勃起功能障碍患者阴茎血流检测及心理测评结果分析

Psychological factors and penile blood supply in patients with erectile dysfunction

目的:对行阴茎海绵体注射血管活性药物试验(ICI)联合阴茎彩色多普勒超声检查(CDDU)的ED患者进行症状自评量表(SCL-90)和艾森克人格问卷(EPQ)评估,分析心理因素对ED患者阴茎供血的影响。方法:选择2018年8~11月在男科门诊就诊的106例ED患者进行研究,患者行ICI联合CDDU检查前进行SCL-90和EPQ评估,将CDDU检查结果分为正常组与异常组,各组患者SCL-90各因子分及总分与全国常模结果进行t检验分析,同时对EPQ评估人格类型在各组的分布差异进行χ~2检验分析。结果:①ICI联合CDDU检查结果异常者64例,正常者42例;CDDU异常组左右侧动脉最大收缩期血流速度(PSV)[(19.39±5.07)、(18.98±4.57) cm/s]较正常组[(30.90±6.83)、(30.74±7.00) cm/s]明显下降(P<0.01),左侧动脉舒张末期血流速度(EDV)明显上升[(3.21±2.78) cm/s vs(1.77±2.38)cm/s,P<0.01];①与SCL-90全国常模比较,106例行ICI联合CDDU检查的ED患者抑郁[(1.70±0.64)分vs(1.50±0.59)分,P<0.01]、焦虑[(1.62±0.56)分vs(1.39±0.43)分,P<0.01]、强迫[(1.86±0.61)分vs(1.62±0.58)分,P<0.01]、敌对[(1.65±0.66)分vs(1.48±0.56)分,P<0.01]、恐怖[(1.33±0.45)分vs(1.23±0.41)分,P=0.02]、精神病性[(1.61±0.55)分vs(1.29±0.41)分,P<0.01]因子评分和总分[(1.61±0.48)分vs(1.44±0.48)分,P<0.01]明显增高,其中CDDU检查结果正常组焦虑[(1.60±0.53)分,P<0.01]、强迫[(1.83±0.63)分,P=0.02]和精神病性[(1.61±0.48)分,P<0.01]因子评分明显增高, CDDU检查结果异常组抑郁[(1.73±0.65)分,P<0.01]、焦虑[(1.64±0.59)分,P<0.01]、强迫[(1.88±0.60)分,P<0.01]、敌对[(1.68±0.75)分,P<0.01]、恐怖[(1.35±0.44)分,P=0.02]、精神病性[(1.61±0.59)分,P<0.01]因子评分和总分[(1.63±0.51)分,P<0.01]明显增高;③CDDU检查结果正常组与异常组SCL-90各因子分和总分均不存在显著性差异(P>0.05);④EPQ评估的人格类型在CDDU检查结果正常与异常组间分布未见显著性差异(χ~2=1.12,P=0.77)。结论:ED患者人格类型主要为粘液质与抑郁质,且其患病后存在一系列心理问题,包括抑郁、焦虑等,同时阴茎供血不足患者心理问题表现更为严重。

Objective: To explore the psychological factors and blood supply to the penis in ED patients. Methods: From August to November 2018, we obtained Symptom Checklist 90(SCL-90) scores and conducted an Eysenck Personality Questionnaire(EPQ) investigation among 106 ED patients in our Department of Andrology, followed by the test of intracavernosal injection of the vasoactive agent(ICI-VAA) and color duplex Doppler ultrasonography(CDDU). According to the results of ICI-VAA and CDDU, we divided the patients into a normal and an abnormal group, compared their item and total scores on SCL-90 with the national norm by t-test and analyzed the distribution of personality types in different groups by Chi-square test. Results: The results of ICI-VAA and CDDU showed 42 cases to be normal and the other 64 abnormal. Compared with the normal group, the abnormal cases exhibited significantly decreased peak systolic velocity(PSV) in the left and right corpus cavernosum([30.90 ± 6.83] vs [19.39 ± 5.07] cm/s, P < 0.01;[30.74 ± 7.00] vs [18.98 ± 4.57] cm/s, P < 0.01), but increased end-diastolic velocity(EDV) in the left corpus cavernosum([1.77 ± 2.38] vs [3.21 ± 2.78] cm/s, P < 0.01). The ED patients undergoing ICI-VAA and CDDU obtained remarkably higher SCL-90 scores than the national norm on depression(1.70 ± 0.64 vs 1.50 ± 0.59, P < 0.01), anxiety(1.62 ± 0.56 vs 1.39 ± 0.43, P < 0.01), compulsion(1.86 ± 0.61 vs 1.62 ± 0.58, P < 0.01), hostility(1.65 ± 0.66 vs 1.48 ± 0.56, P < 0.01), phobia(1.33 ± 0.45 vs 1.23 ± 0.41, P = 0.02), and psychoticism(1.61 ± 0.55 vs 1.29 ± 0.41, P < 0.01) as well as a higher total score(1.61 ± 0.48 vs 1.44 ± 0.48, P < 0.01). The patients with normal results of CDDU got markedly increased scores on anxiety(1.60 ± 0.53, P < 0.01), compulsion(1.83 ± 0.63, P = 0.02) and psychoticism(1.61 ± 0.48, P < 0.01), and so did those with abnormal results of CDDU on depression(1.73 ± 0.65, P < 0.01), anxiety(1.64 ± 0.59, P < 0.01), compulsion(1.88 ± 0.60, P < 0.01), hostility(1.68 ± 0.75, P < 0.01), phobia(1.35 ± 0.44, P = 0.02), psychoticism(1.61 ± 0.59, P < 0.01) and an increased total score as well(1.63 ± 0.51, P < 0.01). Statistically significant differences were not found in either the item scores or the total score on SCL-90(P > 0.05), nor in the distribution of the EPQ personality types between the normal and abnormal cases(χ~2 = 1.12, P = 0.77). Conclusion: The personality types of ED patients are mainly phlegmatic and melancholic, and their psychological problems chiefly include depression and anxiety, which are more serious in those with insufficient penile blood supply.