Gao Songzhan, Liu Rusheng, Niu Peining, Guan Yichun, Yuan Chunjie, Chen Jianhuai, Yang Xianfeng
Department of Andrology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Andrology, Siyang Traditional Chinese Medicine Hospital, Suqian, China.
J Affect Disord. 2025 Nov 15;389:119666. doi: 10.1016/j.jad.2025.119666. Epub 2025 Jun 11.
Anxiety is considered to play a key role in the development and maintenance of premature ejaculation (PE). In addition, PE patients often co-occur with anxiety, however, the central mechanisms underlying this comorbidity have remained elusive. This study aimed to explore whether trait and state anxiety-related PE shared common or distinct mechanisms in the brain.
A total of 90 PE patients and 45 healthy controls (HCs) were enrolled. Patients were divided into subgroups including 45 patients with low trait anxiety (LTA) and 45 patients with high trait anxiety (HTA) by state and trait anxiety inventory-trait version (STAI-T). In addition, patients were divided into another two groups including 42 patients with low state anxiety (LSA) and 48 patients with high state anxiety (HSA) by STAI-state version (STAI-S). Magnetic resonance imaging (MRI) data were acquired, preprocessed and the measure of voxel-mirrored homotopic connectivity (VMHC) was calculated and compared between all groups. Moreover, we evaluated whether VMHC of brain regions showed distinct mechanisms between trait and state anxiety-related PE were associated with the severity of PE and anxiety.
Compared with HCs, patients with LTA exhibited increased VMHC in the attention network (AN), default mode network (DMN) and subcortical network (SCN), decreased VMHC in DMN while patients with HTA showed increased VMHC in SCN, decreased VMHC in DMN and AN. Compared with patients with LTA, patients with HTA demonstrated decreased VMHC in DMN and AN. Compared with HCs, patients with LSA had increased VMHC in DMN, decreased VMHC in AN and DMN while patients with HSA exhibited increased VMHC in AN, DMN and SCN, decreased VMHC in DMN, AN and sensory-motor network (SMN). Compared with patients with LSA, patients with HSA demonstrated increased VMHC in DMN. Moreover, premature ejaculation diagnostic tool (PEDT) scores were negatively associated with VMHC of DMN and AN while STAI-T scores were negatively related to VMHC of DMN in patients with HTA. PEDT, STAI-S and STAI-T scores were all negatively associated with VMHC of DMN in patients with HSA.
Our findings demonstrated that decreased interhemispheric functional connectivity (FC) in DMN and AN might be associated with high trait anxiety-related PE while increased interhemispheric FC in DMN might be relate to high state anxiety-related PE. Therefore, trait and state anxiety-related PE might be driven by distinct mechanisms in the brain.
焦虑被认为在早泄（PE）的发生和维持中起关键作用。此外，PE患者常伴有焦虑，然而，这种共病的中枢机制仍不清楚。本研究旨在探讨特质性和状态性焦虑相关的PE在大脑中是否具有共同或不同的机制。
共纳入90例PE患者和45例健康对照（HCs）。根据状态-特质焦虑量表-特质版（STAI-T），将患者分为低特质焦虑（LTA）组45例和高特质焦虑（HTA）组45例。此外，根据状态-特质焦虑量表-状态版（STAI-S），将患者分为低状态焦虑（LSA）组42例和高状态焦虑（HSA）组48例。采集磁共振成像（MRI）数据，进行预处理，并计算体素镜像同伦连接性（VMHC），比较所有组之间的VMHC。此外，我们评估了大脑区域的VMHC在特质性和状态性焦虑相关的PE之间是否表现出不同的机制，以及是否与PE和焦虑的严重程度相关。
与HCs相比，LTA患者在注意网络（AN）、默认模式网络（DMN）和皮质下网络（SCN）中的VMHC增加，DMN中的VMHC减少，而HTA患者在SCN中的VMHC增加，DMN和AN中的VMHC减少。与LTA患者相比，HTA患者在DMN和AN中的VMHC降低。与HCs相比，LSA患者在DMN中的VMHC增加，AN和DMN中的VMHC减少，而HSA患者在AN、DMN和SCN中的VMHC增加，DMN、AN和感觉运动网络（SMN）中的VMHC减少。与LSA患者相比，HSA患者在DMN中的VMHC增加。此外，早泄诊断工具（PEDT）评分与DMN和AN的VMHC呈负相关，而在HTA患者中，STAI-T评分与DMN的VMHC呈负相关。在HSA患者中，PEDT、STAI-S和STAI-T评分均与DMN的VMHC呈负相关。
我们的研究结果表明，DMN和AN中半球间功能连接性（FC）降低可能与高特质焦虑相关的PE有关，而DMN中半球间FC增加可能与高状态焦虑相关的PE有关。因此，特质性和状态性焦虑相关的PE可能由大脑中不同的机制驱动。
