枸橼酸西地那非联合星状神经节阻滞对男性性功能障碍患者血管内皮功能的影响及机制研究

Effects of sildenafil citrate combined with stellate ganglion block on the vascular endothelial function in male patients with sexual dysfunction

目的观察枸橼酸西地那非联合星状神经节阻滞(SGB)对男性性功能障碍(SD)患者血管内皮功能的影响,并探讨其机制。方法选择2011年6月至2012年10月收治的SD患者104例,随机分为对照组和研究组,每组52例。对照组给予枸橼酸西地那非治疗,研究组在口服枸橼酸西地那非基础上给予SGB治疗。比较2组血清性激素[总睾酮(TT)、游离睾酮(FT)、性激素结合球蛋白(SHBG)]、血管内皮功能[一氧化氮(NO)、内皮素(ET-1)、肱动脉血流介导的血管扩张功能(FMD)]、炎性因子[白介素6(IL-6)、肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)]、氧化应激[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]及外周血单核细胞(PBMCs)沉默信息调节因子2相关酶1(SIRT1)mRNA和蛋白表达变化。结果2组治疗后TT、FT、SHBG、NO、FMD、SOD、GSH-Px、SIRT1 mRNA和蛋白表达均较治疗前显著提高,ET-1、IL-6、TNF-α、hs-CRP、MDA均较治疗前显著降低(P<0.05),且研究组以上指标变化幅度大于对照组(P<0.05)。结论枸橼酸西地那非联合SGB能够显著提高SD患者机体性激素含量,并改善血管内皮功能,其机制与调节SIRT1表达,从而抑制炎性反应和氧化应激有关。

Objective To investigate the effects of sildenafil citrate combined with stellate ganglion block(SGB)on the vascular endothelial function in male patients with sexual dysfunction(SD),and to explore its action mechanism.Methods A total of 104 male patients with SD who were admitted and treated in our hospital from Junuary 2011 to October 2012 were enrolled in the study,who were randomly divided into research group(n=52)and control group(n=52).The patients in control group were treated by oral sildenafil citrate,however,the patients in research group,on the basis of control group,were treated by SGB.The serum levels of sex hormone(TT,FT and SHBG),vascular endothelial function(NO,ET-1 and FMD),inflammatory cytokines(IL-6,TNF-αand hs-CRP),oxidative stress(MDA,SOD and GSH-Px)and the expression levels of SIRT1 mRNA and proteins in PBMCs before and after treatment were observed and compared between the two grousp.Results After the treatment,the levels of TT,FT,SHBG,NO,FMD,SOD,GSH-Px and the expression levels of SIRT1 mRNA and proteins in both groups were significantly,as compared with those before treatment,but the levels of ET-1,IL-6,TNF-α,hs-CRP and MDA in both groups were significantly decreased(P<0.05).Moreover the changes in the indexes mentioned above in research group were more significant than those in control group(P<0.05).Conclusion The sildenafil citrate combined with SGB can effectively increase the sexual hormone content and improve vascular endothelial function in male patients with SD,and its action mechanism may be associated with the up-regulation of SIRT1 expression so as to inhibit the inflammation reaction and oxidative stress.