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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (4): 680-686. doi: 10.19723/j.issn.1671-167X.2024.04.022

• 论著 • 上一篇    下一篇

阴茎海绵体注射试验对阴茎血管功能影响的回顾性研究

陈延1,2,李况蒙3,洪锴1,2,张树栋1,程建星1,2,郑仲杰1,2,唐文豪1,2,赵连明1,2,张海涛1,2,姜辉4,*(),林浩成1,2,*()   

  1. 1. 北京大学第三医院泌尿外科，北京 100191
    2. 北京大学第三医院生殖医学中心，北京 100191
    3. 北京大学第三医院超声医学科，北京 100191
    4. 北京大学第一医院泌尿外科，北京 100034
  • 收稿日期:2024-03-16 出版日期:2024-08-18 发布日期:2024-07-23
  • 通讯作者: 姜辉,林浩成 E-mail:jianghui55@163.com;haochenglin292@163.com
  • 基金资助:
    国家自然科学基金(82371633);北京大学临床科学家计划专项-中央高校基本科研业务费(BMU2023PYJ H012)

Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function

Yan CHEN1,2,Kuangmeng LI3,Kai HONG1,2,Shudong ZHANG1,Jianxing CHENG1,2,Zhongjie ZHENG1,2,Wenhao TANG1,2,Lianming ZHAO1,2,Haitao ZHANG1,2,Hui JIANG4,*(),Haocheng LIN1,2,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
    3. Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
    4. Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2024-03-16 Online:2024-08-18 Published:2024-07-23
  • Contact: Hui JIANG,Haocheng LIN E-mail:jianghui55@163.com;haochenglin292@163.com
  • Supported by:
    the National Natural Science Foundation of China(82371633);the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program(BMU2023PYJ H012)

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摘要：

目的: 探究勃起功能障碍(erectile dysfunction，ED)患者年龄、不同激素水平及生化指标对阴茎海绵体血管功能的影响。方法: 回顾分析2020年1月至2023年8月于北京大学第三医院生殖医学中心男科进行彩色双频多普勒超声(color duplex Doppler ultrasonography，CDDU)联合阴茎海绵体注射试验(intracavernosal injection test，ICI)的ED患者的临床资料。使用SPSS 29.0建立数据库进行数据处理，采用多因素Logistic回归进行分析。结果: 共纳入700例ED患者，其中ICI结果阴性380例，阳性320例；阴茎海绵体动脉收缩期速度(peak systolic velocity，PSV) < 25 cm/s者84例，≥25 cm/s者616例；舒张末期速度(end diastolic velocity，EDV)>5 cm/s者202例，≤5 cm/s者498例；PSV和/或EDV结果异常者264例，PSV和EDV结果均正常者436例。血管性ED患者相较于非血管性ED患者雌二醇和睾酮水平更低(t=-3.546，P＜0.001；t=-2.089，P=0.037)，高血糖发生率更高(χ2=12.772，P=0.002)。动脉性ED患者相较于非动脉性ED患者年龄更大(t=3.953，P＜0.001)，高血糖发生率更高(χ2= 9.518，P=0.009)，雌二醇/睾酮比值更高(t=2.330，P=0.020)。动静脉混合性ED患者相较于均正常者的患者年龄更高(t=3.567，P＜0.001)，睾酮水平更低(t=-2.288，P =0.022)，高血糖发生率更高(χ2=12.877，P= 0.002)，雌二醇/睾酮比值更大(t=2.096，P =0.037)。多因素Logistic回归分析表明，雌二醇水平升高是血管性ED的保护因素(OR=1.009，95%CI：1.004~1.014)，葡萄糖≥7.0 mmol/L是血管性ED的危险因素(OR=0.381，95%CI：0.219~0.661)；年龄增长是动脉性ED的危险因素(OR=0.960，95%CI：0.938~0.982)；年龄增长(OR=0.976，95%CI：0.958~0.993)、葡萄糖5.6~6.9 mmol/L(OR=0.591，95%CI：0.399~0.876)是动静脉混合性ED的危险因素。结论: 高血糖和年龄增长可能使阴茎海绵体血管功能减退，而雌二醇水平升高可能对阴茎海绵体血管功能有保护作用。

关键词: 勃起功能障碍, 彩色双频多普勒超声, 阴茎海绵体注射, 血管, 危险因素

Abstract:

Objective: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted. Results: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels (t=-3.546, P < 0.001), lower testosterone levels (t=-2.089, P=0.037), and a higher rate of hyperglycemia (χ2=12.772, P=0.002) compared with those with non-vascular ED. The patients with arterial ED were older (t=3.953, P < 0.001), had a higher rate of hyperglycemia (χ2=9.518, P=0.009), and a higher estrogen/testosterone ratio (t=2.330, P=0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age (t=3.567, P < 0.001), lower testosterone levels (t=-2.288, P=0.022), a higher rate of hyperglycemia (χ2=12.877, P=0.002), and a larger estrogen/testosterone ratio (t=2.096, P=0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED (OR=1.009, 95%CI: 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor (OR=0.381, 95%CI: 0.219-0.661). Older age was a risk factor for arterial ED (OR=0.960, 95%CI: 0.938-0.982). Additionally, older age (OR=0.976, 95%CI: 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L (OR=0.591, 95%CI: 0.399-0.876) were also risk factors for mixed arterio-venous ED. Conclusion: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.

Key words: Erectile dysfunction, Color duplex Doppler ultrasonography, Intracavernosal injection, Blood vessels, Risk factors

中图分类号: 

  • R698.1

表1

ICI结果阴性与阳性患者间各临床指标的比较"

Items ICI-negative (n=380) ICI-positive (n=320) Statistics P
Age/years 35.04±9.63 33.52±8.52 t=2.213 0.027
Estrogen/(pmol/L) 103.50±27.88 111.91±33.87 t=-3.546 ＜0.001
Prolactin χ2=1.456 0.583
  ＜2 μg/L 2 (0.5) 0
  2-18 μg/L 343 (90.3) 293 (91.6)
  >18 μg/L 35 (9.2) 27 (8.4)
Testosterone/(nmol/L) 11.72±3.70 12.36±4.27 t=-2.089 0.037
Uric acid/(μmol/L) 405.11±86.55 401.80±88.71 t=0.499 0.618
Total cholesterol/(mmol/L) 4.88±1.01 4.79±0.91 t=1.246 0.213
Triglycerides χ2=4.607 0.203
  ＜1.50 mmol/L 230 (60.5) 207 (64.7)
  1.51-1.99 mmol/L 70 (18.4) 40 (12.5)
  2.00-4.99 mmol/L 71 (18.7) 65 (20.3)
  >5.00 mmol/L 9 (2.4) 8 (2.5)
HDL/(mmol/L) 1.14±0.25 1.12±0.24 t=0.889 0.374
LDL/(mmol/L) 3.03±0.83 3.01±0.75 t=0.433 0.665
Glucose χ2=12.772 0.002
  ＜5.6 mmol/L 249 (65.5) 244 (76.3)
  5.6-6.9 mmol/L 80 (21.1) 56 (17.5)
  ≥7.0 mmol/L 51 (13.4) 20 (6.3)
HbA1c χ2=1.080 0.583
  ＜5.6% 11 (28.9) 3 (21.4)
  5.7%-6.4% 6 (15.8) 4 (28.6)
  ≥6.5% 21 (55.3) 7 (50.0)
Estrogen/Testosterone 9.57±3.56 9.86±4.02 t=-1.023 0.307

表2

PSV＜25 cm/s和≥25 cm/s患者间各临床指标的比较"

Items PSV＜25 cm/s (n=84) PSV≥25 cm/s (n=616) Statistics P
Age/years 38.01±9.17 33.84±9.06 t=3.953 ＜0.001
Estrogen/(pmol/L) 110.33±31.82 106.94±30.92 t=0.941 0.347
Prolactin χ2=0.244 >0.999
  ＜2 μg/L 0 2 (0.3)
  2-18 μg/L 77 (91.7) 559 (90.7)
  >18 μg/L 7 (8.3) 55 (8.9)
Testosterone/(nmol/L) 11.36±3.70 12.10±4.02 t=-1.610 0.108
Uric acid/(μmol/L) 395.24±80.32 404.74±88.43 t=-0.933 0.351
Total cholesterol/(mmol/L) 5.02±0.98 4.82±0.96 t=1.802 0.072
Triglyceride χ2=2.546 0.467
  ＜1.50 mmol/L 46 (54.8) 391 (63.5)
  1.51-1.99 mmol/L 15 (17.9) 95 (15.4)
  2.00-4.99 mmol/L 20 (23.8) 116 (18.8)
  >5.00 mmol/L 3 (3.6) 14 (2.3)
HDL/(mmol/L) 1.10±0.22 1.13±0.25 t=-1.189 0.235
LDL/(mmol/L) 3.09±0.88 3.01±0.78 t=0.783 0.434
Glucose χ2=9.518 0.009
  ＜5.6 mmol/L 48 (57.1) 445 (72.2)
  5.6-6.9 mmol/L 21 (25.0) 115 (18.7)
  ≥7.0 mmol/L 15 (17.9) 56 (9.1)
HbA1c χ2=2.218 0.330
  ＜5.6% 1 (11.1) 13 (30.2)
  5.7%-6.4% 3 (33.3) 7 (16.3)
  ≥6.5% 5 (55.6) 23 (53.5)
Estrogen/Testosterone 10.60±4.22 9.58±3.70 t=2.330 0.020

表3

EDV≤5 cm/s和>5 cm/s患者间各临床指标的比较"

Items EDV≤5 cm/s (n=498) EDV>5 cm/s (n=202) Statistics P
Age/years 33.92±8.96 35.38±9.60 t=-1.913 0.056
Estrogen/(pmol/L) 107.80±31.74 106.22±29.25 t=0.613 0.540
Prolactin χ2=1.287 0.505
  ＜2 μg/L 1 (0.2) 1 (0.5)
  2-18 μg/L 455 (91.4) 181 (89.6)
  >18 μg/L 42 (8.4) 20 (9.9)
Testosterone/(nmol/L) 12.15±4.06 11.68±3.78 t=1.395 0.164
Uric acid/(μmol/L) 402.30±89.47 406.79±82.57 t=-0.635 0.526
Total cholesterol/(mmol/L) 4.80±0.97 4.92±0.96 t=-1.531 0.126
Triglyceride χ2=4.516 0.211
  ＜1.50 mmol/L 322 (64.7) 115 (56.9)
  1.51-1.99 mmol/L 72 (14.5) 38 (18.8)
  2.00-4.99 mmol/L 94 (18.9) 42 (20.8)
  >5.00 mmol/L 10 (2.0) 7 (3.5)
HDL/(mmol/L) 1.13±0.25 1.13±0.24 t=-0.307 0.759
LDL/(mmol/L) 3.01±0.79 3.05±0.82 t=-0.618 0.537
Glucose χ2=5.785 0.055
  ＜5.6 mmol/L 363 (72.9) 130 (64.4)
  5.6-6.9 mmol/L 86 (17.3) 50 (24.8)
  ≥7.0 mmol/L 49 (9.8) 22 (10.9)
HbA1c χ2=2.608 0.271
  ＜5.6% 8 (23.5) 6 (33.3)
  5.7%-6.4% 5 (14.7) 5 (27.8)
  ≥6.5% 21 (61.8) 7 (38.9)
Estrogen/Testosterone 9.60±3.68 9.94±4.01 t=-1.066 0.287

表4

PSV和/或EDV结果异常与均正常患者间各临床指标的比较"

Items Abnormal PSV and/or EDV (n=264) Normal PSV and EDV(n=436) Statistics P
Age/years 35.95±9.57 33.37±8.78 t=3.567 ＜0.001
Estrogen/(pmol/L) 106.73±30.09 107.72±31.61 t=-0.408 0.683
Prolactin χ2=0.477 0.949
  ＜2 μg/L 1 (0.4) 1 (0.2)
  2-18 μg/L 239 (90.5) 397 (91.1)
  >18 μg/L 24 (9.1) 38 (8.7)
Testosterone/(nmol/L) 11.57±3.77 12.28±4.09 t=-2.288 0.022
Uric acid/(μmol/L) 402.29±82.28 404.39±90.60 t=-0.315 0.753
Total cholesterol/(mmol/L) 4.92±0.95 4.79±0.97 t=1.729 0.084
Triglyceride χ2=4.847 0.185
  ＜1.50 mmol/L 152 (57.6) 285 (65.4)
  1.51-1.99 mmol/L 49 (18.6) 61 (14.0)
  2.00-4.99 mmol/L 55 (20.8) 81 (18.6)
  >5.00 mmol/L 8 (3.0) 9 (2.1)
HDL/(mmol/L) 1.13±0.23 1.13±0.25 t=-0.202 0.840
LDL/(mmol/L) 3.05±0.83 3.01±0.77 t=0.730 0.466
Glucose χ2=12.877 0.002
  ＜5.6 mmol/L 165 (62.5) 328 (75.2)
  5.6-6.9 mmol/L 66 (25.0) 70 (16.1)
  ≥7.0 mmol/L 33 (12.5) 38 (8.7)
HbA1c χ2=6.096 0.058
  ＜5.6% 7 (28.0) 7 (25.9)
  5.7%-6.4% 8 (32.0) 2 (7.4)
  ≥6.5% 10 (40.0) 18 (66.7)
Estrogen/Testosterone 10.10±4.10 9.46±3.55 t=2.096 0.037

表5

ICI结果的多因素Logistic分析"

Variable Group description B SE Wald df P OR 95%CI
Estrogen 0.009 0.003 13.170 1 ＜0.001 1.009 1.004-1.014
Glucose ＜5.6 mmol/L(Reference group) 12.928 2 0.002
5.6-6.9 mmol/L -0.311 0.198 2.467 1 0.116 0.732 0.497-1.080
≥7.0 mmol/L -0.996 0.282 11.764 1 ＜0.001 0.381 0.219-0.661

表6

PSV结果的多因素Logistic分析"

Variable B SE Wald df P OR 95%CI
Age -0.041 0.011 12.851 1 ＜0.001 0.960 0.938-0.982
Estrogen/Testosterone -0.053 0.029 3.443 1 0.064 0.948 0.897-1.003

表7

PSV和/或EDV结果的多因素Logistic分析"

Variable Group description B SE Wald df P OR 95%CI
Age -0.025 0.009 7.146 1 0.008 0.976 0.958-0.993
Glucose ＜5.6 mmol/L(Reference group) 7.020 2 0.030
5.6-6.9 mmol/L -0.525 0.201 6.851 1 0.009 0.591 0.399-0.876
≥7.0 mmol/L -0.278 0.277 1.005 1 0.316 0.758 0.440-1.304
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ISSN 1671-167X
CN 11-4691/R
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