系统性硬化症患者的勃起功能障碍、内皮功能障碍和微血管损伤。
Erectile dysfunction, endothelium dysfunction, and microvascular damage in patients with systemic sclerosis.
机构信息
Department of Clinical Medicine, Clinical Immunology Unit-Scleroderma Center, Sapienza University of Rome, Rome, Italy.
出版信息
J Sex Med. 2013 May;10(5):1380-8. doi: 10.1111/jsm.12110. Epub 2013 Feb 27.
INTRODUCTION
Erectile dysfunction (ED) prevalence in men with systemic sclerosis (SSc) is high and can be considered a manifestation of endothelium damage.
AIM
This study aims to correlate ED with endothelial dysfunction and digital vascular damage in SSc patients.
MAIN OUTCOME MEASURES
The main outcome measures were erectile function, Doppler indices of cavernous arteries, flow-mediated dilation (FMD), capillaroscopic damage, skin perfusion, and digital pulsatility.
METHODS
In 23 SSc patients, erectile function was investigated using the International Index of Erectile Function-5 (IIEF-5). Doppler indices of cavernous arteries, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured at the penoscrotal junction before and after pharmacostimulation with 20 mg prostaglandin E1. FMD and nailfold videocapillaroscopy (NVC) were used to evaluate endothelial dysfunction and capillaroscopic damage. Skin perfusion and digital sphygmic waves were measured by laser Doppler perfusion imaging (LDPI) and digital photoplethysmography (PPG), respectively.
RESULTS
IIEF-5 score was reduced in 83% of patients. PSV was reduced in 96%, while EDV was increased in 48% of patients. A positive correlation was observed between IIEF-5 score and FMD (r = 0.71, P < 0.0001) and between the former and PSV (r = 0.76, P < 0.0001). A negative correlation was observed between EDV and FMD (r = -0.509, P < 0.01). FMD and Doppler indices were reduced with capillaroscopic damage progression. A positive correlation exists between LDPI perfusion and IIEF-5 score (r = 0.743, P < 0.0001) and between the former and PSV (r = 0.714, P < 0.0001), while a negative correlation is observed between LDPI perfusion and EDV (r = -0.677, P < 0.0001). A positive correlation exists between PPG pulsatility and IIEF-5 score (r = 0.752, P < 0.0001) and between the former and PSV (r = 0.747, P < 0.0001), while negative correlation is observed between PPG pulsatility and EDV (r = -0.689, P < 0.0001).
CONCLUSION
In SSc patients, ED correlates with endothelial dysfunction and digital microvascular damage.
简介
系统性硬化症（SSc）患者的勃起功能障碍（ED）患病率较高，可被视为内皮损伤的表现。
目的
本研究旨在探讨 SSc 患者 ED 与内皮功能障碍和数字血管损伤的相关性。
主要观察指标
主要观察指标为勃起功能、海绵体动脉多普勒指数、血流介导的扩张（FMD）、甲襞微循环损伤、皮肤灌注和数字脉搏波。
方法
对 23 例 SSc 患者进行国际勃起功能指数-5（IIEF-5）评估。在药物刺激 20mg 前列腺素 E1 前后，在阴茎阴囊交界处测量海绵体动脉的多普勒指数、收缩期峰值速度（PSV）、舒张末期速度（EDV）和阻力指数（RI）。使用血流介导的扩张（FMD）和甲襞视频显微镜（NVC）评估内皮功能障碍和甲襞微循环损伤。使用激光多普勒灌注成像（LDPI）和数字光体积描记法（PPG）分别测量皮肤灌注和数字容积脉搏波。
结果
83%的患者 IIEF-5 评分降低。96%的患者 PSV 降低，48%的患者 EDV 升高。IIEF-5 评分与 FMD 呈正相关（r=0.71，P<0.0001），与 PSV 呈正相关（r=0.76，P<0.0001）。EDV 与 FMD 呈负相关（r=-0.509，P<0.01）。FMD 和多普勒指数随着甲襞微循环损伤的进展而降低。LDPI 灌注与 IIEF-5 评分呈正相关（r=0.743，P<0.0001），与 PSV 呈正相关（r=0.714，P<0.0001），而与 EDV 呈负相关（r=-0.677，P<0.0001）。PPG 脉冲波与 IIEF-5 评分呈正相关（r=0.752，P<0.0001），与 PSV 呈正相关（r=0.747，P<0.0001），而与 EDV 呈负相关（r=-0.689，P<0.0001）。
结论
在 SSc 患者中，ED 与内皮功能障碍和数字微血管损伤相关。
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