摘要
阴茎勃起的过程是一个复杂的多因素调控过程,它包括中枢神经系统的性唤起、外周神经系统的信号传递、阴茎海绵体血管舒张以及静脉被动闭塞引发充血等一系列过程。在分子水平上,勃起过程依赖于支配血管平滑肌的舒张神经和收缩神经的精确动态调控,各种化学信号比如性激素、NO、内皮素、PGE-1的相互作用等等。任何水平的、系统性或局灶性的、器质性或功能性的障碍都将导致勃起功能障碍(erectile dysfunction,ED)的发生,从而不能完成满意的性交行为。研究表明终末期肾病能够在多个环节上对勃起功能产生负面影响。诱发终末期肾病患者ED发生的病理生理机制包括:内分泌因素、血管因素、神经因素、心理因素、血液因素和药理学等因素[1]。肾移植作为治疗终末期肾病最有效的手段已经得到了广泛认可。随着移植技术的普及和成熟,接受肾移植治疗的终末期肾病患者数量逐年增长,然而肾移植对终末期肾病患者勃起功能的作用仍然存在疑问[2,3]。移植受者移植后ED涉及到多个因素,包括心理因素、神经因素、血管因素和内分泌因素等[4],本文的主要目的在于对肾移植术后ED的机制及危险因素进行简单的总结。
Erection is a coordinated physiological process that requires arousal via the central nervous system（CNS）,signaling via peripheral nerves,vasodilatation within the corpus cavernosum and trapping of blood within the confines of the tunica albuginea by passive veno-occlusion.At the molecular level,the process depends on a delicate balance between vasodilators and vasorelaxors in corporal smooth muscle.Various chemical signals,e.g.testosterone,noradrenaline,nitric oxide（NO）,endothelin,prostaglandin-E1（PGE-1） and others,are involved in sexual function and dysfunction.Systemic or local compromise of this system at any level can lead to the development of erectile dysfunction（ED）,which is defined as the inability to achieve or maintain a sufficient erection for satisfactory sexual performance.End-stage renal disease（ESRD） has been reported to cause wide-ranging disturbances of male erectile function.The underlying pathophysiological mechanisms of ED associated with ESRD have been attributed to many factors,including biochemical,endocrinological,vasculogenic,psychiatric,neurogenic,haematological and pharmacological factors[1].Kidney transplantation（KT） has become a widely used therapy for ESRD.With improving therapies and procedures,the total number of transplants has increased.Despite the medical advances enabling this success,the ability of KT to restore erectile function is still a problem.The cause of erectile dysfunction in transplant recipients is often multifactorial,including also psychogenic,neurogenic,vasculogenic and endocrine factors[4].The purpose of this article is to review the possible mechanisms and risk factors of ED after KT.
出处
《实用医院临床杂志》
2011年第6期15-19,共5页
Practical Journal of Clinical Medicine
关键词
肾移植
终末期肾病
勃起功能障碍
肾动脉重建
危险因素
Kidney transplantation
End-stage renal disease
Erectile dysfunction
Renal artery reconstruction
Risk factor
