Blanco R, Saenz de Tejada I, Goldstein I, Krane R J, Wotiz H H, Cohen R A
Department of Urology, Boston University School of Medicine, Massachusetts.
J Urol. 1990 Aug;144(2 Pt 1):278-80. doi: 10.1016/s0022-5347(17)39431-4.
Impotence in the diabetic man may be secondary to a neuropathic condition of the autonomic penile nerves. The relationship between autonomic neuropathy and impotence in diabetes was studied in human corporeal tissue obtained during implantation of a penile prosthesis in 19 impotent diabetic and 15 nondiabetic patients. The functional status of penile cholinergic nerves was assessed by determining their ability to accumulate tritiated choline (34), and synthesize (34) and release (19) tritiated-acetylcholine after incubation of corporeal tissue with tritiated-choline (34). Tritiated-choline accumulation, and tritiated-acetylcholine synthesis and release were significantly reduced in the corporeal tissue from diabetic patients compared to that from nondiabetic patients (p less than 0.05). The impairment in acetylcholine synthesis worsened with the duration of diabetes (p less than 0.025). No differences in the parameters measured were found between insulin-dependent (11) and noninsulin-dependent (8) diabetic patients. The ability of the cholinergic nerves to synthesize acetylcholine could not be predicted clinically with sensory vibration perception threshold testing. It is concluded that there is a functional penile neuropathic condition of the cholinergic nerves in the corpus cavernosum of diabetic impotent patients that may be responsible for the erectile dysfunction.
糖尿病男性的阳痿可能继发于自主神经支配阴茎神经的神经病变。在19例阳痿糖尿病患者和15例非糖尿病患者植入阴茎假体期间获取的人体阴茎组织中，研究了自主神经病变与糖尿病阳痿之间的关系。通过测定阴茎胆碱能神经在与氚标记胆碱共同孵育后积累氚标记胆碱（34）、合成（34）和释放（19）氚标记乙酰胆碱的能力，来评估其功能状态。与非糖尿病患者相比，糖尿病患者阴茎组织中的氚标记胆碱积累、氚标记乙酰胆碱合成和释放显著减少（p<0.05）。乙酰胆碱合成的损害随糖尿病病程延长而加重（p<0.025）。胰岛素依赖型（11例）和非胰岛素依赖型（8例）糖尿病患者之间，所测参数无差异。胆碱能神经合成乙酰胆碱的能力无法通过感觉振动觉阈值测试进行临床预测。得出的结论是，糖尿病阳痿患者海绵体中存在胆碱能神经的功能性阴茎神经病变，这可能是勃起功能障碍的原因。
