Kev sib deev thiab kev ua me nyuam muaj nuj nqi nyob rau theem kawg ntawm lub raum kab mob thiab cuam tshuam ntawm lub raum hloov

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Mahboob Lessan-Pezeshki¹, Shirin Ghazizadeh²

Abstract

Cov kab mob raum Advanced yog txuam nrog impaired spermatogenesis thiab testicular puas. Kev tsom xam cov phev feem ntau qhia tau tias qhov txo qis ntawm ejaculate, oligo- lossis ua tiav azoospermia, thiab feem pua ​​​​ntawm cov phev qis. Erectile dysfunction (ED) kuj tshwm sim nyob rau hauv cov neeg mob uas mob raum tsis ua hauj lwm (CRF) thiab tau pom ntau tshaj 50 feem pua ​​​​ntawm cov neeg mob no. Muaj kev txhim kho tsis tu ncua ntawm kev ciaj sia thiab kev ua neej zoo tom qab hloov lub raum. Ib qho tseem ceeb tshaj plaws ntawm kev hloov lub raum zoo rau cov tub ntxhais hluas yog qhov muaj peev xwm ntawm tus txiv neej tus neeg mob rau leej txiv. Hauv tsab xov xwm no peb thawj zaug tshuaj xyuas cov kab mob ntawm kev ua me nyuam tsis ua tiav qhov kawg ntawm lub raum kab mob (ESRD), tom qab ntawd ED hauv ESRD thiab nws cov kev tswj hwm tau tham txog, thaum kawg,kev sib deevkev ua haujlwmHauv cov neeg mob hloov lub raum thiab kev tswj hwm ntawm ED hauv cov neeg mob no raug tshuaj xyuas. (Asian J Androl 2008 Tsib Hlis; 10:441–446)

Ntsiab lus:kab mob raum kawg; erectile kawg; kev yug me nyuam;hloov raum

qhov twg yuav cistanche

1 Kev Taw Qhia

Rau ntau tus txiv neej cov neeg mob uas lub raum tsis ua haujlwm, impotence thiab poob ntawm libido thiab infertility yog nquag tshwm sim. Cov teeb meem no tuaj yeem txhim kho tab sis tsis tshua muaj kev cuam tshuam nrog lub tsev kho mob lim dej, feem ntau ua rau lub neej tsis zoo [1–3]. Los ntawm kev sib piv, lub raum ua haujlwm tau zoo yog qhov yuav rov qab zoo duakev sib deev kev ua si; Txawm li cas los xij, qee qhov kev ua haujlwm ntawm cov khoom siv rov ua haujlwm yuav nyob twj ywm tsis zoo.

Lub uremic milieu plays lub luag haujlwm tseem ceeb hauv cov noob caj noob ceskev sib deevkev ua haujlwm tsis zoonyob rau theem kawg ntawm lub raum kab mob (ESRD). Kev puas siab puas ntsws thiab lub cev kev ntxhov siab uas tuaj yeem ua rau muaj kev cuam tshuam hauv kev sib deev muaj nuj nqi kuj muaj nyob rau hauv cov neeg mob uas lub raum tsis ua haujlwm [3, 4]. Nyob rau hauv tsab xov xwm tam sim no, peb thawj zaug tshuaj xyuas cov pathophysiology ntawm kev yug me nyuam tsis ua haujlwm hauv ESRD, tom qab ntawd erectile kawg (ED) hauv ESRD thiab nws cov kev tswj hwm tau tham txog. Thaum kawg,kev ua haujlwm ntawm kev sib deev hauv cov neeg mob lub raum hloovthiab kev tswj hwm ntawm ED hauv cov neeg mob no raug tshuaj xyuas.

2 Pathphysiology ntawm kev ua me nyuam tsis ua hauj lwm hauv ESRD

Cov kab mob raum mob ntev heev yog txuam nrog kev ua tsis taus spermatogenesis thiab testicular puas [3-5]. Kev tsom xam cov phev feem ntau qhia tau tias txo qis ntawm ejaculate, oligozoospermia, lossis ua tiav azoospermia, thiab qis feem pua ​​​​ntawm cov phev motile. Testicular histology qhia tau hais tias txo cov spermatogenic kev ua si sib txawv los ntawm kev txo qis ntawm cov spermatocytes paub tab kom ua tiav aplasia ntawm cov kab mob.

Cov yam ntxwv ua rau lub cev puas tsuaj hauv uremia tsis to taub zoo. Nws muaj peev xwm hais tias cov yas hauv cov raj lim dej, xws li phthalate, tuaj yeem ua lub luag haujlwm hauv cov neeg mob uas tau kho hemodialysis.

Uremia kuj tseem cuam tshuam gonadal steroidogenesis. Cov ntshav tag nrho thiab dawb testosterone concentrations feem ntau txo qis, txawm hais tias lub peev xwm khi thiab kev sib deev ntawm cov tshuaj hormone-binding globulin yog qhov qub [5]. Cov ntshav concentration ntawm luteinizing hormone (LH) nce siab hauv cov txiv neej uremic; Qhov no yog qhov tshwm sim ntawm kev txo qis testosterone tawm tswv yim.

Follicle-stimulating hormone (FSH) secretion kuj nce, txawm hais tias mus rau qib sib txawv ntau [3]. Kev nce qib FSH tej zaum yog qhov tshwm sim ntawm kev txo qis testosterone thiab inhibin, Sertoli cell khoom. Lub plasma FSHconcentration nyiam siab tshaj plaws hauv cov neeg mob uremic uas muaj kev puas tsuaj loj tshaj plaws rau cov tubules seminiferous thiab suav tias yog qib qis tshaj ntawm inhibin. Nws tau raug pom tias nce FSH qib qhia tau hais tias tsis zoo rau kev rov ua haujlwm ntawm cov spermatogenic tom qab hloov lub raum [3]. Cov qib basal ntawm serum prolactin tau nce siab hauv feem ntau ntawm cov neeg mob uremic, thiab cov lus teb rau thyrotropin-tso cov tshuaj hormones txo qis thiab qeeb [6]. Cov txheej txheem rau hyperprolactinemia hauv lub raum tsis ua haujlwm ntev tsis tau txhais tau zoo. Kev nce kev tswj hwm tus kheej ntawm prolactin yog ib qho tseem ceeb rau kev ua haujlwm ntawm hyperprolactinemia, tab sis qhov txo qis hauv metabolic tshem tawm kuj tseem tuaj yeem ua lub luag haujlwm.

3 ED hauv ESRD

ED txhais tau tias yog qhov tsis muaj peev xwm ua tiav thiab tswj kom muaj erection txaus los tso cai txaus siabkev sib deevkev sib deev[7]. ED tuaj yeem tshwm sim los ntawm kev puas siab puas ntsws, neurologic, hormonal, arterial, lossis cavernosal impairment los yog kev sib xyaw ntawm cov yam ntxwv no. ED tau pom nyob hauv ntau dua 50 feem pua ​​​​ntawm cov neeg mob uas muaj lub raum tsis ua haujlwm (CRF) [8]. Ntau yam tshwm sim los koom nrog hauv kev tsim ntawm impotence hauv cov neeg mob CRF. Cov no muaj xws li kev txawv txav ntawm cov neurohormonal tswj system ntawm hypothalamic-pituitary-gonadal axis, theem nrab hyperparathyroidism, thiab kev ua haujlwm ntawm lub cev nqaij daim tawv nqaij ntawm qhov chaw mos, lossis hauv qhov chaw mos cov lus teb rau kev so stimuli thiab / lossis derangements hauv cov hlab ntsha lossis cov hlab ntsha. kua txiv ntawm noov [9].

Cov neeg mob uas muaj keeb kwm ntawm kev ua haujlwm erectile ib txwm ua ntej pib mob raum yuav muaj qhov ua rau lwm tus, xws li neuropathy lossis kab mob peripheral vascular. Lub xub ntiag ntawm lub zais zis neurogenic qhia txog qhov mob hauv qab neuropathy, thaum kev tshawb pom ntawm cov kab mob peripheral vascular taw tes rau cov ntshav tsis txaus penile. Qhov tsis muaj cov yam ntxwv ntawm kev sib deev ua ke nrog cov noob qes me me qhia tias hypogonadism. Kev noj ntau cov tshuaj, xws li beta-blockers thiab tricyclic antidepressants, yuav ua rau ED.

Rau cov neeg mob uas tsis pom tseeb ua rau impotence tom qab kev ntsuam xyuas thawj zaug, yuav tsum tau xav txog cov teeb meem puas siab puas ntsws, xws li kev ntxhov siab lossis kev nyuaj siab. Qhov tshwm sim ntawm nocturnal penile tumescence (NPT) ntawm cov neeg coob ntawm cov neeg mob uremic yog qhov qis dua li cov neeg ib txwm muaj [10]. Kev tswj hwm ntawm qhov ntsuas nocturnal penile tumescence yuav pab kom paub qhov txawv ntawm cov organic thiab puas siab puas ntsws; Qhov tsis muaj erection thaum pw tsaug zog qhia tau hais tias cov organic ua haujlwm tsis zoo. Kev kuaj pom zoo, txawm li cas los xij, tsis suav nrog lub cev ua rau [10].

cistanche erectile kawg

4 Kev tswj hwm ntawm ED hauv ESRD

Thawj kauj ruam hauv kev kho cov txiv neej uremic nrog kev ua txhaum ntawm kev sib deev yog nce qhov kev xa tawm ntawm kev lim ntshav, txiav cov tshuaj nrog cov kev mob tshwm sim ntawm impotence, thiab kho cov ntshav tsis txaus ntawm lub raum mob ntev. Raws li ib qho piv txwv, kev tswj hwm ntawm tib neeg erythropoietin recombinant kom nce hematocrit mus rau ntawm 33 feem pua ​​​​thiab 36 feem pua ​​​​yuav txhim kho kev sib deev [11]. Kev kho mob ntawm CRF cov neeg mob nrog erythropoietin yog txuam nrog kev txo qis hauv cov ntshav hauv cov ntshav prolactin thiab kev txhim kho hauv kev sib deev tsis zoo [12]. Kev kho ntawm hyperprolactinemia los ntawm bromocriptine kuj tseem cuam tshuam nrog kev txhim kho hauv kev sib deev dysfunction. Cabergoline, uas ua rau xeev siab ntau dua li bromocriptine thiab tsawg kawg yog zoo li kev kho mob hyperprolactinemia, yuav tsum tau sim ua ntej [13].

Sildenafil tau siv tau zoo hauv kev kho mob ED hauv ob qho tib si hemodialysis thiab peritoneal dialysis cov neeg mob thiab feem ntau siv rau kev puas siab puas ntsws, vascular, neurogenic ua [14-17]. Sildenafil yog ib qho kev xaiv inhibitor ntawm phosphodiesterase type 5 (PDE5), uas inactivates cyclic guanosine monophosphate (GMP). Txij li thaum nws tso tawm thaum Lub Peb Hlis 1998, nws tau dhau los ua cov tshuaj xaiv rau cov txiv neej feem ntau nrog ED. Thaum kev sib deev stimulation tso tawm nitric oxide (NO) mus rau hauv cov leeg nqaij leeg, inhibition ntawm PDE5 los ntawm sildenafil ua rau ib tug cim nce ntawm cyclic GMP concentrations nyob rau hauv lub caj pas noov, corpus cavernosum, thiab corpus spongiosum, ua rau kom cov nqaij ntshiv so thiab erection zoo dua. . Sildenafil tsis muaj kev cuam tshuam rau qhov chaw mos thaum tsis muaj kev sib deev stimulation thaum cov concentrations NO thiab cyclic GMP tsawg [18]. Sildenafil muaj kev cuam tshuam me ntsis ntawm libido. Ntawm ntau dua 3 700 cov txiv neej nrog qhov nruab nrab ntawm 6 lub hlis ntawm kev kis tus kab mob sildenafil, feem ntau cov xwm txheej tsis zoo yog me me mus rau nruab nrab thiab nws tus kheej txwv nyob rau lub sijhawm [19]. Ntawm cov txiv neej noj 25-100 mg ntawm sildenafil, 16 feem pua ​​​​tau qhia txog mob taub hau, 10 feem pua ​​​​sawv, 7 feem pua ​​​​dyspepsia, 4 feem pua ​​​​qhov ntswg congestion, thiab 3 feem pua ​​​​tsis pom kev (piv txwv li cov xim me me thiab ib ntus tinge lossis nce rhiab heev rau lub teeb). Cov nqi no yog ob zaug siab dua ntawm cov txiv neej noj 100 mg ntawm sildenafil ib yam li cov txiv neej uas tau noj qis dua. Qhov pom kev tshwm sim yog tej zaum muaj feem xyuam rau inhibition ntawm phosphodiesterase hom 6 hauv retina. Tsis muaj qhov tsis pom kev ntev ntev tau raug tshaj tawm, thiab qhov tshwm sim ntawm qhov pom kev tshwm sim zoo sib xws hauv cov txiv neej ntshav qab zib thiab cov neeg tsis muaj ntshav qab zib [20]. Txawm li cas los xij, vim tias lub sijhawm luv luv ntawm kev sim tshuaj thiab qhov nyuaj hauv kev kuaj pom qhov hloov pauv ntawm lub retinal, qhov kev nyab xeeb ntev ntawm kev kho mob sildenafil tseem tsis tau paub. Hauv cov txiv neej uas muaj kab mob ntawm lub qhov muag, kev sib tham ophthalmologic yuav raug lees paub ua ntej pib kho sildenafil. Cov xwm txheej tsis zoo ntawm cov hlab plawv (qhov ntswg congestion, mob taub hau, thiab dej ntws) yog qhov mob me thiab ntuav rau feem coob ntawm cov txiv neej. Tus nqi ntawm cov kab mob plawv loj (angina thiab coronary-artery disorder) yog tsawg. Sildenafil absorbed zoo thaum yoo mov, thiab cov ntshav plasma ntau tshaj plaws nyob rau hauv 30-120 min (txhais tau tias, 60 min). Nws raug tshem tawm feem ntau los ntawm lub siab metabolism, thiab lub davhlau ya nyob twg ib nrab hnub yog kwv yees li 4 teev. Qhov pom zoo pib koob tshuaj yog 50 mg noj 1 teev ua ntej kev sib deev. Qhov kev pom zoo tshaj plaws yog ib zaug hauv ib hnub. Raws li kev ua tau zoo thiab cov kev mob tshwm sim, cov koob tshuaj tuaj yeem nce mus rau 100 mg lossis txo mus rau 25 mg [18]. Contraindicated siv sildenafil thiab nitrates nyob rau hauv txhua daim ntawv, tsis tu ncua los yog intermittently, yog contraindicated. Kev tswj hwm ntawm testosterone rau cov txiv neej uremic feem ntau ua tsis tau rov qab libido lossis potency, txawm tias normalized serum testosterone.

Lub tshuab nqus tsev tumescence tuaj yeem ua tau zoo hauv kev rov ua kom muaj zog hauv uremic impotent txiv neej tsis teb rau kev kho mob. Kev tswj hwm zinc kuj yog ib qho kev xaiv kho mob tsim nyog hauv cov txiv neej uremic.

5 Kev ua haujlwm loj hlob hauv cov neeg mob lub raum hloov

Kev hloov pauv hauv lub raum yog qhov kev xaiv zoo tshaj plaws thiab muaj txiaj ntsig zoo tshaj plaws uas tuaj yeem muab rau cov neeg mob uas muaj kev puas tsuaj loj tiag tiag los kho lawv txoj kev noj qab haus huv thiab muab qhov ua tau zoo ntawm lawv txoj kev sib deev thiab kev ua me nyuam.

Fertility, raws li kev soj ntsuam los ntawm cov phev suav, txhim kho hauv ib nrab ntawm cov neeg mob hloov pauv. Kev sib deev hormone profile nyiam normalize [21].

Cov yam ntxwv uas yuav ua rau muaj teeb meem qee yam hauv kev rov ua haujlwm ntawm kev sib deev thiab kev ua me nyuam hauv hom neeg mob no suav nrog kev siv lub sijhawm ntev ntawm kev lim ntshav peritoneal, qib siab FSH ntau ua ntej kev hloov pauv, thiab kev ua haujlwm tsis zoo ntawm cov kab mob graft [22].

Ib qho kev txhim kho tau raug tshaj tawm hauv cov phev zoo hauv peb qhov tseem ceeb (tus naj npawb, morphology, thiab motility ntawm spermatozoa) hauv cov neeg mob tom qab hloov lub raum [22].

Feem ntau, cov tshuaj tiv thaiv kab mob feem ntau siv rau cov neeg mob hloov lub raum tsis tau cuam tshuam nrog kev cuam tshuam tsis zoo rau tus neeg mob spermatogenesis nrog cov teebmeem teratogenic rau lawv cov xeeb ntxwv [23]. Txawm li cas los xij, ntau qhov kev tshawb fawb tau ua los ntsuas qhov cuam tshuam ntawm kev tiv thaiv kab mob tiv thaiv kab mob qhia tias qee tus ntawm cov kab mob no tuaj yeem ua rau muaj kev phom sij vim tias lawv cuam tshuam rau lub qog ua haujlwm thiab txo qis fertility. Cyclosporine (CSA) yog ib qho tseem ceeb ntawm kev kho mob tus neeg sawv cev thiab ib qho kev tivthaiv nyob rau hauv ntau yam tshuaj tiv thaiv kab mob siv rau hauv cov neeg tau txais kev hloov raum [23, 24]. Qee qhov kev tshawb fawb qhia tau tias CSA yog ib qho tshuaj uas muaj peev xwm gona tshuaj lom: nws tau ua rau muaj kev cuam tshuam tsis zoo rau kev ua me nyuam muaj peev xwm hauv kev sim ua qauv zoo li hauv tib neeg. Hauv qee hom tsiaj, xws li Sprague-Dawley strain nas, Seethalakshmi et al. [25] pom tau hais tias kev tswj hwm ntawm CSA ua rau muaj qhov tsis txaus intratesticular synthesis ntawm androgens thiab txo qis hauv spermatogenesis, txawm hais tias qhov kev txo qis no rov qab los tom qab exogenous ntawm gonadotrophins tau tswj hwm. Nws kuj tseem tuaj yeem soj ntsuam cov txiaj ntsig tsis zoo ntawm CSA los ntawm kev kuaj ntshav qog ntshav hauv cov dev [26] thiab nas [27] kho nrog CSA rau lub sijhawm luv, qhov pom qhov txawv txav hauv spermatogenesis tau pom. CSA tuaj yeem cuam tshuam rau testosterone biosynthesis los ntawm kev puas tsuaj ncaj qha rau Leydig hlwb thiab cov kab mob germinal, thiab kev cuam tshuam ncaj qha ntawm hypothalamic-pituitary-gonadal axis tau raug qhia.

Kev tsom xam cov phev hauv khoos phis tawj hauv cov neeg tsis muaj lub raum hloov pauv tau pom tias ob qho tib si phev concentration thiab ncaj-line tshaj tawm (VSL) tau sib cuam tshuam rau cov qib cyclosporine tag nrho cov ntshav. Stabilization ntawm cyclosporine tag nrho cov ntshav los ntawm theem nyob rau hauv lub hom phiaj kho theem yuav txhim kho lub fertility peev xwm nyob rau hauv lub raum hloov neeg tau txais kev pab. Lub sijhawm ntawm hemodialysis ua ntej hloov pauv tseem ceeb heev hauv qhov no. Lub sij hawm siv rau hemodialysis yog inversely correlated nrog cov feem pua ​​​​ntawm cov spermatozoa motile thiab lub amplitude ntawm lateral taub hau hloov [28].

Azathioprine (AZA), lwm yam tshuaj uas nquag ua ke nrog CSA, suav tias yog genotoxic [29]. Txawm li cas los xij, ob peb txoj kev tshawb fawb tau txheeb xyuas qhov cuam tshuam ntawm AZA ntawm kev ua me nyuam ntawm tib neeg. Ntau qhov kev tshawb fawb qhia tias prednisone yuav tsis koom nrog hauv cov phev cell puas [29].

Kaczmarek et al. [30] pom tias cov neeg tau txais kev hloov lub plawv tau kho nrog sirolimus tau txo qis testosterone ntau ntau thiab ntau dua ntawm cov tshuaj hormones gonadotropic, LH, thiab FSH piv nrog calcineurin inhibitor-based immunosuppression pawg.

Tsis muaj qhov tshwm sim ntau ntxiv ntawm qhov tsis zoo ntawm cev xeeb tub hauv cov poj niam cev xeeb tub los ntawm cov neeg tau txais kev hloov pauv [21]. Txawm li cas los xij, muaj qee qhov kev txhawj xeeb txog kev xeeb tub nrog Ganciclovir, uas yog siv rau kev kho mob ntawm cytomegalovirus kab mob hauv cov neeg mob hloov pauv [31].

6 Kev ua haujlwm ntawm kev sib deev hauv cov neeg mob lub raum hloov

Cov neeg tau txais kev hloov pauv lub raum tau txais kev txom nyem los ntawm uremia. Lawv tau siv sijhawm ntau heev rau kev lim ntshav thiab feem ntau muaj lwm yam mob, suav nrog ntshav siab thiab ntshav qab zib. Txawm hais tias kev hloov pauv tau zoo tuaj yeem txhim kho erectile muaj nuj nqi thiab rov qab libido, nyob rau hauv ntau zaus qee qhov kev ua txhaum ntawm kev sib deev tuaj yeem tshwm sim.

Ntshav siab yog tshwm sim ntawm cov neeg hloov pauv; CSA tuaj yeem ua rau muaj ntshav siab ntau ntxiv thiab tseem ua rau muaj ntshav siab hauv cov neeg mob uas muaj ntshav siab ua ntej hloov lub raum.

Cov tshuaj antihypertensive muaj qhov tsis zoo rau cov txiv neej kev ua haujlwm ntawm kev sib deev, nrog rau cov teebmeem ntawm libido thiab erection [32]. Cov tshuaj muaj feem xyuam hauv ED suav nrog beta-blockers (propranolol thiab labetalol), alpha-blockers (prazosin), sympatholytics (clonidine), vasodilators (hydralazine), thiab diuretics (thiazides thiab spironolactone).

Lwm cov tshuaj uas tseem tuaj yeem ua lub luag haujlwm hauv ED hauv cov neeg mob hloov pauv yog HMG-CoA reductase inhibitors (lovastatin thiab simvastatin), antidepressants (serotonin reuptake inhibitors, tricyclics, thiab monoamine oxidase inhibitors), thiab H2 antagonists (cimetidine, ranitidine, thiab famotidine) .

Ketoconazole, uas yog siv rau hauv qee qhov chaw hloov pauv kom nce qib cyclosporine thiab txo cov nqi ntawm calcineurin inhibitors, tuaj yeem ua rau ED vim nws cov tshuaj tiv thaiv antiandrogenic.

Lwm yam tseem ceeb xws li kev haus luam yeeb thiab haus cawv yuav ua rau tus txiv neej ua haujlwm tsis ua haujlwm kom txhim kho tom qab hloov pauv.

Kev haus luam yeeb yuav ua rau vasoconstriction thiab penile venous to vim nws cov nyhuv contractile ntawm cov leeg nqaij [33]. Cawv hauv me me txhim kho erection thiab nce libido vim nws cov nyhuv vasodilatory thiab kev tawm tsam ntawm kev ntxhov siab; Txawm li cas los xij, ntau npaum li cas tuaj yeem ua rau hauv nruab nrab sedation, txo libido, thiab ED ib ntus. Kev haus dej cawv ntev ntev tuaj yeem ua rau hypogonadism thiab polyneuropathy, uas tuaj yeem cuam tshuam rau cov hlab ntsha ntawm tes [34].

Autonomic neuropathy tuaj yeem cuam tshuam kev ua haujlwm erectile, thiab kev cuam tshuam ntawm ob qho tib si hypogastric hlab ntsha tuaj yeem ua rau muaj kev puas tsuaj rau cov hlab ntsha.

7 Kev tswj hwm ntawm ED hauv cov neeg mob raum hloov pauv

Cov txiv neej cov neeg mob yuav tsum tau nug txog lawv txoj haujlwm kev sib deev thiab raug xa mus rau kev ntsuam xyuas urological thaum tsim nyog. Keeb kwm, androgens tau touted li txhim kho txiv neej muaj nuj nqi. Niaj hnub no, muaj kev kho mob zoo dua, thiab kev kho testosterone yuav tsum poob siab rau cov txiv neej uas ED tsis cuam tshuam nrog hypogonadism [18]. Tsis muaj kev txwv tshwj xeeb rau kev siv sildenafil hauv cov neeg mob hloov pauv kom ntev li ntev tau kev ceev faj txog cov kab mob coronary artery concomitant. Kev sib deev tau xav tias yuav muaj feem cuam tshuam rau myocardial infarction hauv tsuas yog 0.9 feem pua ​​​​ntawm 858 txiv neej hauv ib txoj kev tshawb fawb [35]. Yog li ntawd, qhov kev pheej hmoo siab ntawm kev sib deev yog qhov tsawg (1 lub caij nyoog hauv ib lab rau tus txiv neej noj qab haus huv). Raws li cov ntaub ntawv los ntawm National Center for Health Statistics thiab FraminghamHeart Study, tus nqi ntawm kev tuag los ntawm myocardial infarction los yog mob stroke rau cov txiv neej nyob rau hauv lub hnub nyoog ntau yam uas ED yog ntau tshaj li 170 rau ib lab tus txiv neej nyob rau ib lub lis piam. Yog li ntawd, nws zoo nkaus li tias kev kho sildenafil muaj kev nyab xeeb rau cov txiv neej feem ntau. Txawm li cas los xij, vim tias feem ntau ntawm cov txiv neej uas tuag tau muaj kab mob plawv, cov kab mob plawv yuav tsum tau ua tib zoo soj ntsuam ua ntej kho. Kev sib xyaw ua ke ntawm nitrates thiab sildenafil tau ua rau muaj kev ntxhov siab hnyav thiab 16 tus neeg tuag hauv Tebchaws Meskas. Yog li ntawd, kev kho nitrate yog ib qho contraindication rau kev kho sildenafil [18].

Transurethral kev tswj hwm ntawm alprostadil (ib daim ntawv hluavtaws ntawm prostaglandin E1) lossis kev txhaj tshuaj intracavernous uas ua rau muaj erection txaus rau kev sib deev tau siv ua tiav. Txoj kev kho intracavernous zoo tshaj plaws yog siv peb cov tshuaj sib xyaw uas muaj papaverine, phentolamine, thiab alprostadil (Trimix, WedgewoodPharmacy, Swedesboro, NJ, USA). Cov koob tshuaj ib txwm siv ntawm trimix tov yog los ntawm 0.1 mL txog 0.5 mL. Tus nqi teb rau qhov kev daws teeb meem no yog siab li 90 feem pua ​​[36].

Feem coob ntawm cov txiv neej uas lub raum ua haujlwm tuaj yeem tos ntsoov rov qab los ntawm kev sib deev kev sib deev piv rau qib ua ntej mob. Txawm li cas los xij, kev sib deev tsis zoo tuaj yeem tshwm sim hauv qee cov neeg mob tom qab hloov pauv, hais txog qhov xav tau kev tshuaj xyuas ntxiv hauv pawg neeg mob no.

Siv:

1 Diemont WL, Vruggink PA, Meuleman EJ, Doesburg WH, Lemmens WA, Berden JH. Kev sib deev dysfunction tom qab lub raum hloov kho. Am J Raum Dis 2000; 35: 845–51.

2 Rosas SE, Joffe M, Franklin E, Strom BL, Kotzker W, Brensinger C, et al. Lub koom haum ntawm kev txo qis ntawm lub neej thiab kev ua haujlwm tsis zoo hauv cov neeg mob hemodialysis. Raum Int 2003; 64:232–8.
3 Holdsworth SR, de Kretser DM, Atkins RC. Ib qho kev sib piv ntawm hemodialysis thiab kev hloov pauv hauv kev thim rov qab uremic cuam tshuam ntawm kev ua haujlwm ntawm txiv neej. Clin Nephrol 1978; 10:146–50.
4 Toorians AW, Janssen E, Laan E, Gooren LJ, Giltay EJ, Oe PL, et al. Lub raum tsis ua haujlwm ntev thiab kev ua haujlwm ntawm kev sib deev: kev kho mob raws li kev soj ntsuam kev sib deev. Nephrol Dial Hloov 1997; 12: 2654–63.
5 Holdsworth S, Atkins R, de Kretser D. Pituitary-testicular axis hauv cov txiv neej uas muaj lub raum tsis ua haujlwm. N Engl J Med 1977; 296: 1245–9.
6 Hagen C, Olgaard K, McNeilly AS, Fisher R. Prolactin thiab pituitary-gonadal axis hauv cov txiv neej uraemic cov neeg mob ntawm kev lim ntshav tsis tu ncua. Acta Endocrinol (Copenh) 1976: 29–38.
7 Rowe SJ, Montague DK, Steinmuller DR, Lakin MM, Novick AC. Kev kho cov organic impotence nrog penile prosthesis nyob rau hauv cov neeg mob hloov lub raum. Urology 1993; 41:16–20.
8 Procci WR, Hoffman KI, Chatterjee SN. Kev sib deev ua haujlwm ntawm cov neeg tau txais kev hloov lub raum. J Nerv Ment Dis 1978; 166:402–7 : kuv.

9 Schrier RWM. Kab mob ntawm lub raum thiab urinary ib ntsuj av. 7 edn. Philadelphia: Lippincott Williams & Wilkins; Xyoo 2001.

10 Kwan M, Greenleaf W, Mann J, Crapo L, Davidson J. Qhov xwm txheej ntawm androgen ua rau txiv neej kev sib deev: ib qho kev sim ua ke-kev qhia txog tus kheej ntawm cov txiv neej hypogonadal. J Clin Endocrinol Metab 1983; 57:557–62.

11 Delano B. Kev txhim kho hauv lub neej zoo tom qab kev kho mob nrog r-HuEPO hauv cov neeg mob anemic hemodialysis. Am J Raum Dis 1989:14–8.
12 Haffner D, Nissel R, Wuhl E, Schaefer F, Bettendorf M, Tönshoff B, et al. Cov teebmeem metabolic ntawm kev kho mob ntev mus ntev hauv cov menyuam yaus prepubertal nrog raum tsis ua haujlwm thiab tom qab hloov lub raum. Pawg Kawm German
rau Kev Loj Hlob Hormone Kho nyob rau hauv Chronic Renal Failure. Pediatr Res 1998; 43:209–15.
13 Biller B, Molitch M, Vance ML, Cannistraro KB, Davis KR, Simons JA, et al. Kev kho mob ntawm prolactin-secreting macroadenomas nrog dopamine agonist cabergoline ib lub lim tiam. J Clin Endocrinol Metab 1996; 81: 2338–43.
14 Grossman EB, Swan SK, Muirhead GJ, Gaffney M, Chung M, DeRiesthal H, et al. Pharmacokinetics thiab hemodynamics ntawm sildenafil citrate hauv cov txiv neej hemodialysis cov neeg mob. Raum Int 2004; 66: 367–74.
15 Ifudu O. Kev saib xyuas cov neeg mob uas tau txais hemodialysis. N Engl J Med 1998; 339: 1054–62.
16 Palmer JM, Chatterjee SN. Cov teeb meem urological hauv lub raum hloov pauv. Surg Clin North Am 1978; 58:305–19.
17 Seibel I, Poli De Figueiredo CE, Telöken C, Moraes JF. Kev ua tau zoo ntawm qhov ncauj sildenafil hauv cov neeg mob hemodialysis nrog erectile kawg. J Am Soc Nephrol 2002; 13:2770–5.
18 Lue TF. Erectile Dysfunction. N Engl J Med 2000; 342: 1802–13 : kuv.
19 Morales A, Gingell C, Collins M, Wicker PA. Osterloh IB. Clinical kev nyab xeeb ntawm qhov ncauj sildenafil citrate (VIAGRA) hauv kev kho mob erectile kawg. Int J Impot Res 1998; 10:69–73.
20 Nqe D, Gingell J, Gepi-Attee S, Wareham K. Sildenafil: Kawm txog kev kho qhov ncauj tshiab rau erectile kawg hauv cov txiv neej ntshav qab zib. Diabet Med 1998; 15:821–5.
21 Danovitch GM. Phau ntawv qhia txog kev hloov raum. 4 edn. Philadelphia: Lippincott Williams & Wilkins: 2005.
22 De Celis R, Pedrón-Nuevo N. Txiv neej fertility ntawm lub raum hloov cov neeg mob nrog ib mus rau kaum xyoo ntawm evolution siv ib tug pa kev tiv thaiv kab mob. Arch Androl 1999; 42:9–20.
23 Handelsman DJ, McDowell IF, Caterson ID, Tiller DJ, Hall BM, Turtle JR. Testicular muaj nuj nqi tom qab hloov lub raum: sib piv ntawm Cyclosporin A nrog azathioprine thiab prednisolone ua ke ua ke. Clin Nephrol 1984; 22:144–8.
24 Gates RD. Nonsurgical kho ntawm infertility: kev kho tshwj xeeb. Hauv: Lipshultz LI, Howard SS, editors. Infertility nyob rau hauv tus txiv neej. 2 edn. St. Louis: Phau Ntawv Mosby-Year; 1991, p371–94, ib.
25 Seethalakshmi L, Flores C, Pob Zeb Diamond DA, Menon M. Kev thim rov qab ntawm cov tshuaj lom neeg ntawm cyclosporine rau txiv neej kev loj hlob thiab lub raum ua haujlwm ntawm nas los ntawm kev tswj hwm ib txhij ntawm hCG ntxiv rau FSH. J Urol 1990; 144: 1489–92.
26 Seethalakshmi L, Pob Zeb Diamond DA, Malhotra RK, Mazanitis SG, Kumar S, Menon M. Cyclosporine induced testicular dysfunction: kev sib cais ntawm nephrotoxic tivthaiv thiab kev ntsuam xyuas ntawm 60-hnub rov qab lub sij hawm. Hloov pauv Proc
1988; 20: 1005–10.
27 Seethalakshmi L, Flores C, Carboni AA, Bala R, DiamondDDA, Menon M. Cyclosporine: nws cuam tshuam rau cov qog ua haujlwm thiab fertility hauv cov nas prepubertal. J Androl 1990; 11:17–24.
28 Eid MM, Abdel-Hamid IA, Sobh MA, el-Saied MA. Kev soj ntsuam ntawm cov phev txav cov yam ntxwv hauv cov neeg tsis muaj lub raum hloov pauv tau siv computerized tsom xam. Int J Androl 1996; 19:338–44.
29 Olshan AF, Mattison DR, Zwanenburg TS. International Commission for Protection tiv thaiv Environmental Mutagens thiab Carcinogens. Cyclosporine A: kev tshuaj xyuas ntawm genotoxicity thiab muaj peev xwm ua rau muaj kev cuam tshuam rau tib neeg kev loj hlob thiab kev loj hlob. Daim ntawv ceeb toom ntawm Pawg Ua Haujlwm ntawm genotoxicity ntawm cyclosporine A, Lub Yim Hli 18, 1993. Mutat Res 1994; 317: 163–73.
30 Kaczmarek I, Groetzner J, Adamidis I, Landwehr P, Mueller M, Vogeser M, et al. Sirolimus impairs gonadal muaj nuj nqi hauv cov neeg txais kev hloov lub plawv. Am J ntawm Hloov 2004; 4:1084–8.
31 Nevins T, Dunn DL. Kev siv ganciclovir rau tus kab mob cytomegalovirus. J Am Soc Nephrol 1992; 2: S270–3.
32 Matthew RW, editor. Kev kho mob ntawm kev hloov lub raum: Philadelphia: Lippincott Williams & Wilkins: 2005.
33 Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid M, Tanagho EA. Qhov cuam tshuam ntawm kev haus luam yeeb rau ntawm noov erection. J Urol 1987; 138: 438–41.
34 Miller N, Kub MS. Tib neeg kev sib deev teb thiab cawv thiab tshuaj. J Subst Abuse Treat 1988; 5:171–7.
35 Muller JE, Mittleman MA, Maclure M, Sherwood JB, Tofler GH. Ua rau myocardial infarction los ntawm kev sib deev: tsis tshua muaj kev pheej hmoo thiab kev tiv thaiv los ntawm kev tawm dag zog lub cev tsis tu ncua. JAMA 1996; 275: 1405–9.
36 de Mattos AM, Bennett WM, Barry JM, Norman DJ. HLA-zoo tib yam sibling raum hloov pauv-ib 21-yr ib leeg-chaw kev paub. Clin Hloov 1999; 13:158–67.