补肾填精法通过调控一氧化氮和血管内皮素治疗糖尿病勃起功能障碍的作用机制研究

Study on the mechanism of tonifying kidney and replenishing essence in treating diabetic erectile dysfunction by regulating NO and ET-1

目的分析中医药补肾填精法治疗糖尿病勃起功能障碍(DMED)的效果,同时检测患者治疗前后的血管内皮素(ET-1)和一氧化氮(NO)变化,初步探究其作用机制。方法选取2017年6月至2019年12月在南京中医药大学附属沭阳医院首次就诊的80例DMED患者作为研究对象。分为治疗组(n=40)和对照组(n=40)。在其血糖控制正常的情况下,治疗组给予具有补肾填精功效的中草药治疗,对照组给予他达拉非片治疗,疗程均为3个月,观察两组治疗前后及停药1个月后性功能恢复状况及国际勃起功能指数(IIEF-5)评分,同时比较两组治疗前和停药1个月后的ET-1及NO的变化。结果治疗组勃起功能、IIEF-5评分较治疗前均有所提高,差异具有统计学意义(P<0.01),停药1个月后两项仍明显高于治疗前,差异具有统计学意义(P<0.01);治疗组ET-1及NO水平较治疗前均明显改善,差异具有统计学意义(P<0.01),且明显优于对照组,差异具有统计学意义(P<0.01)。对照组勃起功能、IIEF-5较治疗前亦有所提高,差异具有统计学意义(P<0.01),但停药1个月后均与治疗前无明显差别,差异无统计学意义(P>0.05);对照组ET-1及NO水平治疗前后均无明显变化,差异无统计学意义(P>0.05)。治疗组远期疗效明显优于对照组,差异具有统计学意义(P<0.01)。结论补肾填精法可提高并维持DMED患者的勃起功能和IIEF-5评分,改善ET-1和NO水平可能为其发挥作用的重要机制之一。

Objective To analyze the efficacy of tonifying kidney and replenishing essence with traditional Chinese medicine in the treatment of diabetic mellitus erectile dysfunction(DMED), and detect the changes of endothelin-1(ET-1) and nitric oxide(NO) of patients before and after treatment, so as to preliminarily explore its mechanism of action. Methods 80 patients with DMED who were admitted to the Shuyang Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from June 2017 to December 2019 were randomly divided into treatment group(n=40) and control group(n=40). Under the condition of normal blood glucose control, the treatment group was treated with Chinese herbal medicine with kidney tonifying and essence replenishing, while the control group was treated with tadalafil tablets. The course of treatment was 3 months. The sexual function recovery status and International Index of Erectile Function(IIEF-5) score of the two groups were observed before and after treatment and 1 month after drug withdrawal. Meanwhile, the changes of ET-1 and NO in the two groups before treatment and after 1 month of drug withdrawal were compared. Results Erectile function and IIEF-5 score in the treatment group were improved compared with those before treatment(P<0.01), and they were still significantly higher one month after drug withdrawal than those before treatment(P<0.01). The levels of ET-1 and NO were significantly improved(P<0.01) and significantly better than those of the control group(P<0.01). Erectile function and IIEF-5 in the control group were also improved compared with those before treatment(P<0.01), but there was no significant difference after 1 month of drug withdrawal(P>0.05). The levels of ET-1 and NO in the control group did not change significantly before and after treatment(P>0.05). The long-term effect of the treatment group was significantly better than that of the control group(P<0.01). Conclusions Tonifying kidney and replenishing essence can improve and maintain erectile function and IIEF-5 score of DMED patients, and improving ET-1 and NO levels may be one of the important mechanisms of its action.