Patel Jay Pravin, Lee Eric Hweegeun, Mena Carlos Ignacio, Walker Charles N
Yale School of Medicine & Yale School of Management, New Haven, CT, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Transl Androl Urol. 2017 Jun;6(3):556-565. doi: 10.21037/tau.2017.03.52.
Erectile dysfunction (ED) affects approximately 18 million American men. ED may be attributed to several etiologies, including arteriogenic, psychogenic, neurogenic, hormonal, drug-induced, and systemic disease or aging related factors. Specific to arteriogenic ED, three major mechanisms have been identified: (I) endothelium-dependent vasodilatory impairment; (II) sympathetic nerve activity elevation; (III) atherosclerotic luminal narrowing. Additionally, these insults have been linked to the insulin resistant state, which in turn is comorbid with obesity, dyslipidemia, diabetes, and hypertension. In this review, we summarize the evidence regarding the impact of metformin-an insulin sensitizer-on the three mechanisms of arteriogenic ED. We report that metformin treatment positively affects two of three pathways, specifically through enhanced endothelium-dependent vasodilation and sympathetic nerve activity attenuation, but does not seem to have a significant impact on hypertension regulation. Given the encouraging data found in both animal and clinical studies, we advocate for further studies on metformin use in ED.
勃起功能障碍（ED）影响着约1800万美国男性。ED可能归因于多种病因，包括动脉源性、心理性、神经性、激素性、药物性以及与全身疾病或衰老相关的因素。具体针对动脉源性ED，已确定三种主要机制：（I）内皮依赖性血管舒张功能受损；（II）交感神经活动增强；（III）动脉粥样硬化管腔狭窄。此外，这些损伤与胰岛素抵抗状态有关，而胰岛素抵抗状态又与肥胖、血脂异常、糖尿病和高血压并存。在本综述中，我们总结了关于二甲双胍（一种胰岛素增敏剂）对动脉源性ED的三种机制影响的证据。我们报告称，二甲双胍治疗对三种途径中的两种有积极影响，具体是通过增强内皮依赖性血管舒张和减弱交感神经活动，但似乎对高血压调节没有显著影响。鉴于在动物和临床研究中都发现了令人鼓舞的数据，我们主张进一步研究二甲双胍在ED治疗中的应用。
