Pharmacology of penile erection.
Pharmacology of penile erection.
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DOI：
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发表时间：
2001-09
影响因子：
21.1
通讯作者：
K. Andersson
中科院分区：
文献类型：
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作者：
K. Andersson
勃起基本上是一种脊髓反射，可以通过阴茎传入神经的募集来启动，也可以通过视觉、嗅觉和想象的刺激来启动。该反射涉及自主神经和躯体传出神经，并受到脊髓上影响的调节。已经确定了几个涉及勃起控制的中央发射器。多巴胺、乙酰胆碱、一氧化氮 (NO) 和肽，如催产素和促肾上腺皮质激素/α-黑素细胞刺激激素，似乎具有促进作用，而血清素可能是促进作用，也可能是抑制作用，而脑啡肽是抑制作用。在外围，收缩因子和松弛因子之间的平衡控制着海绵体平滑肌的收缩程度，并决定了阴茎的功能状态。去甲肾上腺素通过刺激α(1)-肾上腺素受体来收缩海绵体和阴茎血管。神经源性NO被认为是阴茎血管和海绵体松弛的最重要因素。神经或内皮释放的其他介质的作用尚未明确确定。勃起功能障碍（ED）可能是由于阴茎平滑肌无法放松所致。这种无能力可能有多种原因。然而，ED 患者对目前可用的药物治疗反应良好。所使用的药物能够部分或完全替代控制阴茎勃起的功能失常的内源性机制。大多数药物对阴茎组织有直接作用，促进阴茎平滑肌松弛，包括前列腺素 E(1)、NO 供体、磷酸二酯酶抑制剂和 α-肾上腺素受体拮抗剂。中枢神经中枢中参与勃起启动的多巴胺受体已成为治疗 ED 的目标。舌下给药的阿扑吗啡是此类药物中的第一种。
Erection is basically a spinal reflex that can be initiated by recruitment of penile afferents, but also by visual, olfactory, and imaginary stimuli. The reflex involves both autonomic and somatic efferents and is modulated by supraspinal influences. Several central transmitters involved in the erectile control have been identified. Dopamine, acetylcholine, nitric oxide (NO), and peptides, such as oxytocin and adrenocorticotropic/alpha-melanocyte-stimulating hormone, seem to have a facilitatory role, whereas serotonin may be either facilitatory or inhibitory, and enkephalins are inhibitory. Peripherally, the balance between contractant and relaxant factors controls the degree of contraction of the smooth muscle of the corpora cavernosa and determines the functional state of the penis. Noradrenaline contracts both corpus cavernosum and penile vessels via stimulation of alpha(1)-adrenoceptors. Neurogenic NO is considered the most important factor for relaxation of penile vessels and corpus cavernosum. The role of other mediators released from nerves or endothelium has not been definitely established. Erectile dysfunction (ED) may be due to inability of penile smooth muscles to relax. This inability can have multiple causes. However, patients with ED respond well to the pharmacological treatments that are currently available. The drugs used are able to substitute, partially or completely, the malfunctioning endogenous mechanisms that control penile erection. Most drugs have a direct action on penile tissue facilitating penile smooth muscle relaxation, including prostaglandin E(1), NO donors, phosphodiesterase inhibitors, and alpha-adrenoceptor antagonists. Dopamine receptors in central nervous centers participating in the initiation of erection have been targeted for the treatment of ED. Apomorphine, administered sublingually, is the first of such drugs.