School of Medicine, Tehran University of Medical Sciences, Tehran Province, District 6, Pour Sina St, P94V+8MF, TehranTehran, Iran.
Reprod Biol Endocrinol. 2024 Nov 19;22(1):148. doi: 10.1186/s12958-024-01317-4.
Erectile dysfunction (ED) has been linked to insulin resistance (IR), with various surrogate indices being used to assess this association. This systematic review and meta-analysis aimed to evaluate the relationship between IR indices and the incidence and severity of ED.
A comprehensive search across PubMed, Embase, Web of Science, and Scopus was carried out. Required data were extracted and meta-analyzed. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the studies' risk of bias. Sensitivity analyses and meta-regressions were conducted to explore heterogeneity and the impact of confounding variables.
Seventeen studies with a total of 3810 patients with ED and 8252 without ED were included. Meta-analysis revealed that males with ED had significantly higher levels of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (SMD = 0.59, 95% CI [0.15, 1.03], I = 82%, P < 0.01), Triglyceride-Glucose Index (TyG) (SMD = 0.53, 95% CI [0.31, 0.75], I = 69%, P < 0.01), and Visceral Adiposity Index (VAI) (SMD = 0.45, 95% CI [0.25, 0.64], I = 76%, P < 0.01) compared to those without ED. However, there was no significant correlation between a one-unit increase in HOMA-IR (OR = 0.63, 95% CI [0.03, 13.69], I = 91%, P = 0.77) or TyG (OR = 0.53, 95% CI [0.02, 11.53], I = 88%, P = 0.68) and the odds of ED. Additionally, a one-unit increase in VAI was associated with more severe ED (SMD = 0.34, 95% CI [0.03, 0.64], I = 16%, P = 0.03). The diagnostic accuracy of these indices varied.
The results indicate a significant connection between insulin resistance and erectile dysfunction, as shown by HOMA-IR, TyG, and VAI. Yet, their usefulness in predicting ED is restricted because of significant differences and inconsistencies in diagnostic precision. More research is required to determine the clinical importance of these indices in treating ED.
勃起功能障碍（ED）与胰岛素抵抗（IR）有关，各种替代指标被用于评估这种关联。本系统评价和荟萃分析旨在评估 IR 指标与 ED 的发生和严重程度之间的关系。
对 PubMed、Embase、Web of Science 和 Scopus 进行全面检索。提取必需数据并进行荟萃分析。采用纽卡斯尔-渥太华量表（NOS）评估研究的偏倚风险。进行敏感性分析和荟萃回归分析，以探讨异质性和混杂变量的影响。
纳入了 17 项研究，共纳入 3810 例 ED 患者和 8252 例非 ED 患者。荟萃分析显示，ED 男性的稳态模型评估的胰岛素抵抗（HOMA-IR）（SMD=0.59，95%CI[0.15,1.03]，I=82%，P<0.01）、甘油三酯-葡萄糖指数（TyG）（SMD=0.53，95%CI[0.31,0.75]，I=69%，P<0.01）和内脏脂肪指数（VAI）（SMD=0.45，95%CI[0.25,0.64]，I=76%，P<0.01）水平显著高于非 ED 患者。然而，HOMA-IR 每增加一个单位（OR=0.63，95%CI[0.03,13.69]，I=91%，P=0.77）或 TyG（OR=0.53，95%CI[0.02,11.53]，I=88%，P=0.68）的增加与 ED 发生的几率之间没有显著相关性。此外，VAI 每增加一个单位与更严重的 ED 相关（SMD=0.34，95%CI[0.03,0.64]，I=16%，P=0.03）。这些指标的诊断准确性存在差异。
结果表明，HOMA-IR、TyG 和 VAI 等指标显示胰岛素抵抗与勃起功能障碍之间存在显著关联。然而，由于诊断精度的显著差异和不一致性，它们在预测 ED 方面的实用性受到限制。需要进一步的研究来确定这些指标在治疗 ED 中的临床重要性。
