Department of Andrology, China-Japan Friendship Hospital, Beijing, China.
Graduate School of Beijing University of Chinese Medicine, Beijing, China.
Endocrine. 2024 Jun;84(3):903-913. doi: 10.1007/s12020-023-03653-8. Epub 2023 Dec 28.
PURPOSE: Lipid parameters have been shown to have significant predictive value for cardiovascular disease, but few studies have evaluated their correlation with erectile dysfunction (ED) in young men. METHODS: The case-control study encompassed 186 young ED patients (ages 20-40) and 186 healthy controls. Lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL ratio, TG/HDL ratio, and LDL-C/HDL-C ratio, were assessed in all participants. The International Index of Erectile Function (IIEF-5) scores were collected for all participants to evaluate erectile status. Multivariate logistic regression analysis was utilized to appraise the association of lipid-related parameters with ED. Single-nucleotide polymorphisms (SNPs) significantly correlated with lipid parameters (TC, TG, LDL-C, HDL-C) were selected from genome-wide association studies (GWAS) as instrumental variables (IV) (P < 5.0 × 10). Summary data for ED was gathered from a GWAS with a sample size of (n = 17,353 cases/28,210 controls). The inverse variance weighted (IVW) method was employed as the primary mendelian randomization (MR) analysis method to assess causal effects. Causal estimates were represented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Results from the case-control study revealed that, when compared with the control group, levels of LDL-C, TG, UA, LDL-C/HDL-C, TG/HDL-C, and TC/HDL-C in the ED group were significantly elevated (P < 0.01), while HDL-C was significantly decreased (P < 0.01) in the ED group. Multivariate logistic regression analysis indicated LDL-C/HDL-C as a risk factor for both the incidence and severity of ED (P < 0.001). Two-sample MR analysis demonstrated no significant causal correlation between lipid parameters-LDL-C (OR, 0.98, 95% CI, 0.88-1.08, P = 0.616), HDL-C (OR, 1.07, 95% CI: 0.96-1.19, P = 0.249), TC (OR, 1.07, 95% CI, 0.96-1.18, P = 0.208), TG (OR, 0.98, 95% CI, 0.80-1.13, P = 0.579) -and an increased risk of ED (all P > 0.05). CONCLUSIONS: The case-control analysis ascertained a significant association between LDL-C, HDL-C, LDL-C/HDL-C, and ED and its severity. However, results from the MR study do not support a causal role of lipid parameters in ED.
目的：脂质参数已被证明对心血管疾病具有重要的预测价值，但很少有研究评估它们与年轻男性勃起功能障碍（ED）的相关性。
方法：这项病例对照研究纳入了 186 例年轻 ED 患者（年龄 20-40 岁）和 186 例健康对照者。所有参与者均评估了脂质参数，包括总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、TC/HDL 比值、TG/HDL 比值和 LDL-C/HDL-C 比值。所有参与者均采用国际勃起功能指数（IIEF-5）评分评估勃起功能状态。采用多变量 logistic 回归分析评估脂质相关参数与 ED 的相关性。从全基因组关联研究（GWAS）中选择与脂质参数（TC、TG、LDL-C、HDL-C）显著相关的单核苷酸多态性（SNP）作为工具变量（IV）（P<0.05×10）。从一项样本量为 17353 例病例/28210 例对照的 GWAS 中汇总 ED 的汇总数据。采用逆方差加权（IVW）方法作为主要的孟德尔随机化（MR）分析方法来评估因果关系。因果估计值表示为比值比（OR）及其 95%置信区间（CI）。
结果：病例对照研究结果显示，与对照组相比，ED 组的 LDL-C、TG、UA、LDL-C/HDL-C、TG/HDL-C 和 TC/HDL-C 水平显著升高（P<0.01），而 HDL-C 水平显著降低（P<0.01）。多变量 logistic 回归分析显示 LDL-C/HDL-C 是 ED 发生和严重程度的危险因素（P<0.001）。两样本 MR 分析表明，脂质参数 LDL-C（OR，0.98，95%CI，0.88-1.08，P=0.616）、HDL-C（OR，1.07，95%CI：0.96-1.19，P=0.249）、TC（OR，1.07，95%CI，0.96-1.18，P=0.208）和 TG（OR，0.98，95%CI，0.80-1.13，P=0.579）与 ED 风险增加之间无显著因果关联（均 P>0.05）。
结论：病例对照分析确定了 LDL-C、HDL-C、LDL-C/HDL-C 与 ED 及其严重程度之间存在显著相关性。然而，MR 研究的结果不支持脂质参数在 ED 中起因果作用。
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