选择不同剂量他达拉非治疗ED的临床标准初步探索

Standard doses of tadalafil for different ED patients

目的:本文通过观察不同剂量他达拉非(希爱力)对于勃起功能障碍(ED)患者的治疗效果,探索他达拉非剂量与阴茎血流彩色多普勒参数之间的关系。方法:对136例ED患者在治疗前后进行IIEF-5评分同时用彩色多普勒超声联合阴茎血管活性药物前列腺素(PGE1)注射试验,检测阴茎双侧海绵体动脉的收缩期最大流速(PSV)。根据治疗前不同的PSV值,随机分为4组,采用了疗程为4周的隔日晚餐后口服不同剂量他达那非的用药方案。A组:PSV>15 cm/s,选择10 mg剂量;B组:PSV>15 cm/s,选择5 mg剂量;C组:PSV<15 cm/s,选择10 mg剂量;D组:PSV<15 cm/s,选择5 mg剂量。结果:治疗4周后,经统计学分析,4组IIEF-5评分以及阴茎双侧海绵体动脉的PSV与治疗前相比均有显著提高(P<0.01)。而且治疗4周后,A组与B组IIEF-5评分以及阴茎双侧海绵体动脉的PSV之间没有明显差异;C组却显著高于D组(P<0.01)。结论:隔日口服不同剂量的他达那非均能有效提高ED患者阴茎海绵体动脉的收缩期最大流速,改善患者的勃起质量。PSV>15 cm/s的ED患者可选择小剂量5 mg隔日;PSV<15 cm/s的ED患者尽量选择较大剂量10 mg隔日,以取得更好的疗效。

Objective：To observe the effects of different doses of tadalafil on ED,and to search for appropriate doses for the treatment of different ED patients.Methods：Based on the baseline peak systolic velocity（PSV） of cavernosal arteries,136 ED patients were divided into Groups A（PSV 〉15 cm/s）,B（PSV 〉15 cm/s）,C（PSV 〉15 cm/s） and D（PSV 〉15 cm/s） to receive oral tadalafil at 10 mg（Groups A and C） and 5 mg（Groups B and D） on alternate days for 4 weeks.All of them were scored on IIEF-5 and detected for PSVs of the bilateral cavernosal arteries by color Doppler ultrasonography and intracavernous injection of prostaglandin E1 before and after the medication.Results：After 4 weeks of tadalafil treatment,IIEF-5 scores and PSVs were remarkably improved in all the four groups as compared with the baseline（P〈0.01）,significantly higher in Group C than in D（P〈0.01）,but with no significant differences between A and B.Conclusion：Oral tadalafil can improve PSV and hence penile erection in ED patients either at a low or a high dose.To reduce side effects and drug cost,the patients with PSV 15 cm/s can be medicated at 5 mg,while those with PSV 15 cm/s at 10 mg or more on alternate days.Natl J Androl,2010,16（9）：860-863