厄贝沙坦与美托洛尔的联合方案对男性高血压患者性功能的影响

Effect of different combined antihypertensive regimen on the erectile function in male hypertensivepafien~

目的 探讨非洛地平联合厄贝沙坦或美托洛尔两种降压方案对男性高血压病患者性功能的影响.方法 123例高血压病患者随机分为两组：非洛地平（5 mg/d）＋厄贝沙坦（150 mg/d）组（F＋I组,64例）;非洛地平（5 mg/d）＋琥珀酸美托洛尔（47.5 mg/d）组（F＋M组,59例）.监测患者血压变化;治疗第0、24周用国际男性性功能问卷（IIEF）评价患者的性功能,同时用放射性免疫法测血清睾酮和性激素结合蛋白、硫代巴比妥酸法测丙二醛、ELISA 法测8-羟基脱氧鸟苷和4-羟基壬烯酸.结果 F＋I组治疗后性欲积分值增高（P〈0.05）,轻度勃起功能障碍患者的勃起功能评分增加;勃起功能障碍患者8-羟基脱氧鸟苷治疗前、后分别为（146.02±60.54）ng/L比 （139.89±62.03）ng/L,丙二醛治疗前、后分别为（6.59±1.75）μmol/L比（6.01±1.65）μmol/L,治疗前后比较差异有统计学意义（P〈0.05）.两组治疗前后血压达标率、有效率、勃起功能障碍的发生率、睾酮、性激素结合蛋白、4-羟基壬烯酸差异均无统计学意义（P〉0.05）.结论 相对于F＋M组,F＋I组可能更有益于男性高血压病患者性功能,但这种获益是否与该组治疗后患者氧化应激状态的改变有关。

Objective To compare the effects of felodipine combined irbesartan regimen with that of felodipine combined metoprolol regimen on the sexual function in male hypertensive patients. Method One handred and twenty-three male hypertensive paitients （age 25 to 60） were randomly assigned to felodipine （5 mg/d） plus irbesartan （ 150 mg/d, n=64） group and felodipine （5 mg/d） plus metoprolol （47.5 mg/d, n=59） group. Dosage of felodipine were doubled after 4 weeks if the blood pressure were ≥140/ 90 mm Hg （1 mm Hg=0.133 kPa）. At the baseline and post 24th week treatment, sexual function of patients was assessed by the International Index of Erectile Function （IIEF） Questionaire. Serum testosterone （T）, sex hormone binding globulin （SHBG）, 4-hydroxynonenal （HNE）, 8-hydroxy-2′-deoxyguanosine （8-OHdG） and Malonaldehyde （MDA） were measured by Radioimmunoassay （RIA）, ELISA and TBA respectively. Results Total prevalence of erectile dysfunction （ED）,T, SHBG and HNE were similar between pre- and post-treatment in two groups （P〉0.05）. On the other hand, the scores of the mild ED and sexual desire （SD） were improved and both serum 8-OHdG and MDA in patients with ED decreased [（146.02±60.54）ng/L vs. （139.89±62.03）ng/L, P=0.048 and （6.59±1.75）μmol/L vs. （5.51±1.65）μmol/L,P=0.039] in Felodipine plus Irbesartan group. Conclusion The results suggested that Felodipine ＋ Irbesartan regimen may be superior to Felodipine ＋ metoprolol regimen for male hypertensive patients with mild ED