男性肾功能衰竭患者血液透析与肾移植后勃起功能的比较

Erectile function of renal failure patients after hemodialysis or kidney transplantation:A comparative study

目的:对比研究男性肾功能衰竭患者血液透析与肾移植后勃起功能的变化并讨论其原因。方法:回顾性分析2015年1月至2021年1月于东部战区总医院行血液透析和肾移植并主诉有勃起功能障碍(ED)的160例男性患者的临床资料。年龄25~45(31.7±4.8)岁,其中血液透析组80例[(32±4.5)岁]、肾移植组80例[(31.4±5.1)岁]。分别记录两组患者的血清睾酮(T)、雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)水平变化,比较两组患者国际勃起功能(IIEF-5)评分、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果:肾移植组患者较血液透析组T明显增高[(17.75±7.32)nmol/L vs(7.45±3.54)nmol/L],E2明显降低[(94.17±40.79)pmol/L vs(151.37±20.89)pmol/L],两组之间均有显著性差异(P<0.01),两组FSH、LH水平无明显差异[分别为(8.97±2.36)IU/L vs(8.12±5.12)IU/L,(4.69±2.18)IU/L vs(5.16±3.87)IU/L,P均>0.05]。肾移植患者中,重度ED较血透患者少(3.75%vs 16.25%),有显著性差异(P<0.05)。两组均有不同程度焦虑和抑郁,其中血透组重度焦虑和抑郁患者较肾移植组明显增多(分别为6.25%vs 30.00%,6.25%vs 31.25%,P均<0.05),中度焦虑和抑郁患者两组相当(分别为25.00%vs 22.50%,23.75%vs 20.00%,P均>0.05),肾移植组轻度焦虑和抑郁患者较血透组多(分别为68.75%vs 47.50%,70.00%vs 48.75%,P均<0.05)。结论:对于男性肾功能衰竭患者,肾移植术对ED的改善作用较为明显,血液透析对ED改善效果不佳,患者激素水平改变及焦虑和抑郁为重要原因。

Objective:To study the changes in the erectile function of the male patients with renal failure after hemodialysis(HD)or kidney transplantation(KT)and explore the causes of these changes.Methods:From January 2015 to January 2021,160 male patients with renal failure complaining of ED underwent HD(n=80)or KT(n=80)in the General Hospital of Eastern Theater Command.The patients were aged 25-45(31.7±4.8)years,32±4.5 years in the HD group and 31.4±5.1 years in the KT group.We recorded the levels of serum T,E2,FSH and LH and the scores on IIEF-5,Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)of the patients,and compared them between the two groups.Results:Compared with the patients in the HD group,those in the KT group showed a significantly higher T level([7.45±3.54]vs[17.75±7.32]nmol/L,P<0.01)and a lower E2 level([151.37±20.89]vs[94.17±40.79]pmol/L,P<0.01),but no statistically significant difference from the former group in the levels of FSH([8.12±5.12]vs[8.97±2.36]IU/L,P>0.05)and LH([5.16±3.87]vs[4.69±2.18]IU/L,P>0.05).There were fewer cases of severe ED in the KT than in the HD group(3.75%vs 16.25%,P<0.05).Different degrees of anxiety and depression were observed in both groups,with fewer severe cases of anxiety(6.25%vs 30.00%,P<0.05)and depression(6.25%vs 31.25%,P<0.05)and more mild cases of anxiety(68.75%vs 47.50%,P<0.05)and depression(70.00%vs 48.75%,P<0.05)in the KT than in the HD group,but no statistically significant difference in the incidence of moderate anxiety(25.00%vs 22.50%,P>0.05)and depression(23.75%vs 20.00%,P>0.05)between the KT and HD groups.Conclusion:For male patients with renal failure,kidney transplantation can evidently improve erectile function,while hemodialysis has a poorer effect.The altered hormone levels,anxiety and depression of the patients are important causes of the changes in their erectile function.