疏肝温阳散对抑郁症勃起功能障碍患者的疗效及机制研究

Efficacy and Mechanism of Shugan Wenyang Powder in the Treatment of Erectile Dysfunction in Patients with Depression and Erectile Dysfunction

目的:观察疏肝温阳散对抑郁症勃起功能障碍(ED)患者的临床疗效,并通过一氧化氮(NO)-环磷酸鸟苷(cGMP)信号通路探讨其作用机制。方法:选取该院门诊及住院的抑郁症伴随ED患者100例为观察对象,将其随机分为观察组与对照组,各50例。对照组患者口服盐酸曲唑酮治疗,观察组患者在对照组的基础上加用疏肝温阳散,两组患者均连续治疗4周。对两组患者ED治疗后的临床疗效进行评定;采用汉密尔顿抑郁量表17项(HAMD-17)、抑郁自评量表(SDS)评价两组患者的抑郁症状,采用国际勃起功能指数量表(IIEF-5)评价两组患者的勃起功能,采用抗抑郁药不良反应量表(SERS)、世界卫生组织生活质量测定量表(WHOQOL-BREF)评价两组患者的不良反应情况和生活质量;取两组患者阴茎海绵体内血液,采用酶联免疫吸附试验检测血浆神经元型一氧化氮合酶(nNOS)、内皮型一氧化氮合酶(eNOS)、NO和cGMP的表达水平。结果:治疗4周后,观察组患者ED临床总有效率为92.0%(46/50),对照组为76.0%(38/50),观察组患者明显高于对照组,差异有统计学意义(P<0.05)。治疗4周后,观察组患者的HAMD-17、SDS及SERS评分与对照组相比明显降低,IIEF-5、WHOQOL-BREF评分较对照组明显升高;观察组患者阴茎海绵体血浆中nNOS、eNOS、NO和cGMP含量较对照组明显升高,差异均有统计学意义(P<0.05)。结论:疏肝温阳散对抑郁症ED患者具有较好的疗效,能够改善患者抑郁症状和勃起功能,提高生活质量,减轻不良反应,其机制可能与调节NO-cGMP信号通路,促进阴茎海绵体舒张相关。

OBJECTIVE:To observe the clinical efficacy of Shugan Wenyang powder in the treatment of erectile dysfunction in patients with depression and erectile dysfunction(ED),and to explore its mechanism through NO-cGMP signal pathway.METHODS:One hundred patients with depression and ED in the hospital were randomly divided into the observation group and control group,with 50 cases in each group.The control group was treated with Tadalafil tablets,while the observation group received Shugan Wenyang powder on the basis of western medicine.Both groups were treated for 4 weeks.The clinical efficacy of ED treatment in two groups was evaluated.The depressive symptoms of two groups were evaluated by Hamilton Depression Scale 17(HAMD-17)and self rating Depression Scale(SDS),the erectile function of two groups was evaluated by international erectile function index(IIEF-5),and the adverse drug reactions and quality of life of two groups were evaluated by antidepressant adverse reaction scale(SERS)and World Health Organization Quality of life scale(WHOQOL-BREF).The expression levels of nNOS,eNOS,NO and cGMP in plasma of corpus cavernosum of penis were detected by enzyme-linked immunosorbent assay.RESULTS:After 4 weeks of treatment,the total effective rate of ED in the observation group was 92.0%(46/50),significantly higher than 76.0%(38/50)in the control group,the difference was statistically significant(P<0.05).After 4 weeks of treatment,the HAMD-17,SDS and SERS scores of the observation group were significantly lower than those of the control group,and the IIEF-5 and WHOQOL-BREF scores were significantly higher than those of the control group;the levels of nNOS,eNOS,NO and cGMP in plasma of corpus cavernosum in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).CONCLUSIONS:The efficacy of Shugan Wenyang powder in the treatment of erectile dysfunction in patients with depression and ED is significant,which can improve the depressive symptoms,erectile function and the quality of life,and effectively reduce the adverse drug reactions.Its mechanism may be related to regulating NO-cGMP signal pathway and promoting the relaxation of penile spongy body.