SIMPLE, NONINVASIVE, RISK-FREE DIFFERENTIAL DIAGNOSIS OF VASCULOGENIC IMPOTENCE

血管源性阳痿的简单、无创、无风险的鉴别诊断

• 批准号: 03670762
• 负责人: SHIRAI Masafumi
• 金额: $ 1.34万
• 依托单位: TOHO UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1991
• 资助国家: 日本
• 起止时间: 1991 至 1993
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-03670762/
• 关键词: Impotence; Vasculogenic impotence; Papaverine hydrochloride; Cefotiam; Penogram; Arteriogenic impotence; Venogenic impotence; セフオチアム

VASCULOGENIC IMP0TENCE CAN BE DIAGNOSED BY INJECTING THE VASOACTIVE DRUG, PAPAVERINE HYDROCHLORIDE, INTRACAVERNOUSLY, BUT THIS DOES NOT ENABLE THE DIAGNOSTICIAN TO DETERMINE WHETHER THE AFFERENT ARTERIAL OR EFFERENT VENOUS SYSTEM IS IMPAIRED.IN THIS STUDY, WE DEVELOPED A TECHNIQUE THAT ENABLES US TO DETERMINE WHICH OF THESE TWO SYSTEMS IS INVOLVED.TO TEST FOR THE AFFERENT ARTERIAL SYSTEM, TC-99m LABELED HUMAN SERUM ALBUMIN WAS ADMINISTERED INTRAVENOUSLY TO THE CORPUS CAVERNOSUM PENIS TO PRODUCE A TIME-DEPENDENT SCINTIGRAM USING A GAMMA CAMERA.THE REGION OF INTEREST WAS SET UP TO DELINEATE PENILE HEMODYNAMICS AS A PENOGRAM CURVE.AFTER ISOTOPE INJECTION, PAPAVERINE WAS ADMINISTERED INTO THE CORPUS CAVERNOSUM PENIS TO SIMULTANEOUSLY RECORD CHANGES IN BOTH THE PENOGRAM CURVE AND PENILE CIRCUMFERENCE AND RIGIDITY.THE SECOND GENERATION ANTIBIOTIC CEFOTIAM, WHICH CANNOT BE METABOLIZED IN VIVO TOGETHER WITH PARAVERINE AND SHOWS AN EFFERENT PATTERN (r=0.82, p<0.01) EXTREMELY SIMILAR TO THAT OF PAPAVERINE, WAS ADMINISTERED INTO THE PENIS TO MEASURE ITS TIME-DEPENDENT CONCENTRATIONS IN PERIPHERAL BLOOD.THE RESPONSE OF THE PENOGRAM CURVE TO PAPAVERINE LOADING WAS EXPRESSED SIMULTANEOUSLY IN A PENOGRAM INDEX (PI), AND THE CEFOTIAM EFFERENCE INDICATED AS A CEFOTIAM CLEARANCE INDEX (CCI). THESE INDICES WERE COMPARED WITH THE DEGREE OF ERECTION.THE PI WAS 75.5 (〕SY.+-.〔) 8.4 FOR THE COMPLETE -ERECTION GROUP AND 46.8 (〕SY.+-.〔) 16.0 FOR THE INCOMPLETE-ERECTION GROUP.THE PI OF THE NON-ERECTION GROUP WAS 40.5 (〕SY.+-.〔) 10.4. THE PI DECREASED SIGNIFICANTLY FOR THE INCOMPLETE-ERECTION AND NON-ERECTION GROUPS, COMPARED TO THE COMPLETE-ERECTION GROUP.WITH REFERENCE TO CHANGES IN PENILE ARTERIES SHOWN USING A COLOR DOPPLER FLOWMETER, WE DIAGNOSED PATIENTS AS HAVING ARTERIOGENIC IMPOTENCE WHEN THEIR PI WAS LESS THAN THE NORMAL VALUE OF 60. IN CONTRAST, THE CCI SHOWED NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS, PROBABLY BECAUSE THE CCI WAS AFFECTED BY THE AFFERENT BLOOD FLOW VOLUME AND RATE.

血管源性阳痿可以通过静脉注射血管活性药物盐酸罂粟碱来诊断，但这并不能使诊断医生确定是传入动脉系统还是输出静脉系统受损。在这项研究中，我们开发了一种技术，使我们能够确定涉及这两个系统中的哪一个。为了检测传入动脉系统，TC-99m标记的人血清白蛋白被静脉注射到阴茎海绵体，使用伽马照相机产生一个随时间变化的闪烁图。建立感兴趣的区域，以描绘阴茎血流动力学的笔画曲线。经同位素注射后，将罂粟碱注入海绵体阴茎，同时记录阴茎笔画曲线、阴茎周长和刚性的变化。第二代抗生素头孢替安在体内不能与帕帕碱一起代谢，其输出模式（r=0.82, p<0.01）与罂粟碱极为相似，被给予阴茎以测量其在外周血中的时间依赖性浓度。戊图曲线对罂粟碱负荷的响应同时用戊图指数（pi）表示，头孢替安的差异用头孢替安清除指数（cci）表示。将这些指标与勃起程度进行比较。PI为75.5（±±）。[)完全安装组为8.4分，46.8分(]sy .+-。[)不完全安装组16.0。非勃起组的PI为40.5（±±）。[] 10. b与完全勃起组相比，不完全勃起组和非勃起组的PI明显下降。参考彩色多普勒血流计显示的阴茎动脉的变化，当患者的PI低于正常值60时，我们诊断为动脉源性阳痿。相比之下，cci在各组间无显著差异，可能是由于cci受到传入血流量和流速的影响。

项目成果

高波 眞佐治,他: "セフオチアムの末梢血中流出濃度測定による血管性インポテンスの診断への応用" 日本泌尿器科学会雑誌. 81. 1127-1128 (1990)

Masaharu Takanami 等人：“通过测量外周血中头孢替安的浓度来诊断血管性阳痿的应用”日本泌尿外科协会杂志 81. 1127-1128 (1990)。

Ishii,N.,et al.: "Venous and arterial impotences-a new method for differential diagnosis." International Journal of Impotence Research. 4(suppl.2). A60 (1992)

Ishii,N.,et al.：“静脉和动脉阳萎——鉴别诊断的新方法。”

白井將文: "ペノグラムによる血管性インポテンスの診断" 核医学技術. 13. 173-177 (1993)

Masafumi Shirai：“通过笔图诊断血管性阳痿”核医学技术 13. 173-177 (1993)。

白井將文: "ペノグラム(インポテンスの診断)" 核医学.29. 782-783 (1992)

Masafumi Shirai：“Penogram（阳痿诊断）”核医学.782-783（1992）。

白井將文: "ペノグラム(インポテンスの診断)" 核医学. 29. 782-783 (1992)

Masafumi Shirai：“Penogram（阳痿诊断）”核医学。 29. 782-783 (1992)