男性慢性肾脏病合并性功能障碍的研究现状

Sexual dysfunction in males with chronic kidney disease

性功能障碍在男性慢性肾脏病(CKD)患者的发病率较普通男性高,其中勃起功能障碍是最常见的临床表现。内分泌系统功能失调与男性CKD患者性功能障碍的发生密切相关,主要包括下丘脑-垂体-性腺轴的紊乱和高泌乳素血症。同时,血管、神经系统、心理、微量元素、药物等因素也参与了发病过程。目前,主要通过量表评估、临床表现及专科检查对男性CKD患者的性功能障碍进行诊断。治疗上以纠正内分泌系统功能紊乱为基础,包括重组人促红细胞生成素、1,25-(OH)_2 D3、溴隐亭、氯沙坦、锌制剂等药物治疗及肾移植治疗。此外,5型磷酸二酯酶抑制剂等性功能障碍的常规治疗方法可作为补充。本文将从男性CKD合并性功能障碍的危险因素、病因、病理生理、诊断及治疗等方面的研究现状进行综述。

The incidence of sexual dysfunction is higher in men with chronic kidney disease（ CKD） than in those without,of which ED is the most common clinical manifestation. Sexual dysfunction is closely related to malfunction of the endocrine system in CKD males,mainly including the disorder in the hypothalamus-pituitary-gonadal axis and hyperprolactinemia. Besides,blood vessels,the nervous system,psychological status,trace elements,and drugs are also contributory factors. At present,sexual dysfunction in CKD males is diagnosed chiefly by scale assessment,clinical manifestation and special examination,and its treatment focuses on the correction of the endocrine system malfunction,as by kidney transplantation or by drug therapy with recombinant human erythropoietin,1,25-（OH）_2 D3,bromocriptine,losartan,or zinc preparation. In addition,conventional treatment with phosphodiesterase-5 inhibitors can be used as a supplement. This paper outlines the recent progress in the studies of sexual dysfunction in CKD males,covering its risk factors,etiology,pathophysiology,diagnosis and treatment.