Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Andrology. 2020 Mar;8(2):400-406. doi: 10.1111/andr.12701. Epub 2019 Sep 18.
Hyperactivity of the sympathetic nervous system was considered as one of the factors involved in the pathological mechanisms of premature ejaculation (PE). Sympathetic skin response of the penis (PSSR) was used to evaluate the activity of sympathetic innervations in the penis, which was controlled by the central nervous system (brain). Shorter PSSR was found in PE patients; however, little was known regarding the central neural mechanisms of PE patients with high sympathetic activity.
PSSR of PE patients was evaluated, and diffusion tensor images of participants were collected. Graph theoretical analysis was employed to examine the differences of the topological properties of structural brain connectome between PE patients with high sympathetic activity and healthy controls (HCs). Moreover, the relationships between topological characteristics and clinical features in PE patients were also explored.
Decreased local efficacy was found in the left amygdala, right pallidum and thalamus in the white matter brain networks of PE when compared with HC (survived false discovery rate (FDR) correction). In addition, PE patients showed decreased global efficacy in the left amygdala and right rolandic operculum, supramarginal gyrus, heschl gyrus, inferior temporal gyrus, pallidum and thalamus; however, these results did not survive FDR correction. Finally, the local efficacy of right thalamus had a positive correlation with the premature ejaculation diagnostic tool (PEDT) scores, while the local efficacy of left amygdala was negatively associated with the state score of the state-trait anxiety inventory (STAI) and penile shaft sensory threshold.
The results highlighted the abnormal topological properties of structural brain connectome in PE with high sympathetic activity. We also suggested that the clinical features of PE were related to the abnormality of several brain regions involved in the central control of ejaculation and emotion. This study provided new insights into the central neural mechanisms of PE, which might offer biological markers for understanding the physiopathology of PE.
交感神经系统的过度活跃被认为是早泄（PE）病理机制的因素之一。阴茎交感皮肤反应（PSSR）用于评估阴茎交感神经支配的活动，该活动由中枢神经系统（大脑）控制。PE 患者的 PSSR 较短；然而，对于交感神经活动较高的 PE 患者的中枢神经机制知之甚少。
评估 PE 患者的 PSSR，并收集参与者的弥散张量图像。采用图论分析方法，研究交感神经活动较高的 PE 患者与健康对照（HC）之间大脑结构连接组拓扑性质的差异。此外，还探讨了 PE 患者拓扑特征与临床特征之间的关系。
与 HC 相比，PE 患者的大脑白质网络中左侧杏仁核、右侧苍白球和丘脑的局部效率降低（经校正后假发现率（FDR）校正）。此外，PE 患者的左侧杏仁核和右侧 Rolandic 脑回、缘上回、Heschl 回、颞下回、苍白球和丘脑的全局效率也降低，但这些结果未通过 FDR 校正。最后，右侧丘脑的局部效率与早泄诊断工具（PEDT）评分呈正相关，而左侧杏仁核的局部效率与状态-特质焦虑量表（STAI）的状态评分呈负相关，与阴茎干感觉阈值呈负相关。
研究结果强调了交感神经活动较高的 PE 患者大脑结构连接组拓扑性质的异常。我们还认为，PE 的临床特征与涉及射精和情绪中枢控制的几个脑区的异常有关。本研究为交感神经活动较高的 PE 的中枢神经机制提供了新的见解，可能为理解 PE 的生理病理提供生物学标志物。
