中国2型糖尿病且无心血管疾病临床症状患者勃起功能障碍的心血管风险分析
Analysis of cardiovascular risks for erectile dysfunction in Chinese patients with type 2 diabetes mellitus lacking clinical symptoms of cardiovascular diseases.
作者信息
Yuan Penghui, Ma Delin, Zhang Yucong, Gao Xintao, Wang Jiaxin, Li Rui, Liu Zhuo, Wang Tao, Yang Yan, Yuan Gang, Yu Xuefeng, Wang Shaogang, Liu Jihong, Liu Xiaming
机构信息
Department of Urology and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Transl Androl Urol. 2020 Dec;9(6):2500-2509. doi: 10.21037/tau-20-999.
BACKGROUND
Erectile dysfunction (ED) is common but usually underdiagnosed in diabetics. The correlation between different vascular lesions and ED in diabetics without clinical cardiovascular symptoms is unknown. The aim was to explore the association between cardiovascular risks and ED in Chinese type 2 diabetic men lacking clinical performance.
METHODS
Erectile function of patients with type 2 diabetes was assessed by the 5-item International Index of Erectile Function (IIEF-5) questionnaire. The data of clinical characteristics and vascular lesions at carotid and lower limb sites assessed by the Doppler ultrasound were collected to evaluate diabetes- metabolic indices. Univariate and multivariate analyses were conducted to find statistical correlation between cardiovascular risks and diabetic ED.
RESULTS
A total of 71.21% reported suffering from ED. Lower limb plaques were more common (45.38%) than carotid district (35.62%) in diabetes. Men with ED had higher carotid intima-media thickness (IMT) (P<0.001) and the presence of lower limb plaques (P<0.001) compared with men without ED. After adjusting for age, diabetic duration, blood pressure (BP) and antidiabetic medication, carotid IMT greater than 0.75 mm (P<0.001) and the presence of lower limb plaques (P=0.051) remained associated with the presence of ED and its severity. Compared with isolated atherosclerosis at carotid or lower limb district, vascular lesions at any site and both sites were more correlative with ED presence (all P<0.001).
CONCLUSIONS
The prevalence of ED is high among Chinese diabetic men. A higher carotid IMT and the presence of lower limb plaques indicate a tight correlation between peripheral atherosclerosis and diabetic ED. ED may be the only clinical association of symptomatic cardiovascular diseases (CVDs) in diabetes. It is significant to screen ED to prevent the further development of severe symptomatic CVDs.
背景
勃起功能障碍（ED）在糖尿病患者中很常见，但通常诊断不足。无临床心血管症状的糖尿病患者中不同血管病变与ED之间的相关性尚不清楚。目的是探讨无临床表现的中国2型糖尿病男性心血管风险与ED之间的关联。
方法
采用5项国际勃起功能指数（IIEF-5）问卷评估2型糖尿病患者的勃起功能。收集通过多普勒超声评估的颈动脉和下肢部位的临床特征和血管病变数据，以评估糖尿病代谢指标。进行单因素和多因素分析，以发现心血管风险与糖尿病性ED之间的统计相关性。
结果
共有71.21%的患者报告患有ED。糖尿病患者中下肢斑块（45.38%）比颈动脉区（35.62%）更常见。与无ED的男性相比，有ED的男性颈动脉内膜中层厚度（IMT）更高（P<0.001），下肢斑块的发生率更高（P<0.001）。在调整年龄、糖尿病病程、血压（BP）和抗糖尿病药物后，颈动脉IMT大于0.75 mm（P<0.001）和下肢斑块的存在（P=0.051）仍与ED的存在及其严重程度相关。与颈动脉或下肢区孤立的动脉粥样硬化相比，任何部位和两个部位的血管病变与ED的存在更相关（所有P<0.001）。
结论
中国糖尿病男性中ED的患病率很高。较高的颈动脉IMT和下肢斑块的存在表明外周动脉粥样硬化与糖尿病性ED之间存在密切相关性。ED可能是糖尿病中有症状心血管疾病（CVD）的唯一临床关联。筛查ED对于预防严重有症状CVD的进一步发展具有重要意义。
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