Lawrence I G, Price D E, Howlett T A, Harris K P, Feehally J, Walls J
Department of Diabetes and Endocrinology, Leicester Royal Infirmary, UK.
Nephrol Dial Transplant. 1997 Apr;12(4):741-7. doi: 10.1093/ndt/12.4.741.
Erythropoietin (rHuEpo) therapy has been shown to improve sexual function in the male dialysis population, with several studies suggesting a direct effect upon endocrine function, as well as correction of anaemia. Nevertheless many male dialysis patients receiving rHuEpo continue to complain of sexual dysfunction.
At a dedicated renal impotence clinic, 65 male dialysis patients were screened for endocrine disturbances. Baseline serum sex hormones were compared between those receiving and not receiving rHuEpo, using either the two-sample t test or the Mann-Whitney U test, after assessing for normality. Results from four patients were excluded on account of either medications (antiemetic phenothiazines), hepatic dysfunction, or carcinomatosis.
Twenty-five patients (41.0%) were receiving rHuEpo, the recipients and non-recipients being well matched for haemoglobin (10.19 +/- 0.29 vs 10.55 +/- 0.25 g/dl, n.s.), age (51.1 +/- 1.9 vs 53.6 +/- 2.1 years, n.s.) and duration of sexual dysfunction (median, 3.0 vs 3.0 years, n.s.). The rHuEpo recipients had a higher median creatinine (1090 vs 972 micromol/l, P < 0.02), but similar nutritional status to the non-recipients (albumin 41.0 vs 39.0 g/l, n.s.). The total duration of rHuEpo therapy was 0.85 +/- 0.14 years. Prolactin levels were similar in both the rHuEpo recipients and non-recipients (440 vs 541 mu/l, n.s.), as were LH (11.0 vs 10.5 iu/l, n.s.) and FSH (8.0 vs 6.5 iu/l, n.s.). However, there were significant elevations of testosterone (19.8 +/- 1.3 vs 16.1 +/- 1.1 nmol/l, P < 0.05) and sex hormone binding globulin (SHBG) (40.5 vs 26.0 nmol/l, P < 0.01), with a trend toward elevated oestradiol (304 vs 248 pmol/l, P = 0.095) in the rHuEpo-treated group. Forty-eight subjects (78.7%) received peritoneal dialysis (PD), with the 19 rHuEpo recipients (39.6%) demonstrating increased serum testosterone (21.0 +/- 1.5 vs 16.6 +/- 1.3 nmol/l, P < 0.05), SHBG (40.5 vs 26.5 nmol/l, P < 0.01), LH (15.0 vs 10.0 iu/l, P < 0.01) and FSH (12.0 vs 5.3 iu/l, P < 0.05). These differences were not demonstrated in the 13 haemodialysis (HD) subjects.
Male dialysis patients complaining of sexual dysfunction after correction of anaemia with rHuEpo are characterized by higher levels of serum testosterone and SHBG, but not suppression of hyperprolactinaemia or hyperoestrogenism. Male PD subjects receiving rHuEpo also demonstrated increased LH and FSH.
已有研究表明，促红细胞生成素（rHuEpo）治疗可改善男性透析患者的性功能，多项研究提示其对内分泌功能有直接作用，同时可纠正贫血。然而，许多接受rHuEpo治疗的男性透析患者仍抱怨存在性功能障碍。
在一家专门的肾脏阳痿诊所，对65名男性透析患者进行内分泌紊乱筛查。在评估数据正态性后，使用两样本t检验或曼-惠特尼U检验，比较接受和未接受rHuEpo患者的基线血清性激素水平。4名患者的结果因药物（抗吐吩噻嗪类）、肝功能障碍或癌病而被排除。
25名患者（41.0%）接受rHuEpo治疗，接受者和未接受者在血红蛋白水平（10.19±0.29对10.55±0.25 g/dl，无显著差异）、年龄（51.1±1.9对53.6±2.1岁，无显著差异）和性功能障碍持续时间（中位数，3.0对3.0年，无显著差异）方面匹配良好。接受rHuEpo治疗的患者肌酐中位数较高（1090对972 μmol/l，P<0.02），但营养状况与未接受者相似（白蛋白41.0对39.0 g/l，无显著差异）。rHuEpo治疗的总时长为0.85±0.14年。接受rHuEpo治疗者和未接受者的催乳素水平相似（440对541 μl/l，无显著差异），促黄体生成素（LH）（11.0对10.5 iu/l，无显著差异）和促卵泡生成素（FSH）（8.0对6.5 iu/l，无显著差异）也相似。然而，接受rHuEpo治疗组的睾酮（19.8±1.3对16.1±1.1 nmol/l，P<0.05）和性激素结合球蛋白（SHBG）（40.5对26.0 nmol/l，P<0.01）显著升高，雌二醇有升高趋势（304对248 pmol/l，P=0.095）。四十八名受试者（78.7%）接受腹膜透析（PD），19名接受rHuEpo治疗者（39.6%）血清睾酮（21.0±1.5对16.6±1.3 nmol/l，P<0.05）、SHBG（40.5对26.5 nmol/l，P<0.01）、LH（15.0对10.0 iu/l，P<0.01）和FSH（12.0对5.3 iu/l，P<0.05）升高。在13名血液透析（HD）受试者中未发现这些差异。
用rHuEpo纠正贫血后仍抱怨性功能障碍的男性透析患者，其血清睾酮和SHBG水平较高，但不存在高催乳素血症或高雌激素血症的抑制情况。接受rHuEpo治疗的男性PD受试者LH和FSH也升高。
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