老年性勃起功能障碍的临床特点

Clinical characteristics of erectile dysfunction in aging males

目的通过对老年性勃起功能障碍(ED)患者回顾性研究,探讨其发病规律和临床特点。方法将ED患者分为2组,老年性ED组(49例)和非老年性ED组(425例)。统计各组患者年龄、病程、既往病史(糖尿病、高血压、高血脂)以及国际勃起功能指数评分表(IIEF-5)、夜间阴茎涨大试验(NPT)、阴茎海绵体注射试验(ICI)结果。结果与非老年性ED患者相比,老年性ED患者病程长,同时患有糖尿病、高血压、高血脂的患者比例明显升高(分别为61%、78%、37%)。老年性ED患者IIEF-5评分明显降低,患有重度ED比例明显升高。老年性ED患者平均夜间勃起事件明显减少,每次勃起平均时间明显减少,平均阴茎容量峰/基线比率也明显降低。注射前列地尔后,阴茎海绵体动脉收缩期峰值流速(PSV)及阻力指数(RI)明显小于非老年性ED患者,舒张末期流速(EDV)高于非老年性ED患者。结论老年性ED以器质性病变为主,病程长,程度重,其中尤以血管性ED发病率较高。血管病变导致的阴茎海绵体动脉供血不足和静脉关闭不全是老年性ED发病机制中重要环节。

Objective To investigate the principal and clinical characteristics of erectile dysfunction （ED） in elderly males by retrospective study. Methods All patients were divided into two groups, elderly patients with ED and nonelderly patients with ED. The data of age, course of disease, past medical history, international index of erectile function （ IIEF-5 ）, nocturnal penile tumescence （NPT） and intracavernous injection （ICI） were analyzed. Results Compared with non-elderly patients with ED, the elderly patients had a long course of disease and higher incidence of diabetes, hypertension and hyperlipemia （61%, 78% , 37% , respectively）. Compared with non-elderly patients with ED, the mean score of IIEF-5 of elderly patients was significantly reduced while the rate of severe ED was significantly increased. The erectile frequency, duration and rate of penile volume and baseline of nocturnal erection of elderly patients with ED were all decreased. After injection of alprostadil, the peak systolic velocity（PSV） and resistance index（RI） of elderly patients with ED were significantly lower than those of non-elderly patients, though end diastolic velocity（EDV） was higher. Conclusions Structural ED is the main type of ED in elderly patients, with longer course of disease and severer clinical manifestations, especially in those with vessel disease. The deficiency of corporal blood supply and veno-occlusion caused by vasculopathy might play a key role in the pathogenesis of elderly patients with ED.