曲唑酮治疗心理性勃起功能障碍的功能磁共振研究

fMRI study on Trazodone in the treatment of the psychogenic erectile dysfunction

目的用功能磁共振技术结合药物磁共振技术研究正常男性和心理性勃起功能障碍患者中枢神经系统激活的差异,探讨曲唑酮治疗心理性勃起功能障碍的可能机制。方法A组为30例健康成年男性志愿者,均为右利手;30例心理性勃起功能障碍患者单盲、随机分为B组(用曲唑酮治疗7周)和C组(用安慰剂治疗7周),每组15个患者,所有患者人均为右利手。A组仅进行一次功能磁共振检查;B组和C组在治疗前后均进行功能磁共振检查,治疗前B组和C组不服用任何药物;治疗后B组患者在磁共振扫描前60分钟服用曲唑酮100mg;C组服用安慰剂100mg。所有参与者均用色情录像和非色情录像刺激,用GE1.5TMR扫描系统进行血氧水平依赖的功能磁共振扫描。结果在色情录像的刺激下,与正常男性相比,心理性勃起功能障碍(ED)患者(B组+C组)双侧前扣带回激活范围明显增大(t=6.715,P<0.001),两者存在显著性差异。B组经曲唑酮治疗后,在曲唑酮的干预下,心理性ED患者的双侧前扣带回激活被抑制与正常人接近,而双侧海马激活范围较前增大,双侧脑岛的激活被抑制;B组病人治疗前后前扣带回激活体积存在显著性差异(t=1.930,P<0.05);双侧海马激活较前明显,前后激活体积存在显著性差异(左侧:t=3.790,P<0.001;右侧:t=4.203,P<0.001);脑岛的激活被抑制。C组病人治疗前后在安慰剂的干预下,脑激活图前后无明显改变。结论心理性ED患者在中枢神经系统可能存在潜在的病因;脑岛、前扣带回、海马可能富含5-HT受体;曲唑酮对心理性ED的治疗可能在于调节了脑岛、前扣带回、海马的神经元生物活性;曲唑酮对不同亚型的5-HT受体的调节具有多肽性。

Objective To investigate the central nervous system mechanism of action of Trazodone for the psychogenic erectile dysfunction,and to explore the possible distribution and density of neurotransmitter of the 5-HT receptors and uptake sites by fMRI. Methods Participants were thirty patients with psychogenic erectile dysfunction and thirty potent volunteers. Thirty potent volunteers were as group A, thirty patients with psychogenic erectile dysfunction were divided into group B （treated with Trazodone） and group C （treated with placebo）, with fifteen patients in each group, following a randomized, single blind design. Group A was performed with fMRI only once, while group B and group C were performed with a 7-week interval. Before the treatment, all the participants take nothing before fMRI acquisition. After treatment of 7 weeks, 60 minutes before fMRI acquisition, the group B take trazodone 100 mg,and the group C take the placebo 100 mg. All the patients were assessed with fMRI using the stimulation with movie sequences of neutral and erotic contents. Results Before the treatment, in comparison with the group A, the patients （group B ＋ group C） demonstrated a significant and extended activation in the bilateral anterior cingulate cortex （t= 6. 715, P〈0. 001）. By the evaluation of the clinical diagnosis, there were 14 patients in the group B had a better curative effect, there was no one in the group C who felt better than before; After the treatment, among the patients in the group B who had a better curative effect, the activation of the bilateral anterior cingulate cortex （t= 1. 930,P〈0. 05） and bilateral insula was inhibited, but activation of the bilateral hippocampus was more evident and extensive than before treatment （left： t=3. 790,P〈0. 001 ;right： t=4. 203,P〈0. 001）, that was similar to the one seen in the picture in the group A except that the bilateral insula gyrus activation were lower. There were not any change of the activated neural systems of the brain of both the group A and group C compared with the before treatment with placebo. Conclusion Anterior cingulate cortex, insula gyrus and the hippocampus are rich in 5-HT receptors, Trazodone significantly modulates the biological activity of the anterior cingulate cortex, insula gyrus and the hippocampus of the patients with psychogenic erectile dysfunction, bilaterally, and the effect of the trazodone in modulating the different subtype S-HT receptors is polyphenic.