Central Mechanisms of erectile dysfunction: Ihe onye dọkịta nwere ike ịchọ ịma
International Journal of Impotence Research (2003) 15, Nkwanye 2, S3-S6. doi:10.1038/sj.ijir.3900989
CG Stief1
Ụlọ akwụkwọ ahụike Hannover, Ngalaba Urology, Hannover, Germany
nkịtị
Mmekọrịta dị n'etiti usoro dị n'akụkụ na etiti nke ọrụ erectile akọwapụtaghị nke ọma n'agbanyeghị na sayensị bụ isi na-aga n'ihu na mpaghara a. Ọ dị mkpa site n'echiche ụlọ ọgwụ iji ghọta usoro ndị a ka anyị wee malite ịmalite ọganihu ọgwụgwọ ọzọ na ọgwụgwọ erectile dysfunction (ED). Aghọtara ugbu a na nkwụsị nke etiti na-ekere òkè dị mkpa na ntinye nke nzaghachi erectile na nke a ebutela mmepe nke onye nrụpụta etiti, apomorphine SL (Ixense ™) [apo SL]. Apo SL na-arụ ọrụ na paraventricular nucleus nke hypothalamus dị ka onye na-anabata dopamine agonist. Ọ na-arụ ọrụ dị ka ihe mgbochi proerectile na ọkwa a iji mee ka nzaghachi nke ụzọ erectile na-eso mkpali mmekọahụ kwesịrị ekwesị. Usoro omume etiti a pụrụ iche nke apo SL egosila na ọ dị irè n'ihe dịka 70% nke ndị ọrịa ED n'agbanyeghị na enwere ike ịchọ ntachi obi iji mepụta mmetụta siri ike maka ọnụ ọgụgụ ndị ọrịa kachasị.
Okwu Mmalite
Ọ bụ ezie na aghọtachaghị usoro ndị na-arụ ọrụ erectile nke ọma, enweela ọganihu n'ihe gbasara njikọta nke etiti na usoro dị n'akụkụ. Ịghọta usoro ndị a site na sayensị bụ isi dị oké mkpa ma ọ bụrụ na ịchọ ọgwụ ndị dị irè iji gwọọ nsogbu mmekọahụ dị ka erectile dysfunction (ED) ga-aga nke ọma. Mmepe nke otu klas nke ọgwụ ndị a maara dị ka ndị na-amalite nrụpụta etiti dị ka apo SL enyela ihe mgbakwunye bara uru na armamentarium nke urologist, ma ọrụ ndị ọzọ nwere ike inye aka n'ịchọpụta isi ihe ndị ọzọ nwere ike ịdị irè nke ntinye aka na ụzọ ọrụ erectile.
Central njikwa ọrụ erectile
Usoro etiti, ma supraspinal na spinal, na-arụ ọrụ dị mkpa na arụ ọrụ erectile (Nyocha 1). A na-amalite nrụpụta 'okike' n'ụbụrụ n'ihi mkpali mmekọahụ nke chọrọ nhazi na ntinye aka iji malite nzaghachi erectile kwesịrị ekwesị. A na-ejikọta ihe na-ahụ anya, nke na-esi ísì ụtọ, nke na-emetụ n'ahụ na nke na-eche echiche sitere na lobe occipital, rhinencephalon, thalamus na limbic usoro, n'otu n'otu, na-ejikọta ya na nzaghachi erectile na obere hypothalamic nuclei abụọ, paraventricular nucleus (PVN) na medial preoptic area (MPOA).
Nyocha 1.
Ọrụ MPOA bụ ịmata ihe mkpali mmetụta sitere na etiti ụbụrụ dị elu wee jikọta ha na mkpali mmekọahụ na mmemme moto copulatory.1 MPOA na-etinyekwa aka na omume nne,2 thermoregulation3 na akpịrị ịkpọ nkụ.4 PVN na-arụ ọrụ dị mkpa na ahụ. nzaghachi erectile, na ọgwụ ọgwụ ma ọ bụ ọkụ eletrik nke obere obere hypothalamic nuclei a na-ebute nkwụsị seminal n'ime oke ndị a na-adịghị ahụ anya5 na nrụpụta na ejaculation na oke anesthetized.6 Dopaminergic neurones nke sitere na incertohypothalamic dopamine usoro bụ isi ihe dị na PVN. Ndị a dopaminergic neurones na-abanye na oxytocin nwere neurones.7
Nhazi ọkpụkpụ azụ nke nzaghachi erectile
Neurones sitere na PVN na-agbada n'etiti ụbụrụ ụbụrụ, na ọkwa a, paragigantocellularis nucleus nwere ike ịkwụsị akara ngosi si na mpaghara ụbụrụ dị elu ma ọ bụrụ na ọ bụrụ na ọ bụ ihe na-ekwesịghị ekwesị ịnweta nzaghachi erectile .8,9 Nke a na-emezigharị site na usoro serotinergic ọ bụ ezie na onye na-anabata ya. A naghị akọwapụta ụdị subtypes ndị metụtara ya nke ọma.8 Ozugbo site n'etiti ụbụrụ, ihe mgbaàmà erectile na-agafe n'akụkụ azụ azụ ruo n'akụkụ. Na mgbakwunye na ịnyefe akara akwara ozi, ọkpụkpụ azụ nwere ihe nrịbama nhazi ọrụ ntinye sitere na mpaghara mpaghara na mpaghara etiti dị elu. Enwere isi saịtị abụọ nke njikọta maka ọrụ erectile na ọkpụkpụ azụ, ebe a na-ahụ maka ọkpụkpụ azụ nke sacral site na S2 ruo S4 na ebe thoracic sitere na T11 ruo L2.10 Ihe ngosi erectile na-ahapụ CNS na etiti abụọ a, na ozi ahụ bụ. wee bufee site na neurone autonomic gaa na mpụta.
Ndị na-ahụ maka neurotransmitters
Enwere ọtụtụ neurotransmitters dị n'akụkụ na-etinye aka na njikwa ụlọ. Parasympathetic nitric oxide (colocalized with acetylcholine) innervation na-eme ka izu ike na-arụpụta nrụpụta,10 ebe noradrenergic ọmịiko innervation na-arụpụta detumescence.11 Ndị ọzọ neurotransmitters na-etinye aka na njikwa ọrụ erectile gụnyere nitric oxide na vasoactive interstitial peptide (VIP). Ihe omume dị mkpa dị n'akụkụ na ntinye nke nrụpụta bụ izu ike nke mkpụrụ ndụ akwara dị nro na mgbidi nke corpus cavernosum. A malitere omume a na nzaghachi na nitric oxide na-eme ka ịrị elu nke ndị ozi nke abụọ intracellular dị ka cAMP na cGMP, na-emecha mee ka calcium na-esi na mkpụrụ ndụ na ntụrụndụ.12
Ọrụ nke Central dopamine na ọrụ erectile
Enwere ọtụtụ neurotransmitters nke etiti na-etinyekwa aka na mmalite nke nrụpụta; Otu neurotransmitter dị mkpa bụ dopamine. Dopamine bụ isi ihe na-ebugharị n'ime PVN,5 nke, dị ka a tụlere n'elu, na-arụ ọrụ dị mkpa na njikwa etiti nke nrụpụta. A na-ekewa ndị na-anabata dopamine n'ime ezinụlọ abụọ bụ isi: D1- na D2 ndị nnata nke na-ekewa site na D1 ruo D5. Apo SL nwere mmekọrịta dị elu maka ndị na-anabata D2-dị ka ndị na-anabata ya13 nke a na-eche na ọ bụ ebe bụ isi maka ntinye nke mgbidi na PVN.14 Apo SL na-etinye ya ka ọ dịkwuo nzaghachi erectile site n'ime ihe dị ka conditioner na PVN, na-amụba nzaghachi. na mkpali mmekọahụ nke na-ebute nkwalite erection na mpụta.15
Ịdị irè Clinical nke apo SL
Ajụjụ na-esonụ ka dị, kedu ka usoro ihe omume etiti a pụrụ iche na sayensị bụ isi e depụtara n'elu si asụgharị n'ime usoro ọgwụgwọ? Ihe akaebe maka ọrụ etinyere maka apo SL na ntinye nke erections ka agbakọbara n'oge ọtụtụ ule ụlọ ọgwụ. Ihe karịrị ndị ikom 5000 n'ụwa nile etinyewo aka na ule ndị a, na-anata ihe karịrị 120 000 doses.16 Ndị ọrịa a egosipụtawo ụdị dịgasị iche iche nke ndị ọrịa ED. Ndị ikom nwere nsogbu ndị dị ka benign prostatic hyperplasia, ọrịa akwara obi na ọrịa shuga esonyela.16 Ọzọkwa, ndị ikom nwere ụdị dị iche iche nke ED, dị nro, agafeghị oke na nke siri ike, dị ka a tụlere site na iji International Index of erectile Function (IIEF) debanyere aha. na mmemme nnwale ụlọ ọgwụ. Isi njedebe ikpeazụ n'ime ule ụlọ ọgwụ ndị a bụ pasentị nke mbọ a na-eme ka a rụpụta ụlọ nke ọma nke ọma maka inwe mmekọahụ. Isi njedebe nke abụọ bụ mgbalị pasentị na mmekọ nwoke na nwanyị na afọ ojuju, nke abụọ dị mkpa na ụlọ ọgwụ. Usoro ntule ejirila akwụkwọ ndekọta ndị ọrịa na ọnụ ọgụgụ ọkwa dịka IIEF.17
Apo SL egosila na ọ dị irè na ED, karịsịa na ndị ọrịa nwere ED dị nwayọọ na-agafeghị oke.16 Ihe dị ka ụzọ abụọ n'ụzọ atọ nke ndị ọrịa (Nyocha 2) ga-enwe nzaghachi erectile dị mma n'ime nkeji 20 mbụ nke ịṅụ ọgwụ ahụ n'agbanyeghị na ụfọdụ ndị ọrịa. ga-achọ ogologo oge (Nyocha 3) .16 Ịrụ ọrụ nke apo SL na-eme ka ọ dịkwuo mma site n'ịkwado ugboro ugboro; ya mere, ọ dịkarịa ala anọ dose ka a chọrọ iji nweta mmekọahụ. Mgbe mgbalị anọ gasịrị, nzaghachi siri ike, yana mmụba okpukpu abụọ na pasent nke ụlọ nrụpụta zuru oke maka inwe mmekọahụ ma e jiri ya tụnyere placebo, enwere ike ịtụ anya ma ọ dịkarịa ala 70% nke ndị ọrịa na-azaghachi (Nyocha 4) .18
Summary
Mwepu nke etiti na-ekere òkè dị mkpa n'ịkwalite nrụpụta. Enwere ọtụtụ ihe owuwu etiti sitere na ebe cortical dị elu ruo na nuclei hypothalamic, ọkachasị PVN. Mkpali nke ndị na-anabata D2 dị na PVN nwere mmetụta na-aga n'ihu. Ọ bụ mkpali a site na D2 agonist apo SL na-ebute nrụpụta ụlọ ọgwụ ya maka ụmụ nwoke nwere ED.
Egosiputala ịdị irè nke apo SL n'ụzọ doro anya n'oge ule ụlọ ọgwụ okpukpu abụọ nke crossover n'ihe karịrị ụmụ nwoke 5000 nwere ogo dị iche iche nke ED site na nwayọọ ruo dị njọ. Ọmụmụ ihe ndị a egosila mmụba okpukpu abụọ na pasent nke erections siri ike maka inwe mmekọahụ ma e jiri ya tụnyere placebo na na apo SL dị irè karịsịa na ndị ikom nwere ED dị nwayọọ na-agafeghị oke. Ngwa ngwa mmalite nke apo SL, nke na-eme n'ime 20 min maka ọtụtụ ndị ọrịa nwere ike inyere ndị ikom nwere ED aka imeziwanye onwe ha na mmekọrịta mmekọahụ. Ịdị irè nke apo SL na-abawanye site n'usoro usoro ọgwụgwọ maka ndị ọrịa na-akwado ọgwụgwọ karịrị usoro anọ. Usoro ọgwụgwọ a na-enye ndị ọrịa ohere ịnweta mmekọ nwoke na nwanyị na-eju afọ.
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