Duman Deniz Güney, Biçakci Ercan, Çelikel Çiğdem Ataizi, Akbal Cem
Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey.
J Sex Med. 2016 Mar;13(3):383-8. doi: 10.1016/j.jsxm.2015.12.030. Epub 2016 Feb 4.
Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome (MetS). Although the link between MetS and erectile dysfunction (ED) is well known, clinical studies investigating the association between NAFLD and ED are scant.
To evaluate the relationship between NAFLD and ED.
Male patients with biopsy-proven NAFLD were prospectively asked to fill the five-item International Index of Erectile Function (IIEF-5) questionnaire. Their clinical and histologic variables were compared with the IEFF scores.
IIEF scores; proportions of NAFLD patients who demonstrated ED and/or MetS; association between the severity of histological hepatic damage and ED.
Forty male patients having an age range of 33 (24-57) and a mean age of 40.13 ± 10.22 years with biopsy-proven NAFLD had a median IIEF-5 score of 16 (9-25) and MetS was present in 23 (57.5%). ED severity distributions as moderate, mild, and no ED were 11 (27.5%), 16 (40%), and 13 (32.5 %), respectively. Histological NAFLD score was significantly higher in patients having ED compared with patients with no ED (5.63 ± 1.39 vs. 4.15 ± 1.46; P = .006). MetS diagnosis was significantly more common in patients having ED, compared with those without ED [19 (70.4%) vs. 4 (30.8%), respectively, P = .018)]. When patients with and without ED were compared, gamma glutamyl transferase was significantly lower in ED, whereas components of MetS did not correlate with ED. After multivariate analysis, NAFLD score has remained the only significant outcome associated with ED [P = .03; OR (95% CI): 2.38 (1.079-5.238)].
The current clinical study demonstrates a significant association between nonalcoholic steatohepatitis and ED for the first time. Our findings suggest liver damage may play role in the pathogenesis of ED in patients with NAFLD. Future studies are needed to expand the underlying common mechanisms responsible for this novel hypothesis.
非酒精性脂肪性肝病（NAFLD）被认为是代谢综合征（MetS）的肝脏表现。虽然MetS与勃起功能障碍（ED）之间的联系已为人所知，但调查NAFLD与ED之间关联的临床研究却很少。
评估NAFLD与ED之间的关系。
前瞻性地要求经活检证实为NAFLD的男性患者填写五项国际勃起功能指数（IIEF-5）问卷。将他们的临床和组织学变量与IIEF评分进行比较。
IIEF评分；患有ED和/或MetS的NAFLD患者比例；肝脏组织学损伤严重程度与ED之间的关联。
40名年龄在33岁（24 - 57岁）、平均年龄为40.13±10.22岁且经活检证实为NAFLD的男性患者，IIEF-5评分中位数为16（9 - 25），23名（57.5%）存在MetS。ED严重程度分布为中度、轻度和无ED的分别有11名（27.5%）、16名（40%）和13名（32.5%）。与无ED的患者相比，患有ED的患者组织学NAFLD评分显著更高（5.63±1.39对4.15±1.46；P = 0.006）。与无ED的患者相比，患有ED的患者MetS诊断明显更常见[分别为19名（70.4%）对4名（30.8%），P = 0.018]。比较有ED和无ED的患者时，ED患者的γ-谷氨酰转移酶显著更低，而MetS的组成成分与ED无相关性。多因素分析后，NAFLD评分仍然是与ED相关的唯一显著结果[P = 0.03；OR（95%CI）：2.38（1.079 - 5.238）]。
当前的临床研究首次证明非酒精性脂肪性肝炎与ED之间存在显著关联。我们的研究结果表明肝脏损伤可能在NAFLD患者ED的发病机制中起作用。需要进一步研究以拓展这一新假说背后的共同机制。
