高海拔地区不同海拔高度ED患者夜间睡眠相关勃起(SREs)的真实世界研究

A real⁃world study of nocturnal sleep⁃related erections(SREs)in ED patients at different altitudes in high altitudearea

目的本研究旨在评价高海拔地区不同海拔高度缺氧环境下勃起功能障碍(Erectile dysfunction,ED)患者的夜间睡眠相关勃起(SREs)的临床特点,以评估慢性缺氧环境下ED患者SREs降低的真实世界。方法国际勃起功能指数评分(IIEF⁃5)≤21分及主观描述确诊为ED患者共235例。根据患者久居地海拔高度特点分为四组,对研究对象行股动脉血氧分压测定、勃起状态下阴茎海绵体血氧分压测定、使用RigiScan在NPTR模式下连续两晚监测同时睡眠同步监测并进行比较。结果①研究对象平均年龄(28.5±8.6)岁,四组间年龄均值比较无统计学差异(P>0.05);②IIEF⁃5评分,轻度ED 77例(32.7%)、中度ED 121例(51.6%)、重度ED 37例(15.7%),四组间比较有显著统计学差异(P<0.05);③中心动脉(股动脉)血氧分压值(西宁地区)为(73.9±3.7)mmHg,处于低氧状态(≤80 mmHg);④勃起状态阴茎海绵体血氧分压测量,≥65 mmHg(154例,65.5%),<65 mmHg(81例,34.5%),2300~3500 m与3500~4500 m间有显著统计学差异(P<0.05);⑤NPTR(连续两晚)监测数据,不同海拔高度SREs整晚(8 h以上)总勃起次数2300~3500 m与3500~4500 m无统计学差异(P>0.05),连续两晚勃起事件头端最佳硬度≥60%的维持时间均<600 s,2300~3500 m与3500~4500 m无统计学差异(P>0.05);在整晚(睡眠8 h以上)总勃起事件次数、整晚(睡眠8 h以上)总勃起时间、总勃起时间占整晚时间(睡眠8 h以上)百分比、阴茎头端最佳勃起前后的周长增大百分比、头端最佳勃起硬度、头端最佳勃起硬度≥60%维持时间观察指标上2300~3500 m与3500~4500 m间比较均有显著统计学差异(P<0.05)。结论慢性高原缺氧是引起久居高海拔地区男性人群ED的独立危险因素之一,且发病年龄年轻化。在睡眠质量及睡眠结构改变的相同条件下,随着海拔高度的增加,SRE次数越来越少,ED的程度也越来越重,长期不同程度低氧状态影响氧在海绵体利用度及传递可能是重要原因。

Objective To summarize the clinical characteristics of nocturnal sleep⁃related erections(SREs)in patients with ED(Erectile dysfunction,ED)at different altitudes in high altitude areafor assessing the real world of reduced SREs in ED patients under chronic hypoxic environment.Methods A total of 235 patients with International Index of Erectile Function score(IIEF⁃5)≤21 and subjective descriptions were accurately diagnosed as ED.The patients at different altitudes were divided into four groups according to the altitude of the place of permanent residence(Xining area).Perform femoral artery oxygen partial pressure measurement on the research subjects.During the ICI examination,the penis was in an erect state and blood samples from the corpus cavernosum of the penis were extracted for femoral arteryblood oxygen partial pressure measurement.Simultaneously,sleep synchronization monitoring using RigiScan in NPTR mode for two consecutive nights were performed.Results①The mean age of the subjects was(28.5±8.6)years old,and there was no statistical difference in the comparison of the mean age values among the four groups(P>0.05);②IIEF⁃5 score:77 cases of mild ED(32.7%),121 cases of moderate ED(51.6%)and 37 cases of severe ED(15.7%).There were significant differences in the four groups(P<0.05).③The partial pressure of oxygen in the central artery(femoral artery)(Xining area)was(73.9±3.7)mmHg,and was in hypoxia state(≤80 mmHg);④The partial pressure of oxygen in penile cavernous blood in erect state over 65 mmHg accounted for 65.5%(154 cases)and below 65 mmHg accounted for 34.5%(81cases).There was a statistically significant difference between the patients at 2300~3500 m and the patinets at 3500~4500 m(P<0.05);⑤There was no statistically significant difference(P>0.05)in the total number of erections between the first and second groups of SREs at different altitudes throughout the night(more than 8 hours).The maintenance time of the best head hardness≥60%of erectile events for two consecutive nights was less than 600 s,and there was no significant difference between the first group and the second group(P>0.05).NPTR(two consecutive nights)monitoring data included number of total erectile events during the whole night(sleep 8 h or more),total erection time during the whole night(sleep 8 h or more),total erection time as a percentage of the whole night time(sleep 8 h or more),percentage increase in circumference before and after the best erection at the Penile tip,best erection hardness at the Penile tip.There were statistically significant differences(P<0.05)between 2300 m to 3500 m and 3500 m to 4500 m in the observed indexes of Penile tip optimal erection hardness≥60%maintenance time.Conclusion The study suggests that chronic altitude hypoxia is one of the independent risk factors for ED in men who live at high altitude for a long time,and the age of onset is younger.Under the same conditions of changes in sleep quality and sleep structure,the number of SRE decreases and the degree of ED also became more severe with increase of altitude.It is a possible important cause for long⁃term varying degrees of hypoxia affecting oxygen utilization and delivery in the corpus cavernosum.