Wang Xuesheng, Zhang Fan, Guo Liqiang, Ma Zhen, Liao Limin, Yuan Mingzhen
Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.
Department of Urology, Capital Medical University, Beijing, China.
Transl Androl Urol. 2022 Mar;11(3):397-406. doi: 10.21037/tau-21-953.
The primary objective of this cross-sectional study aimed at evaluating serum levels of homocysteinemia (Hcy) in a cohort of erectile dysfunction (ED) patients, and at assessing the correlation between Hcy and vasculogenic ED.
A total of 119 Chinese patients presenting with ED [International Index of Erectile Function (IIEF)-5≤21] were enrolled in this study. The whole cohort was asked to complete the IIEF-5 questionnaire and blood analysis. A detailed medical history, physical examination, nocturnal penile tumescence (NPT) tests and penile color Doppler ultrasonography (pDUS) were performed by a urologist. Based on the pDUS result, they were further categorized into 2 main groups: non-vasculogenic ED (n=79) and vasculogenic ED (n=40).
Age and Hcy levels were significantly higher in the vasculogenic ED group compared to the non-vasculogenic ED group (38.45±8.51 32.29±7.57 and 22.91±5.85 16.31±5.23 µmol/L, respectively, P<0.01). Univariate and multivariable regression analyses showed that the incidence of vasculogenic ED raised significantly with the increase of Hcy level. After multivariable adjustment, ED patients with hyperhomocysteinaemia (HHcy) had 13.42 times the odds of vasculogenic ED compared with patients without HHcy (OR: 13.42, 95% CI: 3.78 to 47.64). Moreover, the risk of vasculogenic ED was 1.24 (95% CI: 1.04 to 1.48, P=0.01) per-unit increase in Hyc concentration for ED with HHcy. In addition, the smoothing curve revealed that Hcy levels were inversely correlated with peak-systolic velocity (PSV) (β: -0.48, 95% CI: -0.91 to -0.05, P=0.04) in vasculogenic ED patients by multivariate regression analysis. Furthermore, in the analysis of receiver operating characteristic curve, the area under curve for Hcy to predict vasculogenic ED was 0.81 (95% CI: 0.73 to 89) in patients with ED.
These findings suggest a dose-dependent association between Hcy and vasculogenic ED. HHcy was a risk factor for vasculogenic erectile dysfunction. Therefore, HHcy is likely to be a potential indicator to predict and diagnose vasculogenic ED when using pDUS.
本横断面研究的主要目的是评估一组勃起功能障碍（ED）患者的高同型半胱氨酸血症（Hcy）血清水平，并评估Hcy与血管性ED之间的相关性。
本研究共纳入119例出现ED[国际勃起功能指数（IIEF）-5≤21]的中国患者。整个队列被要求完成IIEF-5问卷和血液分析。由泌尿科医生进行详细的病史、体格检查、夜间阴茎勃起（NPT）测试和阴茎彩色多普勒超声检查（pDUS）。根据pDUS结果，他们进一步分为2个主要组：非血管性ED（n=79）和血管性ED（n=40）。
与非血管性ED组相比，血管性ED组的年龄和Hcy水平显著更高（分别为38.45±8.51对32.29±7.57以及22.91±5.85对16.31±5.23µmol/L，P<0.01）。单因素和多因素回归分析表明，血管性ED的发生率随着Hcy水平的升高而显著增加。多因素调整后，高同型半胱氨酸血症（HHcy）的ED患者发生血管性ED的几率是无HHcy患者的13.42倍（OR：13.42，95%CI：3.78至47.64）。此外，对于伴有HHcy的ED患者，Hyc浓度每增加一个单位，血管性ED的风险为1.24（95%CI：1.04至1.48，P=0.01）。此外，平滑曲线显示，通过多因素回归分析，血管性ED患者的Hcy水平与收缩期峰值流速（PSV）呈负相关（β：-0.48，95%CI：-0.91至-0.05，P=0.04）。此外，在受试者工作特征曲线分析中，ED患者中Hcy预测血管性ED的曲线下面积为0.81（95%CI：0.73至89）。
这些发现表明Hcy与血管性ED之间存在剂量依赖性关联。HHcy是血管性勃起功能障碍的一个危险因素。因此，在使用pDUS时，HHcy可能是预测和诊断血管性ED的一个潜在指标。
