL）-10 水平。通过国际勃起功能指数问卷的五分量表测试 ED 的存在和严重程度。
T2DM 患者中 ED 患者与非 ED 患者之间循环内皮功能障碍（ICAM-1、E-选择素）和炎症/抗炎（TNF-α、IL-10、TNF-α：IL-10 比值）标志物的差异，以及在调整其他已知 ED 危险因素后评估生物标志物对 ED 的预测价值。
ED 患者比无 ED 患者年龄更大，糖尿病病程更长。ED 患者血清 E-选择素水平明显升高，IL-10 水平降低；由于 TNF-α 水平较高，TNF-α：IL-10 比值在 ED 患者中更高。两组间 ICAM-1 水平无显著差异。内皮激活标志物和 TNF-α以及糖尿病病程与勃起功能呈负相关。多元分析包括年龄、糖尿病病程、胰岛素治疗、高血压、胰岛素抵抗、血糖控制不佳和代谢综合征，E-选择素水平升高和 TNF-α：IL-10 比值独立预测 ED 存在，而 IL-10 升高与 T2DM 患者 ED 风险降低相关。
无症状 CHD 的 T2DM 患者的 ED 与全身内皮功能障碍和主要的、不平衡的低度炎症反应有关。
