發(fā)布時間：2018-03-02 17:29

  本文選題：低強度體外沖擊波　切入點：陰莖勃起功能障礙　出處：《蘇州大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分低強度體外沖擊波治療勃起功能障礙的臨床療效初步觀察目的臨床觀察低強度體外沖擊波(low intensity extracorporeal shock wave therapy,LI-ESWT)治療勃起功能障礙的療效和安全性。方法采用LI-ESWT治療ED患者104例,包括心理性ED、器質(zhì)性ED和混合性ED�；颊咂骄挲g38.5歲,病程3個月,IIEF-5評分22分。隨機分為試驗組和對照組,各52例。試驗組采用CS-2012A-9型體外沖擊波骨科治療機,低強度體外沖擊波的探頭在ED患者的陰莖的5個不同位置治療,降低能量至工作電壓5Kv,能量密度0.09MJ/mm2,頻率120次/min,每個部位300沖擊波治療。每周治療2次,連續(xù)治療3周,停止治療3周,然后每周治療2次,連續(xù)治療3周,共9周。對照組采用安慰治療(使用相同的治療儀,治療步驟與治療組相同,治療探頭不發(fā)出沖擊波,但會發(fā)出相同的聲音)。受試者經(jīng)LI-ESWT治療后評估SEP3、IIEF-ED評分以及EHS評分,同時記錄不良反應(yīng)事件發(fā)生。結(jié)果低強度體外沖擊波治療后,心理性ED SEP3從46.05%提高到84.29%,IIEF-ED評分從14.14分提高到20.90分;器質(zhì)性ED SEP3從19.41%提高到53.45%,IIEF-ED評分從8.18分提高到14.86分;混合性ED SEP3從12.29%提高到51.33%,IIEF-ED評分從6.67分提高到14.67分,且差異均具有統(tǒng)計學(xué)意義(P0.05)。而對照組差異無統(tǒng)計學(xué)意義(P0.05)。接受LI-ESWT治療后,試驗組心理性ED、器質(zhì)性ED、混合性ED陰莖勃起硬度評分均較治療前有顯著的提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);對照組心理性ED、器質(zhì)性ED、混合性ED EHS差異均無統(tǒng)計學(xué)意義。按照ED程度分別統(tǒng)計,接受LI-ESWT治療后,試驗組輕度ED SEP3從45.76%提高到82.33%,IIEF-ED評分從14.14分提高到20.62分;中度ED SEP3從34.25%提高到62.83%,IIEF-ED評分從10.08分提高到16.83分;重度ED SEP3從6.63%提高到48.68%,IIEF-ED評分從6.26分提高到13.84分,且差異均具有統(tǒng)計學(xué)意義(P0.05);對照組輕度ED、中度ED、重度ED SEP3、IIEF-ED評分差異均無統(tǒng)計學(xué)意義。接受LI-ESWT治療后,試驗組輕度ED、中度ED、重度ED陰莖勃起硬度評分均較治療前有提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);對照組輕度ED、中度ED、重度ED陰莖勃起硬度評分差異均無統(tǒng)計學(xué)意義。按照病程統(tǒng)計,接受LI-ESWT治療后,試驗組ED病史1年SEP3從45.43%提高到82.57%,IIEF-ED評分從13.95分提高到20.67分;ED病史1年SEP3從17.55%提高到54%,IIEF-ED評分從7.87分提高到14.97分;且差異均具有統(tǒng)計學(xué)意義(P0.05);對照組ED病史1年、ED病史1年差異均無統(tǒng)計學(xué)意義。接受LIESWT治療后,試驗組ED病史1年;ED病史1年陰莖勃起硬度評分均較治療前有提高;且差異均具有統(tǒng)計學(xué)意義(P0.05);對照組ED病史1年、ED病史1年差異均無統(tǒng)計學(xué)意義。按照有無吸煙史統(tǒng)計,接受LI-ESWT治療后,有吸煙史的試驗組ED患者SEP3從25.27%提高到30.24%,IIEF-ED評分從9.60分提高到15.87分;無吸煙史的試驗組ED患者SEP3從59.60%提高到67.95%,IIEF-ED評分從10.62分提高到17.84分;且差異均具有統(tǒng)計學(xué)意義(P0.05);有吸煙史的對照組ED患者、無吸煙史的對照組ED患者治療前后差異均無統(tǒng)計學(xué)意義。接受LI-ESWT治療后,有吸煙史的試驗組ED患者、無吸煙史的試驗組ED患者陰莖勃起硬度評分均較治療前有提高;且差異均具有統(tǒng)計學(xué)意義(P0.05);有吸煙史的對照組ED患者、無吸煙史的對照組ED患者治療前后差異均無統(tǒng)計學(xué)意義。按照慢性病史統(tǒng)計,接受LI-ESWT治療后,有高血壓病史的試驗組ED患者SEP3從18.35%提高到53.17%,IIEF-ED評分從7.83分提高到14.74分,陰莖勃起硬度評分較治療前有提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);無高血壓病史的試驗組ED患者SEP3從37.10%提高到75.34%,IIEF-ED評分從12.31分提高到19.28分,陰莖勃起硬度評分較治療前有提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);有高血壓病史的對照組ED患者、無高血壓病史的對照組ED患者治療前后差異均無統(tǒng)計學(xué)意義。接受LI-ESWT治療后,有糖尿病病史的試驗組ED患者SEP3從9.69%提高到49%,IIEF-ED評分從6.69分提高到14分,陰莖勃起硬度評分較治療前有提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);無糖尿病病史的試驗組ED患者SEP3從37.31%提高到72.89%,IIEF-ED評分從11.94分提高到18.72分,陰莖勃起硬度評分較治療前有提高,且差異均具有統(tǒng)計學(xué)意義(P0.05);有糖尿病的對照組ED患者、無糖尿病的對照組ED患者治療前后差異均無統(tǒng)計學(xué)意義。LI-ESWT治療后無疼痛及其它不良反應(yīng)發(fā)生。結(jié)論此臨床研究表明LI-ESWT尤其對高血壓、糖尿病引起的ED有一定的治療效果。低強度體外沖擊波是治療勃起功能障礙安全與有效的方法之一。第二部分低強度體外沖擊波對糖尿病性ED大鼠陰莖海綿體組織血管內(nèi)皮細胞的影響目的:研究低強度體外沖擊波對糖尿病性勃起功能障礙(ED)大鼠陰莖組織血管內(nèi)皮細胞的影響。方法:6只SPF級雄性SD(Sprague Dawley)大鼠用鏈脲左菌素和阿樸嗎啡誘導(dǎo)建立I型糖尿病性ED大鼠模型。之后把造模成功的糖尿病性ED大鼠隨機分成DMED組(未治療組)、DMED+LIESW組(低強度體外沖擊波治療組),沖擊波探頭作用于陰莖體,選用300次的體外沖擊波,工作電壓5Kv,每組均接受LIESW 3次/周,連續(xù)治療2周,每組3只,取3只非糖尿病正常大鼠為對照。治療結(jié)束后先比較各組大鼠的勃起次數(shù);然后將各組大鼠處死并取陰莖組織進行石蠟包埋,采用免疫細胞熒光檢測陰莖海綿體內(nèi)皮細胞標(biāo)志物CD31的表達;采用免疫組織化學(xué)方法檢測各組大鼠陰莖組織中e NOS的表達情況。結(jié)果:DMED組勃起次數(shù)0.00±0.00,顯著低于正常對照組1.50士0.84(P0.01),DM+LISW組勃起次數(shù)1.17士0.65,明顯高于DMED組0.00±0.00(PO.01),低于正常對照組1.50士0.84(P0.01);正常SD大鼠陰莖海綿體組織未見CD31的表達;DMED組大鼠陰莖海綿體組織未見CD31的表達;DMED組大鼠經(jīng)低強度體外沖擊波治療后陰莖海綿體組織可見綠色熒光的內(nèi)皮細胞標(biāo)志物CD31陽性表達。e NOS在各組大鼠陰莖組織中均有表達,DMED組表達水平顯著低于正常對照組(P0.01),DM+LISW組表達水平明顯高于DMED組(PO.01),但低于正常對照組(P0.01)。結(jié)論:低強度體外沖擊波可能通過促進內(nèi)皮細胞再生和增加陰莖組織中的e NOS的表達來改善勃起功能。第三部分低強度體外沖擊波對體外培養(yǎng)的人脂肪間充質(zhì)干細胞增殖的影響及其治療ED機制的初步探討目的:觀察低能量體外沖擊波(LESW)對體外培養(yǎng)的人脂肪組織間充質(zhì)干細胞(ADASs)增殖活性的影響,初步探討體外沖擊波治療男性勃起功能障礙(ED)的可能機制。方法:經(jīng)腹部皮下脂肪,獲得人脂肪間充質(zhì)干細胞。觀察脂肪間充質(zhì)干細胞在內(nèi)皮細胞誘導(dǎo)體系中形態(tài)變化,通過免疫細胞化學(xué)方法及RT-PCR檢測內(nèi)皮細胞分化標(biāo)志物。LESW沖擊前后繪制細胞生長曲線,觀察脂肪干細胞增殖活性的改變。結(jié)果:獲得的人脂肪間充質(zhì)干細胞,流式檢測細胞高表達CD105、CD90;低表達CD34、CD45;脂肪間充質(zhì)干細胞在內(nèi)皮細胞誘導(dǎo)體系中形態(tài)發(fā)生一系列變化,脂肪間充質(zhì)干細胞向內(nèi)皮細胞誘導(dǎo)分化后表達CD31、CD34、Ⅷ因子、VE-cadherin和內(nèi)皮型一氧化氮合成酶等內(nèi)皮細胞特異性抗原;LESW能促進脂肪間充質(zhì)干細胞的增殖,且能量密度為0.09MJ/mm2,300次沖擊波的作用后細胞增殖更加明顯。結(jié)論:實驗分離獲得的脂肪間充質(zhì)干細胞,在體外實驗觀察其可以向內(nèi)皮細胞分化。低強度體外沖擊波可能通過誘導(dǎo)脂肪間充質(zhì)干細胞的增殖,脂肪間充質(zhì)干細胞可能向內(nèi)皮細胞分化,進而治療男性勃起功能障礙。
[Abstract]:The first part of the clinical curative effect of low intensity of extracorporeal shock wave therapy for erectile dysfunction Objective To observe the clinical preliminary observation of low intensity of extracorporeal shock wave (low intensity extracorporeal shock wave therapy, LI-ESWT) efficacy and safety in the treatment of erectile dysfunction. Methods 104 cases of LI-ESWT patients with ED, including psychological ED, organic ED and mixed ED. patients with an average age of 38.5 years, the duration of 3 months, IIEF-5 score of 22 were randomly divided into experimental group and control group, 52 cases in each. The experimental group was treated by CS-2012A-9 type extracorporeal shock wave department of orthopedics treatment machine, low intensity of extracorporeal shock wave probe in 5 different positions in the treatment of ED's penis, reduce the energy to work the energy density of 0.09MJ/mm2, voltage 5Kv, frequency 120 /min, each part of the 300 shock wave treatment 2 times a week for 3 consecutive weeks, stop for 3 weeks, and 2 treatments per week, for 3 weeks, A total of 9 weeks. The control group with placebo (using the treatment, the same treatment steps with the same treatment group, the therapeutic probe emits shock wave, but will sound the same voice). The subjects treated with LI-ESWT assessment SEP3, IIEF-ED score and EHS score, and record adverse events. Results low the strength of extracorporeal shock wave therapy after psychological ED SEP3 increased from 46.05% to 84.29%, IIEF-ED score improved from 14.14 to 20.90; the organic ED SEP3 increased from 19.41% to 53.45%, IIEF-ED score improved from 8.18 to 14.86; the mixed ED SEP3 increased from 12.29% to 51.33%, IIEF-ED score improved from 6.67 to 14.67 points, and the differences were statistically significant (P0.05). While the control group had no significant difference (P0.05). The experimental group received LI-ESWT treatment, psychological ED, organic ED, mixed ED erectile stiffness scores were significant To improve, and the differences were statistically significant (P0.05); the control group psychological ED, organic ED, mixed ED EHS. There were no significant differences in statistics in accordance with the degree of ED were treated with LI-ESWT, experimental group ED SEP3 slightly increased from 45.76% to 82.33%, IIEF-ED score improved from 14.14 to 20.62 moderate ED; SEP3 increased from 34.25% to 62.83%, IIEF-ED score improved from 10.08 to 16.83; severe ED SEP3 increased from 6.63% to 48.68%, the IIEF-ED score improved from 6.26 points to 13.84 points, and the differences were statistically significant (P0.05); control group, mild ED, moderate ED and severe ED SEP3 IIEF-ED score the difference was not statistically significant. After LI-ESWT therapy, the experimental group of mild ED, moderate ED and severe ED penile erection hardness scores were improved, and the differences were statistically significant (P0.05); control group, mild ED, moderate ED and severe ED penile erection hardness rating The difference was not statistically significant. According to disease statistics, treated with LI-ESWT, experimental group ED 1 year history of SEP3 increased from 45.43% to 82.57%, IIEF-ED score improved from 13.95 to 20.67; ED is a 1 year history of SEP3 increased from 17.55% to 54%, IIEF-ED score improved from 7.87 to 14.97; and the difference is statistical significance (P0.05); control group ED 1 years history and the history of ED for 1 years. There were no significant differences in LIESWT after treatment, the test group ED 1 year history of ED; a 1 year history of penile erection hardness scores were improved; and the differences were statistically significant (P0.05); control group ED 1 years history and the history of ED for 1 years. There were no significant differences in smoking history statistics, treated with LI-ESWT, ED of the experimental group of SEP3 patients with a history of smoking increased from 25.27% to 30.24%, IIEF-ED score improved from 9.60 to 15.87; no smoking history of the test group ED from 59 patients with SEP3 Up to 67.95%.60%, the IIEF-ED score improved from 10.62 to 17.84; and the difference was statistically significant (P0.05); the control group of ED patients with a history of smoking, history of smoking control group after treatment of ED patients. There were no significant differences in LI-ESWT treated group, with a history of smoking test in patients with ED. The test group ED patients with erectile hardness score no smoking history than before treatment was improved; and the differences were statistically significant (P0.05); the control group of ED patients with a history of smoking, history of smoking control group after ED treatment there were no significant differences. According to the statistics of chronic disease treated with LI-ESWT ED, experimental group SEP3 patients with a history of hypertension increased from 18.35% to 53.17%, the IIEF-ED score improved from 7.83 points to 14.74 points, the penis erects hardness score before treatment were improved, and the differences were statistically significant (P0.05); hypertension The test group ED patients with a history of SEP3 increased from 37.10% to 75.34%, the IIEF-ED score improved from 12.31 points to 19.28 points, the penis erects hardness score before treatment were improved, and the differences were statistically significant (P0.05); the control group of ED patients with hypertension and non hypertension control group before and after treatment with ED were no statistically significant. After LI-ESWT, the test group ED SEP3 patients with a history of diabetes increased from 9.69% to 49%, the IIEF-ED score improved from 6.69 points to 14 points, the penis erects hardness score before treatment were improved, and the differences were statistically significant (P0.05); group ED patients without a history of diabetes from SEP3 37.31% to 72.89%, the IIEF-ED score improved from 11.94 points to 18.72 points, the penis erects hardness score before treatment were improved, and the differences were statistically significant (P0.05); diabetic control group ED patients without diabetes. No pain and other adverse reactions in the control group before and after treatment with ED had no significant difference after.LI-ESWT treatment. Conclusion the clinical study showed that LI-ESWT especially for hypertension, diabetes caused by ED have a certain therapeutic effect. The low intensity of extracorporeal shock wave therapy for erectile dysfunction is one of the safe and effective methods. The second part of low intensity effect of extracorporeal shock wave on diabetic vascular endothelial cells ED rat penile tissue Objective: To study the low intensity of extracorporeal shock wave on diabetic erectile dysfunction (ED) effects of vascular endothelial cells in rat penile tissue. Methods: 6 SPF male SD (Sprague Dawley) in rats with streptozotocin and the establishment of ED of apomorphine induced type I diabetes rat model. After the successful model of diabetic ED rats were randomly divided into DMED group (treatment group), group DMED+LIESW (low intensity Extracorporeal shock wave therapy group), shock wave probe acting on the body of the penis, extracorporeal shock wave 300 times, working voltage of 5Kv, each group received LIESW 3 times / week, for 2 weeks, 3 rats in each group, 3 rats in nondiabetic rats as control. After the end of treatment were compared to rats erection times; and then the rats were sacrificed and the penile tissue were embedded in paraffin, using immunofluorescence cell corpus cavernosum endothelial cell marker CD31 expression; expression by immunohistochemistry method to detect rat penile tissue e NOS. Results: DMED group of 0 + 0 times of erection, was significantly lower than that of the normal control group is 1.50 + 0.84 (P0.01), DM+LISW group of 1.17 erectile times + 0.65, 0 + 0 was significantly higher than that of DMED group (PO.01), lower than the normal control group is 1.50 + 0.84 (P0.01); the expression of SD in normal rat penile tissue was CD31; DMED rats There was no CD31 expression in corpus cavernosum; DMED rats after low intensity extracorporeal shock CD31 positive expression of.E NOS in penile tissue of rats in each group were expressed in corpus cavernosum visible green fluorescence in the endothelial cell marker wave after the treatment, the expression level of DMED group was significantly lower than the normal control group (P0.01), the expression level of DM+LISW group obviously higher than that of DMED group (PO.01), but lower than the normal control group (P0.01). Conclusion: low intensity extracorporeal shock wave may improve the erectile function by promoting the expression of endothelial cell regeneration and increase in penile tissue e NOS. A preliminary discussion of the third part of low intensity effect of extracorporeal shock wave on cultured human adipose derived mesenchymal stem cell proliferation and its mechanism of treatment of ED Objective: To observe the effect of low energy extracorporeal shock wave (LESW) on cultured human adipose tissue derived mesenchymal stem cells (ADASs) proliferation, preliminary study Extracorporeal shock wave therapy for erectile dysfunction (ED) and the possible mechanism. Methods: the abdominal subcutaneous fat, get human adipose derived mesenchymal stem cells. Observation of adipose derived mesenchymal stem cells induced morphological changes in the system in endothelial cells by immunocytochemical method and RT-PCR detection of endothelial cell differentiation markers before and after.LESW impact rendering the cell growth curve, cell proliferation was observed. Results: the fat stem of human adipose derived mesenchymal stem cells was detected by flow cytometry, the high expression of CD105, CD90; low expression of CD34 and CD45; adipose derived mesenchymal stem cells induced by the system in a series of morphological changes in endothelial cells, adipose derived mesenchymal stem the expression of CD31 cells differentiated into endothelial cells after CD34, factor VIII, VE-cadherin and endothelial nitric oxide synthase of endothelial cell specific antigen; LESW can promote adipose mesenchymal stem cell proliferation, and can Volume density is 0.09MJ/mm2300 times the effect of shock wave after the cell proliferation is more obvious. Conclusion: isolated adipose derived mesenchymal stem cells in experimental observation, which can differentiate into endothelial cells in vitro. The low intensity of extracorporeal shock wave could induce adipose derived mesenchymal stem cells proliferation, adipose mesenchymal stem cells to differentiate into endothelial cells, and the treatment of male erectile dysfunction.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R698.1

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8 黃興,李世林,胡禮泉;生長激素降低與老年勃起功能障礙[J];中華男科學(xué)雜志;2004年11期

9 王憶長;藥物性勃起功能障礙[J];中國社區(qū)醫(yī)師;2005年09期

10 劉春英;淺談新婚勃起功能障礙[J];中國性科學(xué);2005年05期

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