Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea.
J Sex Med. 2012 Jun;9(6):1550-8. doi: 10.1111/j.1743-6109.2012.02720.x. Epub 2012 Apr 10.
Poor glycemic control is associated with erectile dysfunction (ED); however, differences in ED according to the level of glycemic control have been poorly investigated.
The aim of this paper is to investigate the change in erectile function according to the level of glycemic control and to clarify the pathophysiological mechanism of diabetes-associated ED.
Streptozotocin was injected into 55 male Sprague-Dawley rats classified into four groups: control (group 1), diabetes with multiple insulin injections (group 2), diabetes with a single injection (group 3), and untreated diabetes (group 4). Daily insulin injections in groups 2 and 3 were administered for 4 weeks after 10 weeks of diabetic induction.
The main outcome measures are the anova or Kruskal-Wallis tests to evaluate glycosylated hemoglobin (HbA1c), testosterone levels, the ratios of intracavernosal pressure to mean arterial pressure (ICP/MAP), area under the ICP curve to MAP (AUC/MAP), and changes in cavernous tissue and protein expression related to Rho kinase and nitric oxide pathways.
HbA1c levels were different between pairs of groups. Group 4 showed the lowest erectile parameters and group 2 showed near normal level. No differences in erectile parameters were found between groups 1 and 2 or between groups 3 and 4, except the ratio of AUC to MAP for group 1 was significantly higher than that of group 2 (20 Hz stimulation). Decrease in erectile function of group 2 was related to decreased expression of nitrergic nitric oxide synthase or decreased testosterone level compared with group 1. Groups 2 and 3 showed significant differences in erectile parameters, which were associated with difference in apoptotic index. Groups 3 and 4 showed no differences in erectile parameters, although these groups had significant differences in apoptotic index, smooth muscle component, and protein expression ratios of phosphorylated to total myosin phosphatase target subunit 1, endothelial nitric oxide synthase, and Akt.
Improvement in glycemic control assists recovery from diabetes-associated ED; however, only tight glycemic control can provide recovery from ED to a near normal status.
血糖控制不佳与勃起功能障碍（ED）有关；然而，根据血糖控制水平，ED 的差异尚未得到充分研究。
本文旨在研究根据血糖控制水平，勃起功能的变化，并阐明糖尿病相关 ED 的病理生理机制。
将链脲佐菌素注入 55 只雄性 Sprague-Dawley 大鼠，分为四组：对照组（第 1 组）、多次胰岛素注射糖尿病组（第 2 组）、单次注射糖尿病组（第 3 组）和未治疗糖尿病组（第 4 组）。在诱导糖尿病 10 周后，第 2 组和第 3 组每天进行胰岛素注射，持续 4 周。
主要观察指标是anova 或 Kruskal-Wallis 检验，以评估糖化血红蛋白（HbA1c）、睾酮水平、海绵体内压与平均动脉压（ICP/MAP）比值、ICP 曲线下面积与 MAP（AUC/MAP）比值以及与 Rho 激酶和一氧化氮途径相关的海绵体组织和蛋白表达的变化。
各组间 HbA1c 水平存在差异。第 4 组的勃起参数最低，第 2 组接近正常水平。第 1 组和第 2 组之间或第 3 组和第 4 组之间的勃起参数无差异，除了第 1 组的 AUC 与 MAP 比值明显高于第 2 组（20 Hz 刺激）。与第 1 组相比，第 2 组的勃起功能下降与 nitrergic 一氧化氮合酶表达减少或睾酮水平降低有关。第 2 组和第 3 组的勃起参数存在显著差异，这与凋亡指数的差异有关。第 3 组和第 4 组的勃起参数无差异，尽管这些组的凋亡指数、平滑肌成分和磷酸化肌球蛋白磷酸酶靶亚单位 1、内皮型一氧化氮合酶和 Akt 的总蛋白表达比值有显著差异。
改善血糖控制有助于恢复糖尿病相关 ED；然而，只有严格的血糖控制才能使 ED 恢复到接近正常状态。
