后尿道损伤后勃起功能障碍患者的IIEF-5评分与客观诊断指标的比较研究

Comparative study on IIEF-5 score and objective diagnostic index in ED patients after posterior urethral trauma

目的：探讨后尿道损伤患者在勃起功能障碍（ED）诊断过程中客观性检查指标与国际勃起功能障碍问卷表5（IIEF-5）评分的比较联系、差异及其意义。方法本组纳入2013年12月至2014年6月骨盆骨折后尿道狭窄（闭锁）患者44例，患者年龄22～50岁，平均32.5岁。伤后时间3月至10年，平均10.5个月。患者在我院术前在未服用或停用PDE-5抑制剂的情况下进行静脉血睾酮、雌二醇、催乳素、卵泡刺激素、黄体生成素检测，IIEF-5评分、夜间勃起监测（NPT，Rigiscan系统，连续检测2个晚上），如必要时进一步阴茎血流彩色多普勒超声（penile color doppler ultrasound, PCDU）检查。结果术前检查血睾酮、雌二醇、催乳素、卵泡刺激素、黄体生成素均在正常范围内。本组患者术前IIEF-5评分为10.96±3.42；NPT检测夜间勃起次数（2.06±0.97）次，PCDU检查动脉血流收缩期峰速（PSV）（23.18±17.15）cm/s。经IIEF-5评分诊断，本组ED诊断率为42/44（95.45%），其中重度ED 5例，中度ED 18例，中低度ED 16例，轻度ED 3例。通过NPT检测明确诊断器质性ED 40例，PCDU检查为血管性ED 34例，其中动脉性ED 10例，静脉性ED 6例，动静脉混合性ED 18例。结论 IIEF-5评分为主的主观性评分及PCDU、NPT为主的客观性诊断，其两项对于尿道损伤所致ED诊断都有一定的准确性，主观性评分用于此类患者可粗略评价ED情况，但不能区分ED的具体情况。而客观性诊断指标可进一步明确ED程度及性质，在临床上对于尿道外伤后ED的诊断，IIEF-5量表的使用有一定局限性。

IIEF-5 10.96±3.42, NPT tests showed that all patients erectile 2.06±0.97 times at night, PCDU PSV 23.18±17.15cm/s. By IIEF-5 diagnosis： ED diagnostic rate was 42/44 （95.45%）, including severe ED in 5 cases, moderate ED in 18 cases, mild to moderate ED in 16 cases, mild ED in 3 cases. By nocturnal penile tumescence, Organic ED were diagnosed in 40 cases. By PCDU, arterial ED, venous leakage, arteriovenous ED was diagnosed in 10 patients, 6 patients and 18 patients, respectively. Conclusion As a subjective way ,IIEF-5 can make a crude assessment of the patients with ED, without identifying the type of ED. However, objective standards of diagnosis, such as NPT and PCDU, can define the serious degree and real nature of ED. SO, there are limitations in the IIFE-5 diagnosis process in patients with ED.