State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Urology. 2011 Aug;78(2):368-74. doi: 10.1016/j.urology.2011.02.070. Epub 2011 Jun 30.
To investigate whether vasculogenic erectile dysfunction (ED) severity and the clinical response to vardenafil were associated with structural and functional vascular changes in patients with uncomplicated hypertension.
Sexually active hypertensive men (n = 100), aged 50-70 years, completed the International Index of Erectile Function, Erection Function Domain (IIEF-EF) and were divided into 2 groups: 74 men with mild to moderate, moderate, or severe ED (IIEF-EF score ≤18) and without major cardiovascular disease and 26 controls (IIEF-EF score ≥25). Clinical and laboratory evaluations were performed, followed by measurement of the carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) before 4 attempts with 20 mg of vardenafil. The responders had ≥50% positive answers on sexual encounter profile question 3.
The carotid IMT was significantly greater and the FMD was significantly lower in patients with ED than in the control patients. The baseline IIEF-EF score correlated negatively with the carotid IMT (r = -0.48, P < .001) and with the Framingham score (r = -0.41, P < .001) among those with ED. After multivariate logistic regression analysis, the baseline IIEF score was independently and only associated with the carotid IMT (β = 6.105, P = .019). Responders were younger, had a lower cardiovascular risk profile and carotid IMT, and greater baseline IIEF-EF score and FMD than did the nonresponders. On logistic regression analysis, the response to vardenafil was independently associated with the brachial FMD (β = 1.085, P = .002).
In hypertensive men with vasculogenic ED and no other clinical evidence of arteriosclerosis, the ED severity correlated with the carotid IMT, and phosphodiesterase-5 effectiveness correlated with brachial FMD.
研究血管性勃起功能障碍（ED）的严重程度和伐地那非的临床反应是否与单纯高血压患者的结构和功能血管变化有关。
100 名年龄在 50-70 岁的有性生活的高血压男性完成了国际勃起功能指数（IIEF）、勃起功能域（IIEF-EF），并分为 2 组：74 名男性患有轻度至中度、中度或重度 ED（IIEF-EF 评分≤18）且无重大心血管疾病和 26 名对照组（IIEF-EF 评分≥25）。进行临床和实验室评估，然后在 4 次尝试中给予 20mg 伐地那非之前，测量颈动脉内膜中层厚度（IMT）和肱动脉血流介导的扩张（FMD）。应答者在性遭遇概况问题 3 中有≥50%的阳性回答。
与对照组相比，ED 患者的颈动脉 IMT 显著增大，FMD 显著降低。ED 患者的基线 IIEF-EF 评分与颈动脉 IMT（r=-0.48，P<0.001）和Framingham 评分（r=-0.41，P<0.001）呈负相关。经过多变量逻辑回归分析，基线 IIEF 评分是颈动脉 IMT 的独立且唯一的相关因素（β=6.105，P=0.019）。与无反应者相比，应答者更年轻，心血管风险状况和颈动脉 IMT 更低，基线 IIEF-EF 评分和 FMD 更高。在逻辑回归分析中，伐地那非的反应与肱动脉 FMD 独立相关（β=1.085，P=0.002）。
在没有其他动脉硬化临床证据的血管性 ED 高血压男性中，ED 严重程度与颈动脉 IMT 相关，而磷酸二酯酶-5 有效性与肱动脉 FMD 相关。
