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伴勃起功能障碍的男性糖尿病患者的感觉与
自主神经功能的定量检测
OBJECTIVE: To correlate abnormalities of nerve fibres in the lower
limbs with erectile dysfunction in male diabetic patients, using a
range of quantitative sensory and autonomic function tests. PATIENTS
AND METHODS: The study included 68 male diabetic patients with symptomatic
erectile dysfunction and 11 matched diabetics without erectile dysfunction;
none had clinical evidence of peripheral vascular disease or psychological
disorder. Patients were evaluated with a symptom questionnaire based
on the Michigan Neuropathy Screening Instrument questionnaire and
examined clinically. Sural and peroneal nerve-conduction studies,
and quantitative sensory and autonomic tests (vibration, thermal,
light-touch thresholds, sensory and autonomic cutaneous axon-reflexes)
were used to detect nerve abnormalities in the lower limbs, which
were correlated with erectile dysfunction. RESULTS: Symptoms of neuropathy
were more common in the group with male erectile dysfunction (MED),
but statistically significant only for neuropathic pain (53% MED,
18% nonMED, P<0.05, chi-square test) and gastroparesis (44% MED,
0% nonMED, P<0.05). Tests of unmyelinated afferents (warming perception
and capsaicin-induced sensory axon-reflex vasodilatation) were most
often abnormal, sometimes with no other abnormalities on tests or
neurological examination. However, abnormality of warm perception
was not significantly different between groups (81% MED, 70% nonMED),
suggesting that it is a poorer discriminant than abnormal sensory
axon-reflex vasodilatation (89% MED, 22% nonMED, P<0.001). The
only other significant test difference was decreased sural nerve action
potential (70% MED, 22% non-MED, P<0.01). CONCLUSIONS: There appeared
to be preferential involvement of unmyelinated sensory fibres that
mediate axon-reflex vasodilatation in the limbs of diabetic patients
with erectile dysfunction. This test appears to be a helpful indicator
of neurological involvement in erectile dysfunction, and may be used
to monitor the effect of new treatments.
【引自BJU Int 1999 Jan;83(1):66-70】 |
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