心理性勃起功能障碍的功能磁共振成像研究

fMRI study of psychogenic erectile dysfunction

目的研究正常成年男性和心理性勃起功能障碍(ED)患者中枢神经系统的激活情况,探讨两者中枢神经系统兴奋性的差异。方法心理性ED患者12例,均为右利手,无任何精神及其他器质性疾病史。对照组为12例年龄性别相匹配的健康志愿者,均为右利手,无任何性功能障碍史,无器质性病变和其他可能影响脑结构和功能的不良生活习惯和药物滥用史。用色情录像和非色情录像刺激,每个录像片段60s,每个色情和非色情录像片段之间间隔12s。用GE1.5TMR扫描系统进行BOLD-fMRI扫描,头线圈。用3DSPGRT1WI序列进行全脑轴位扫描作为全脑解剖图。结果在视觉和听觉相关色情录像的刺激下,正常男性与心理性ED患者双侧小脑半球、小脑蚓部、双侧额下回、双颞叶、双侧扣带回、角回、左侧杏仁核、丘脑、海马、中脑及桥脑背侧均被激活;与正常男性相比,心理性ED患者双侧前扣带回激活的范围更大,两者的激活体积存在显著性差异(t=4.026,P<0.001),心理性ED患者平均激活体积为(979.64±25.33)mm3,正常男性为(795.43±20.35)mm3。结论边缘系统、脑干、丘脑等在调节男性性行为中起着重要的作用,心理性勃起功能障碍患者可能存在潜在的病因。

Objective To determine the brain region of activation elicited by visual and auditory video sexual stimulation and to investigate whether fMRI brain activation patterns of normal males and the patients with psychogenic erectile dysfunction during video sexual stimulation are different. Methods Participants were twelve patients with psychogenic erectile dysfunction and twelve sexually potent volunteers with no history of sexual function disorder, physical, psychiatric or neurological disease. All the patients were assessed with fMRI of the brain during visual and auditory stimulation with movie sequences of neutral and erotic contents. BLOD-fMRI was performed using a 1.5 T MR scanner. Three-dimensional anatomical images of the entire brain were obtained by using a Tl-weighted three-dimensional anatomical images spoiled gradient echo pulse sequence. Each people was shown neutral and erotic video sequences of 60 s each in a block-study fashion, with a 12 s time interval between two subsequent video sequences. Results During video sexual stimulation, in potent people showed bilateral in the cerebellum, temporal inferior regions, inferior frontal lobe and anterior temporal limbic areas, including anterior cingulate cortex, insula, hypothalamus, bilaterally and the left amygdala. The patients with psychogenic erectile dysfunction demonstrated more significant and extended activation in the anterior cingulate cortex （t= 4. 026, P〈0. 001）. The volume of anterior cingulate cortex was （979.64±25.33） mm^3 in the ED cases, and there was （795.43±20.35） mm^3 in potent people. Conclusion The anterior cingulate cortex may be crucial to the regulation of the penile erection, the occurrence of psychogenic ED may have an underlying aetiological factor.