Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Italy.
Eur J Intern Med. 2013 Apr;24(3):234-40. doi: 10.1016/j.ejim.2013.01.001. Epub 2013 Jan 26.
The low pharmacological response to phosphodiesterase type 5 inhibitors represents an expression of higher endothelial damage in certain categories of patients with erectile dysfunction and high cardiovascular risk. The present study evaluated this objective in type 2 diabetic patients with erectile dysfunction, classified as "non responders" to Sildenafil.
Eighteen "responder" and twelve "non responder" type 2 diabetic patients were evaluated, relatively to different levels of endothelial damage, through the diagnostic use of a new immunophenotype of circulating endothelial progenitor cells (CD45neg/CD34pos/CD144pos) and endothelial microparticles (CD45neg/CD144pos/Annexin Vpos), recently developed and published by our group.
"Non responder" patients showed a significant higher severity [8.0±3.0 (International Index of Erectile Function-abbreviated version with 5 questions) vs 14.0±3.0] and duration (10.0±2.0 vs 7.0±2.0 years) of erectile dysfunction, higher level of penile arterial insufficiency (peak systolic velocity=13.0±16.0 vs 28.0±26.0cm/s; acceleration time=153±148 vs 125±128 mm/s) and finally a significant higher level of endothelial apoptosis [0.15±0.13 vs 0.05±.0.03% (serum concentrations of endothelial microparticles)] associated with higher serum concentrations of circulating late immunophenotype of endothelial progenitor cells (0.40±0.35 vs 0.12±.0.10%).
The results of this study corroborate the clinical value of the low clinical response to phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction in the patients with high cardiovascular risk profile, such as diabetics. In addition, the markers used in this study confirm their potential application in clinical practice as useful indicators of endothelial alteration. However, in the future we will have to assess a larger number of patients and for a longer period of observation in order to better understand the causal and temporal relations.
在某些类别的勃起功能障碍和高心血管风险患者中，对磷酸二酯酶 5 抑制剂的低药理反应代表了更高的内皮损伤的表达。本研究评估了 2 型糖尿病勃起功能障碍患者的这种情况，这些患者被归类为西地那非的“无反应者”。
评估了 18 名“反应者”和 12 名“无反应者”2 型糖尿病患者，通过使用我们小组最近开发和发表的新型循环内皮祖细胞（CD45neg/CD34pos/CD144pos）和内皮微颗粒（CD45neg/CD144pos/Annexin Vpos）的免疫表型，评估不同水平的内皮损伤。
“无反应者”患者表现出显著更高的严重程度[8.0±3.0（5 个问题的国际勃起功能指数缩写版）与 14.0±3.0]和勃起功能障碍的持续时间（10.0±2.0 与 7.0±2.0 年），更高的阴茎动脉不足程度（收缩期峰值速度=13.0±16.0 与 28.0±26.0cm/s；加速时间=153±148 与 125±128mm/s），最后是显著更高的内皮细胞凋亡水平[0.15±0.13 与 0.05±0.03%（血清内皮微颗粒浓度）]，同时伴有循环晚期内皮祖细胞免疫表型的血清浓度升高[0.40±0.35 与 0.12±0.10%]。
本研究的结果证实了在高心血管风险患者（如糖尿病患者）中，对磷酸二酯酶 5 抑制剂治疗勃起功能障碍的低临床反应的临床价值。此外，本研究中使用的标志物证实了它们在临床实践中的潜在应用，作为内皮改变的有用指标。然而，未来我们将不得不评估更多的患者，并进行更长时间的观察，以便更好地理解因果和时间关系。
