Kev cai ntawm kev teeb tsa cov pathways cuam tshuam txog cov ntshav qab zib mellitus-ua rau erectile erectile dysfunction los ntawm cov tshuaj suav Suav: kev tshuaj xyuas
Apr 08, 2025
Abstract: Erectile kawg (ED)yog ib qho ntawm cov kev ua kom haum tshaj plaws ntawm cov txiv neej ua me ntsis kev puas tsuaj, thiab nws tseem muaj kev cuam tshuam ib txwm muaj ntawm cov ntshav qab zib mellitus (dm). Ed yog ze ze rau tus neeg mob lub siab lub neej, tus khub sib deev, thiab tsev neeg ruaj khov. Ib qho ntxiv, nws yog cov teeb meem ceeb toom thaum ntxov rau ntau yam kab mob. Raws li qhov tshwm sim ntawm DM khaws cov ntshav qab zib meylitus-ua rau erectile dysfunction (dmed) nce raws li. Tam sim no, siv tshuaj kho yeeb tshuaj rau ed nthuav qhia cov kev txwv tsawg, thiab kev kho mob ntawm DRA yog qhov nyuaj dua. Yog li ntawd, txhim kho cov tshuaj muaj tshuaj nyab xeeb thiab muaj kev nyab xeeb yog qhov teeb meem kev kuaj mob uas yuav tsum tau daws sai. Cov kev tshawb fawb tsis ntev los no tau ua pov thawj tias kev ntxhov siab hauv Suav (TCM Ntau cov phiajcim pidwating xws li phosphatidylinositol {} Kinase B (PI3K / AKTIC), Ras homolog (NRFF2), Mitogen-urctated protein kinase (mapphone, Adenosine Monphone, thiab Protein Kinase, thaum tseem muaj cov ntaub ntawv tsis muaj txiaj ntsig. Los ntawm kev tshuaj xyuas cov khoom tseem ceeb tau luam tawm nyob rau hauv cov txheej txheem tsis ntev los no, kev tshawb fawb ntawm kev txhim kho saum toj no ntawm kev tswj hwm kev tawm tsam. Qhov kev tshuaj xyuas no yuav tsum muab cov tswv yim tshiab thiab cov ntawv qhia txog kev kuaj mob thiab kho mob ntxiv, kev tshawb fawb, thiab kev siv tshuaj.
Cov ntsiab lus: Ntshav Qab Zib Mellitus;erectile kawg; Tsoos suav tshuaj; kos npe rau txoj kev; Kev Tshawb Fawb Kev Kawm
Cov tshuaj ntsuab tshiab rauErectile kawg
Ntshav Qab Zib Mellitus Erectile kawg (dmed) thiab pi3k / akt signaling txoj kev
Ntshav Qab Zib Mellitus (DM)yog ib qho kev mob metabolic ib txwm muaj kev cuam tshuam los ntawm kev nce ntshav cov ntshav qab zib. Nws tuaj yeem cuam tshuam ib lossis ntau lub nruab nrog cev thoob plaws lub cev, muaj peev xwm ua rau ob qho kev mob hnyav thiab muaj kev phom sij.Erectile kawg li (ED)yog ib qho kev cuam tshuam ntawm cov ntshav qab zib, ua kom pom tseeb raws li tsis txaus ntseeg erectile thiab ejaculatory ua haujlwm, suav nrog cov tsos mob xws litsis muaj zogthiabRetrograde Ejaculation[^1].
Ib lub kaus ntawm kev tshuaj xyuas kev ua si txawv teb chaws pom tias tusKev sib txuas thoob ntiaj teb ntawm cov neeg mob ntshav qab zib yog siab li 65.8%, qhia txog lub nra hnyav ntawm Erectile kawg hauv cov txiv neej muaj ntshav qab zib [^ 2]. Qee qhov kev tshawb fawb tau tshaj tawm tiasNtshav Qab Zib-ntsig Ed (DMA)yog qhov nyuaj dua los kho dua li dav dav ed [^ 3]. Txawm hais tias tsis muaj sia nyob rau lub neej, dos yog txuam nrogZoo ntawm lub neej, kev sib tw txij nkawm, thiab tsev neeg muaj kev ruaj ntseg, thiab tseem ua hauj lwm raws li ib tugNtxov ntxov ceeb toomrau lwm cov kab mob ib txwm muaj.
Tam sim no, muaj kwv yees kwv yees529 lab cov neeg muaj ntshav qab zib thoob ntiaj teb, thiab tus lej no tau npaj siab tshaj1.31 billion los ntawm 2050[^ 4]. Raws li tus naj npawb ntawm cov neeg mob ntshav qab zib, qhov tshwm sim ntawm dmed kuj tseem yuav ua rau nce raws li.
Pathogenesis ntawm dmed
Kev txhim kho ntawm dmed cuam tshuam nrog ntau cov tshuab, feem ntau cuam tshuam nrog:
Endothelials nyob rau hauv Penpile VASTXULATURATURURATURES
Neuropathy
Hormonal tsis txaus
Vascular txhab
Downregulation ntawm Nitric Oxide Synthease (Nos) qhia hauv cov nqaij mos
Nce qib siab tshaj plaws glycation kawg-cov khoom (hnub nyoog)
Oxidative Kev Nyuaj Siab
Mob cov lus teb
Cellular autopyagy dysregulation[^5][^6]
Ntawm cov no,Ntev cov hyperglycemia, hyperinsulinemia, thiab insulin tsis kamyog suav hais tias cov neeg tseem ceeb ua rau cov hnub nyoog tsub zuj zuj thiab nce qib kev ntxhov siab, uas cuam tshuam nrog tusUa kom muaj kev ua haujlwm tseem ceeb, thaum kawg ua rau ed [^ 7]. Lub pathophysiology ntawm DMED koom:
Txawv txawv hemodynamics
Vascular endothelial ua hauj lwm
Neuropathy
Endocrine disorders
Cavernosal du cov leeg mob, thiab lwm yam. [^ 8]
Kev kho cov kev nyuaj thiab muaj peev xwm ntawm cov tshuaj suav suav hauv (TCM)
Txawm tias nrujGlyciMic Tswj thiab Kev Pabcuam Kev Ua Neej, cov tswv yim tam sim no yogfeem ntau tsis txaus kom muaj ntshav qab zib-ua rau kev sib deev tsis zoo[^ 9]. TusThawj-Kab Tshuaj tiv thaivqho tsegPhosphodiesterase Hom 5 Inhibitors (PDE5IS)Cov. Txawm li cas los xij, cov tshuaj no cuam tshuam nrogntau yam kev tsis zoo, thiab24.3% ntawm cov neeg mob qhia tsis muaj txiaj ntsig[^ 10]. Yog li ntawd, tshawb rauKev Kho Mob thiab Kev Nyab Xeeb Kev Nyab Xeebyog ib qho kev xav tau mob kho mob maj nrawm.
Cov kev tshawb fawb tsis ntev los no tau pom tiasTsoos suav tshuaj (TCM)tuaj yeem daws tau daim di ncaujModulating cov phiajcim tseem ceeb taw qhia txoj hauv kev, Txo oxidative kev ntxhov siab, suppressing o, thiab tswj autophagy. TCM muaj qhov zoo ntawmNtau hom phiaj, ntau-txoj kev, thiab Holistic kho cov teebmeem[^11].
Ob peb signaling txoj kev koom tes nrog rau hauv DMS muaj xws li:
Pi3k / AKT
TSIS MUAJ / CGMP
Riama / Rho Kinease
Npf2
Daim mapk
Teev
PKC, thiab lwm yam. [^ 12]
Txawm li cas los xij, tseem muaj ib qhoTsis muaj kev txheeb xyuas kev txheeb xyuascov ntsiab lus no cov txheej txheem no. Yog li ntawd, daim ntawv no aims los saib xyuas cov ntawv nyeem thiab thoob ntiaj teb los tshawb txog covcov luag haujlwm ntawm cov phiajcim txoj hauv kev hauv dmedthiab lub ntsiab lusKev Tshawb Fawb Kev Tiv Thaiv Kev Tshawb Fawb, muab cov kev pom zoo tshiab rau kev tshawb fawb, kev tshawb fawb yooj yim, thiab kev tsim tshuaj.
1. PI3K / AKT Signaling Txoj Kev
1.1 pi3k / akt txoj kev thiab nws lub luag haujlwm hauv DMA
Phosphoinositide 3- kinase (pi3k)yog cov nce qib urtrectator ntawm pi3k / akt signaling txoj kev. Thaum muaj kev ntxhov siab cellular, pi3k ntawm ntshav memma yog phosphorholated, tsimphosphatidylinositol -3, 4, 5- Trisphosphate (PIP3)Cov. PIP3 Tom qab ntawvAKTLos ntawm cytoplasm rau ntshav membra thiab pab txhawb nws lub phosphorylation ntawm lubSer1177site, ua kom puv akt ua kom.
Ua kom AKT pib aCascade ntawm downtream signaling txheej xwm, phosphorylating cov hom phiaj xws li:
B-Cell Lymphoma 2 (Bcl -2 tsev neeg anti-apoptotic protein phem
Cov phiaj xwm tsiaj muaj lub hom phiaj Mammalian (mtor)
Caspase -3
Glycogen synthease Kinase -3 (gsk -3)
Endothelial nitric oxide synthease (enos)
Cov Neeg Sib Tham Cov Lus Sib Thamkev sib txawv ntawm tes, ciaj sia taus, thiab kev tawm tsam apoptotic[^13].
TusPi3k / AKT txoj kev yog dav qhia nyob rau hauv vascular endothelial hlwbthiab plays lub luag haujlwm tseem ceeb hauv kev tswj hwmvasodilation thiab vasoconslictionCov. Ntev hyperglycemia cuam tshuam covKev ua kom zoo ntawm Pi3k / Akt / enos axis, ua rauTxo Nitric Oxide (Tsis Yog) Synthesis-a tus yuam sij molecule hauv cenpile erection. Tsis yog tam sim no yog ib qho ntawm cov kev kawm zoo tshaj plawscua vasodilators, nrog txoj haujlwm tiv thaiv xws li:
Vasodilation
Los tiv thaiv o
Antioxidant cuam tshuam
Kev txwv tsis pub platelet sib ceg
A Txo hauv tsis muaj ntau lawmua rautsis muaj kev so ntawm lub cavernosal du leeg, thaum kawg ua rauerectile kawg[^14].
1.2 kev cuam tshuam ntawm dmed ntawm pi3k / akt evamway los ntawm cov tshuaj suav
Shalofu Zhuyu DecoctionPuas yog cov tshuaj suav pawg Suav ferbal ua ke ntawm ntau yam tshuaj ntsuab, nrog cov teebmeem xws liKev Txhawb Cov Ntshav ncig, tshem cov ntshav stasis, tonuting lub raum, thiab txhawb QiCov. Mao et al. [11] pom tias cov mis no tuaj yeeminhibit o thiab nqaij fibrosis hauv cov nas ntshav qab zib, yog li rov qab txhim kho erectile muaj nuj nqi. Pharmacological tsom xam tias kev siv tshuab los ntawm Shalofu Zhuyu Decoction decocexion decoction tau txhim kho DRED tuaj yeem koom nrogNtau-hom phiaj kev cai, suav nrog:
Cytochrome P4501B1 (Cyp1B1)
Dipeptidyl Peptidase 4 (DPP4)
NITUM Oxide synthease 2 (nos2)
Lipocalin 2 (LCN2)
Pi3k / akt signaling txoj kev
Txoj kev tshawb fawb tau txheeb xyuasiSorhamnetinRaws li thawj lub chaw ua haujlwm tseem ceeb hauv cov qauv thiab ua kev sim ua kom raug. HauvKev Ntsuas Cov Nquab, Isorhamnetin nce qib ntawm:
Superoxide dismutase (sod)
Glutathione peroxidase (GPX)
Cataligle (miv)
Nitric oxide (tsis muaj)
Nws kuj txoMalondialdehyde (MDA)qib, txhim kho lubInteracavosal siab rau txhais tau hais tias interial siab (icp / daim ntawv qhia) piv, thiab nceCov leeg nqaij cov leeg hauv lub cornus Cavernosumntawm cov nas mob ntshav qab zib [^ 15].
HauvKev sim cellular, Isorhamnetin tau qhia rau upregulate cov lus qhia ntawmPi3k, AKT, thiab Enos proteins, tawm tswv yim tias nws yuavQhib lub Pi3k / AKT / Enos signaling txoj kevrau exertAnti-inflammatory, antioxidant, thiab anti-apoptotic cuam tshuam, yog li tiv thaivvascular endothelial hlwb nyob rau hauv lub cornus cavernosum[^15].
Jia Xiaoyue li al. [16] sivShalofu Zhuyu Decoction ua ke nrog Sildenafillos kho cov neeg mob dmed. Ntawm 41 tus neeg mob hauv pab pawg kho, tusTag Nrho Cov Nqi Siv Tau Zoo Tau 90.2%, uas tau zoo dua li sildenafil ib leeg.
Xiaoyao hmoovPuas muaj lwm tus TCM tsim muajquercetin, Kaempferol, -SiSterol, Angela Sinenis, Poria Alma, breenylodes macrocephaxo, butryclocphala, buerylit, zib ntab-kib li licorice, thiab mintCov. Nws yog paubsib haum xeeb lub siab thiab tus po, ua kom them daim siab qi stagnation, thiab ntxiv dag zog rau tus po thiab muab cov ntshavCov. Hauv cov qauv ratmed, xiaoye hmoov tau qhia raudownregulate cov kev qhia ntawm tus receptor rau advanced glycation kawg-cov khoom lag luam (npau taws) ntawm ob qho MRNA thiab Protein qib, thaumUpregulating pi3k thiab akt protein qhia, qhia tias nws kho cov nyhuv yuav yog kho tau los ntawmNpau taws / Pi3k / AKT Txoj Kev[^17].
TusPi3k / akt / mtor avyog ib qho classic signaling cascade rauAutophagy kev caiCov. Pi3k / akt modulates autophagy feem ntau los ntawm kev tswj hwm cov kev ua ntawmtus mtor:
Ua kom Mtor inhibits autophagy
Inhibited mtor txhawb nqa autophagy
Ob qho tib si kev ua kom ntau dhau los lossis kev cuam tshuam ntawm MTOR tuaj yeem cuam tshuam autophagy homeasis, ua rau muajCov txheej txheem thiab kev ua haujlwm tsis taus.
Feng Junlong Et al. [18] pom tiasHiab-centiped granulestuaj yeem nce ntxivTestosterone (t) Qeb, erection zaus, icp / daim ntawv qhia piv, thiabphosphorylation thiab mRNA qhia ntawm pi3k, akt, thiab mtorhauv cov nas ntev. Txoj kev ua tau zoo yogzoo dua rau tadalafil, ib cov tshuaj noj thawj-kab. Lub tshuab tau thovKev ua kom muaj cov Pi3k / AKT / MTOR PATHAY, uastxwv tsis pub muaj qhov hnoos qeevthiab txhim kho erectile muaj nuj nqi.
ICariin II, ib flavonoid compound los ntawmEpimedium, tau kawm los ntawm zhang li al. [19] ntawmHauv Vivo thiab nyob rau hauv Vitro kev simCov. Lawv pom tiasiCariin II ua ke nrog Metformintej zaumQhib lub Pi3k / AKT / MTOR signaling txoj kevrauTxo kev nthuav dav ntau ntawm Corpus Cavernosum du cov leeg hlwb (CCSMCs).
