淫羊藿抗勃起功能障碍研究进展

淫羊藿是我国传统的壮阳药物,随着淫羊霍在抗勃起功能障碍(ED)作用机制中的认识和深入研究,发现其在一氧化氮-环鸟苷酸-磷酸二酯酶5(NO-c GMP-PDE5)通路中起关键作用,能够减少海绵体平滑肌细胞萎缩和凋亡,促进性激素和促性腺激素分泌,增加性器官和性腺的脏器指数等。文中就上述研究进行药理学方面的综述,为其药剂学的进一步开发提供参考。

Sildenafil does not influence hepatic venous pressure gradient in patients with cirrhosis

AIM： To investigate if sildenafil increases splanchnic blood flow and changes the hepatic venous pressure gradient （HVPG） in patients with cirrhosis. Phosphodiesterase type-5 inhibitors are valuable in the treatment of erectile dysfunction and pulmonary hypertension in patients with end-stage liver disease. However, the effect of phosphodiesterase type-5 inhibitors on splanchnic blood flow and portal hypertension remains essentially unknown. METHODS： Ten patients with biopsy proven cirrhosis （five females/five males, mean age 54：1：8 years） and an HVPG above 12 mmHg were studied after informed consent. Measurement of splanchnic blood flow and the HVPG during liver vein catheterization were done before and 80 min after oral administration of 50 mg sildenafil. Blood flow was estimated by use of indocyanine green clearance technique and Fick＇s principle, with correction for non-steady state. RESULTS： The plasma concentration of sildenafil was 222 ± 136 ng/mL 80 min after administration. Mean arterial blood pressure decreased from 77 ±7 mmHg to 66 ± 12 mmHg, P = 0.003, while the splanchnicblood flow and oxygen consumption remained unchanged at 1.14 ± 0.71 L/min and 2.3 ± 0.6 mmol/ min, respectively. Also the HVPG remained unchanged （18 ± 2 mmHg vs 16 ± 2 mmHg） with individual changes ranging from -8 mmHg to ±2 mmHg. In seven patients, HVPG decreased and in three it increased. CONCLUSION： In spite of arterial blood pressure decreases 80 min after administration of the phosphodiesterase type-5 inhibitor sildenafil, the present study could not demonstrate any clinical relevant influence on splanichnic blood flow, oxygen consumption or the HVPG.

Chronic kidney disease and erectile dysfunction

Erectile dysfunction(ED) is a common condition among male chronic kidney disease(CKD) patients.Its prevalence is estimated to be approximately 80% among these patients.It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection.Factors affecting these pathways can induce ED.The etiology of ED in CKD patients is multifactorial.Factors including abnormalities in gonadal-pituitary system,disturbance in autonomic nervous system,endothelial dysfunction,anemia(and erythropoietin deficiency),secondary hyperparathyroidism,drugs,zinc deficiency,and psychological problems are implicated in the occurrence of ED.An improvement of general conditions is the first step of treatment.Sufficient dialysis and adequate nutritional intake are necessary.In addition,control of anemia and secondary hyperparathyroidism is required.Changes of drugs that potentially affect erectile function may be necessary.Further,zinc supplementation may be necessary whenzinc deficiency is suspected.Phosphodiesterase type 5 inhibitors(PDE5Is) are commonly used for treating ED in CKD patients,and their efficacy was confirmed by many studies.Testosterone replacement therapy in addition to PDE5 Is may be useful,particularly for CKD patients with hypogonadism.Renal transplantation may restore erectile function.ED is an early marker of cardiovascular disease(CVD),which it frequently precedes; therefore,it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack.

Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes

1 Introduction Erectile dysfunction （ED） and coronary artery disease （CAD） are closely linked, as both conditions share the same cardiovascular risk factors. Indeed, these risk factors can determine endothelial dysfunction that represents the common underlying mechanism of both ED and CAD. The prevalence of ED is about three-fold higher among diabetic patients than in the general population and a higher prevalence of CAD has been observed in people with diabetes when compared to non-diabetic subjects.Some studies showed that ED can be a powerful marker of silent CAD and a strong predictor of cardiovascular events in apparently uncomplicated type 2 diabetic patients Therefore ED is now considered as a sentinel symptom of silent CAD, as ED often precedes the onset of myocardial ischemia itself by many years.

STUDY ON HEMODYNAMICS OF ERECTION IN DIABETIC ERECTILE DYSFUNCTION

Objective To study the cavernosa hemodynamics in diabetic erectile dysfunction ( ED).Methods 22 diabetic and 35 psychic ED patients were studied by intracavernosum injection of a mixture papaver-ine and phentolamine (30/1mg) to assess the hemodynamics changes of the corpus cavernosum by means of colour duplex ultrasonography. Results The average hemodynamics data of the diabetic ED patients vs that of the psy-chogenic ED patients in terms of peak flow velocity (PFV):20. 06±7.15cm/s vs 35. 82±9. 41cm/s, end diastolic velocity (EDV) : 8. 82±0. 35cm/s vs 5. 51±0. 42cm/s,artery diameter (Ad) : 0. 78±0. 25cm vs 1. 01±0. 42cm, vein diameter ( Vd) : 1.05±0. 32mm vs 1.21±0. 45mm, resistance index(RI) : 0. 72±0. 28 vs 0. 98±0. 31,mean velocity of artery (MV):6. 71±0. 27cm/s vs 10. 31±3. 32cm/s, dorsal deep vein flow(DDVF) : 28. 81±6. 32cm/ s vs 25. 74±0. 58cm/s. Stasticstical differences existed in PFV, Ad,RI and MV(P <0. 01). The arterial wall is thick and rigid in diabetic ED patients. Conclusion Atheroscleorsis and veno-occlusive dysfunction of the corpus cavernosum are essential to the development of diabetic ED.

Rat model of erectile dysfunction caused by cavernous nerve ablation

OBJECTIVE: To identify the rat cavernous nerve and establish a rat model of erectile dysfunction (ED) caused by injury of the cavernous nerve. METHODS: Twenty rats underwent dissections. Cavernous nerves were identified with the aid of an operating microscope and confirmed by electrical stimulation. Then, 42 experimental rats were randomized into 3 groups, including sham-operated controls and unilateral and bilateral cavernous nerve ablation groups. Three weeks after surgery, rat models were evaluated with the Apomorphine test. RESULTS: The major pelvic ganglion lies on either side of the dorsolateral lobes of the prostate.It includes 2 inflows, one called hypogastric nerve and the other, the pelvic nerve. The largest outflow is termed the cavernous nerve. Stimulus parameters which could induce obvious penile erection were 5 volts, a frequency of 20 Hertz and a duration of 5 milliseconds. Three weeks after surgery, apomorphine could induce penile erection of each rat in the controls with a mean of 2.57 +/- 1.40 erections in 30 minutes, while there were no erections (0.00 +/- 0.00) in either the unilateral or bilateral groups. CONCLUSIONS: The rat large ganglion and its cavernous nerve can be easily identified and it produces an obvious response to electrical stimulation. Rats are low cost animals to purchase, easy to house and very available making an ideal animal for developing an ED model caused by cavernous nerve injury. In addition, our study showed that in the early period of cavernous nerve ablation, unilateral and bilateral treated rats lost erectile capacity.

Influence of Acupuncture on Serum Hormone of Erectile Dysfunction Patients

Objective： To explore the influence of acupuncture therapy on erectile dysfunction. Methods： 60 cases of the patients with impotence of erectile dysfunction were observed before and after acupuncture treatment, with determination of serum testosterone （T）, estradiol （E2） and prolactin （PRL）. Results： After the treatments, T concentration was increased, and the contents of E2 and PRL were decreased. Normal sexual action can be maintained. Conclusion： Acupuncture can effectively rectify the disorder of serum hormone, and improve the clinical symptoms.

Clinical observation on warm needling moxibustion for erectile dysfunction

Objective： To observe the therapeutic effect of warm needling moxibustion for erectile dysfunction （ED）. Methods： A total of 46 eligible ED patients were randomized into a treatment group （n=24） and a control group （n=22）. The treatment group was intervened by warm needling moxibustion while the control group by conventional acupuncture treatment, for a total of 4 courses. The therapeutic effect was evaluated by the international index of erectile function 5 （IIEF-5）. Results： After 4 courses of treatment, the overall effective rate was 91.3% in the treatment group （23 completed）, versus 75.0% in the control group （20 completed）, with a significant difference （P〈0.05）. After the treatment, the change of IIEF-5 score in the treatment group was significantly different from that in the control group （P〈0.05）. Conclusion： Warm needling moxibustion can produce a more significant efficacy than conventional acupuncture in the treatment of ED.

Observation on Therapeutic Effects of Acupuncture for Erectile Dysfunction

Objective： To observe the clinical effects of acupuncture treatment for erectile dysfunction. Methods： Eighty-two cases of the patients with erectile dysfunction were identified as two patterns of kidney yang deficiency and damp-heat in lower jiao and were treated with different acupoints for different patterns. Results： The total curative rate was 87.6%. The curative rate was 45.0% in pattern of kidney yang deficiency and 59.1% in pattern of damp-heat in lower jiao. Conclusion： The clinical effect in acupuncture treatment of erectile dysfunction was related to the age of the patients and duration of disease. The higher the age and the longer the duration, the poorer the therapeutic effects were. The curative rate was higher in the treatment of pattern of damp-heat in lower jiao than pattern of kidney yang deficiency.

Analysis on Therapeutic Features of Ancient Acupuncture Treatment for Impotence

To analyze the acupuncture treatment for impotence in 130 kinds of classical medical books by computer, and summarize the rules of acupuncture for this disease. The results showed that selection of acupoints along the meridians, selection of acupoints by body parts, selection of acupoints by pattern identification are the laws of acupuncture for this disease.

Examples of Acupuncture Treatment for Intractable Diseases

1 Spermatorrhea A patient, 16 years old, suffered from spermatorrhea for over one year. At the beginning, it happened once several days, and recently it happened once every other day or every night, accompanied by a withered complexion, soreness and weakness in the lower back and legs, poor sleep, poor memory, a red tongue tip with thin tongue coating, and a thready and rapid pulse. The condition is attributed to kidney deficiency leading to poor containing ability, seminal emissions, and intemal disturbance of monarch fire. Therefore, bilateral Tongli （HT 5）, Shenshu （BL 23）, Guanyuan （CV 4） and Taixi （KI 3） were punctured by the twisting technique for reinforcement,

Assessment of the safety and efficacy of acupuncture in erectile dysfunction treatment

Objective To assess the safety and efficacy of acupuncture in erectile dysfunction treatment.Methods A systematic literature search was conducted to identify relevant studies.Seven electronic databases including Popline,World Health Organization(WHO)Global Health Library(GHL),System for Information on Grey Literature in Europe(SIGLE),Scopus,Institute for Scientific Information(ISI)Web of Science,PubMed and Virtual Health Library(VHL)were utilized to carry out the search.A manual search was further conducted for relevant publications from references of the included articles,relevant papers in PubMed and Google Scholar,and primary studies that had cited the included papers.Hand-search using each keyword to avoid missing any relevant publications was also carried out.Results The literature search yielded 2818 reports after removing duplicates using Endnote software.There were 21 studies eligible for full-text screening and five of which were subsequently included.After two studies identified from the manual search were added,a total of seven studies were found suitable to carry out the systematic review and meta-analysis.Five of them were used for quantitative and qualitative analysis,while two were only used for qualitative analysis.There were four clinical trials,one pilot study,one case report,and one animal study.Conclusion Acupuncture can improve male erectile function.

Ela tablets improve sexual performance in mice with erectile dysfunction caused by repeated restraint stress

Ela tablets contain an optimized extract of a Chinese herbal prescription. The original prescription has been used to treat erectile dysfunction(ED), while the detailed indications and specific treatment mechanisms of Ela tablets remain unclear. In the present study, we aimed to investigate whether Ela tablets could protect mice from ED caused by repeated restraint stress and to explore the possible mechanisms. Mice were restrained daily in centrifuge tubes with venting holes for 14 consecutive days and administered Ela tablets at 1 h before restraining. On the 14 th night, mating experiments were conducted. Thereafter, blood, testicular, and penile samples were collected. Serum testosterone levels were measured using a kit. Testicular tissue morphology was observed by H&E staining. The PDE5 expression in the corpus cavernosum was measured by Western blotting analysis. The results indicated that Ela tablets significantly shortened the sexual arousal time, increased the number of sexual encounters, maintained the normal morphology of testicular tissue, increased the serum testosterone levels, and decreased the PDE5 expression in the corpus cavernosum. Our data showed that Ela tablets elicited protective effects on the sexual ability of mice exposed to repeated restraint stress. Moreover, the underlying mechanism was related to the preservation of testicular tissue morphology, maintenance of testosterone levels, and inhibition of penile PDE5 expression.

Clinical Observation on Combined Acupuncture and Herbs in Treating Impotence

Objective： To observe the clinical efficacy of combined acupuncture and herbs in the treatment of impotence. Methods： One hundred cases of impotence were randomized into two groups： a treatment group in which 50 cases were treated with acupuncture and herbs, and a control group in which another 50 cases were treated with acupuncture alone. The treatment was given once a day and 10 treatments made up one course, with a two-day interval between each two courses. The clinical efficacy was evaluated after two courses. Results： The total effective rate was 98.0% in the treatment group and 76.0% in the control group, with a statistical difference between the two groups （P0.01）. Conclusion： Combined acupuncture and herbs has better results than simple acupuncture in the treatment of impotence.