IMPAIRED NEUROGENIC AND ENDOTHELIUM-MEDIATED RELAXATION OF PENILE SMOOTH-MUSCLE FROM DIABETIC MEN WITH IMPOTENCE
IMPAIRED NEUROGENIC AND ENDOTHELIUM-MEDIATED RELAXATION OF PENILE SMOOTH-MUSCLE FROM DIABETIC MEN WITH IMPOTENCE
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DOI：
10.1056/nejm198904203201601
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发表时间：
1989-04-20
影响因子：
158.5
通讯作者：
COHEN, RA
中科院分区：
文献类型：
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作者：
DETEJADA, IS;GOLDSTEIN, I;COHEN, RA
阴茎海绵体平滑肌的松弛是阴茎勃起的必要条件。为了确定松弛受损与糖尿病患者阳痿的关系，我们对21名糖尿病和42名非糖尿病阳痿男性阴茎假体植入时获得的海绵体组织进行了体外检查。去甲肾上腺素诱导离体下体平滑肌条收缩；然后通过电刺激自主神经和给予三种药物来评估松弛：乙酰胆碱，已知是由内皮源性松弛因子介导的；罂粟碱;硝普钠。后两者直接作用于平滑肌（即，它们与内皮无关）。自主介导的电刺激松弛在糖尿病男性（n = 18）的平滑肌中比在非糖尿病男性（n = 24; P = 0.001）的平滑肌中更不明显。损害程度随糖尿病病程的延长而增加（r = 0.61, P = 0.007）。内皮依赖性松弛也受到损害，糖尿病男性（n = 16）服用乙酰胆碱后肌肉松弛程度低于非糖尿病男性（n = 22; P = 0.001）。在控制吸烟和高血压后，糖尿病的不良反应仍然存在。给予硝普塞和罂粟碱后，糖尿病和非糖尿病男性组织的内皮非依赖性松弛相似。我们的结论是，患有阳痿的糖尿病男性在自主神经和介导海绵体平滑肌松弛的内皮依赖机制上都有损伤。这些发现可能为通过海绵体内注射血管扩张剂诱导平滑肌内皮非依赖性松弛治疗糖尿病男性阳痿提供了理论依据。[J] .中华医学杂志，1989;32(1):25 - 30。
Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we performed an in vitro examination of corpus cavernosum tissue obtained at the time of implantation of a penile prosthesis in 21 diabetic and 42 nondiabetic men with impotence. Contraction was induced in isolated strips of corporal smooth muscle by norepinephrine; then relaxation was assessed with electrical stimulation of autonomie nerves and with the administration of three agents: acetylcholine, which is known to be mediated by endothelium-derived relaxing factor; papaverine; and sodium nitroprusside. The latter two act directly on smooth muscle (i.e., they are endothelium-independent).Autonomically mediated relaxation with electrical stimulation was less pronounced in the smooth muscle from diabetic men (n = 18) than in the smooth muscle from nondiabetic men (n = 24; P = 0.001). The degree of impairment increased with the duration of diabetes (r = 0.61, P = 0.007). Endothelium-dependent relaxation was also impaired, as evidenced by a lower degree of muscle relaxation after the administration of acetylcholine in the tissue from diabetic men (n = 16) than in that from nondiabetic men (n = 22; P = 0.001). The adverse effects of diabetes persisted after we controlled for smoking and hypertension. Endothelium-independent relaxation after the administration of nitroprusside and papaverine was similar in tissue from the diabetic and nondiabetic men.We conclude that diabetic men with impotence have impairment in both the autonomie and the endothelium-dependent mechanisms that mediate the relaxation of the smooth muscle of the corpora cavernosa. These findings may provide a rationale for the treatment of diabetic men with impotence by intracavernosal injection of vasodilators to induce endothelium-independent relaxation of the smooth muscle. (N Engl J Med 1989; 320:1025–30.)