摘要
导言：2型糖尿病（T2DM）是勃起功能障碍（ED）的一个公认风险因素；血糖控制对男性性功能（包括荷尔蒙状况）的确切影响仍有待全面阐明。本研究旨在探讨 T2DM 患者血糖控制程度与内分泌失调和 ED 严重程度之间的具体关系：在相对控制和未控制的 2 型糖尿病男性患者之间进行比较研究。我们认为糖化血红蛋白（HbA1c）在 7.9 mmol/L 或以下的糖尿病（DM）患者病情相对得到控制。我们将出现 ED 的 2 型糖尿病男性患者分为两组--相对受控的 DM（HBA1c 为 7.9 mmol/L 或以下）和未受控的 DM（HBA1c 等于或大于 8 mmol/L），并对他们的实验室结果进行了研究。检索到的数据包括患者的人口统计学特征、体重指数（BMI）、荷尔蒙状况、全血细胞计数（CBC）、血脂状况、前列腺特异性抗原（PSA）、尿酸盐、维生素 D 水平，以及通过国际勃起功能指数（IIEF）评分评估的 ED 严重程度。使用 SPSS 版本 20 进行统计分析，比较两组之间的差异。P<0.05为差异有统计学意义：该研究发现，糖尿病男性血糖控制不佳（HbA1c ≥8%）与 ED 之间存在明显关联（P < 0.0001）。糖尿病持续时间较长与ED和血糖控制不佳均有关联，这表明两者之间存在潜在的因果关系。与血糖控制不良组相比，血糖控制良好的糖尿病患者的体重指数（BMI）较低（P = 0.001），游离睾酮（FT）较高（P = 0.0002），性激素结合球蛋白（SHBG）较低（P = 0.0001），IIEF评分较高（P < 0.0001），这表明糖尿病患者的勃起功能较好，体重控制和睾酮供应的改善可能会带来益处。虽然卵泡刺激素和促黄体生成素水平未受明显影响，但控制良好组的维生素 D 水平更高（P = 0.0002），这表明维生素 D 在 ED 中可能发挥作用，但仍需进一步研究。胆固醇、低密度脂蛋白、高密度脂蛋白、甘油三酯、PSA、促甲状腺激素和 T4 水平未显示出显著差异，但可能值得进一步探讨：本研究表明，糖尿病男性血糖控制不佳与勃起功能受损之间存在关联。在血糖控制不佳的人群中观察到 FT 水平降低、SHBG 升高和 BMI 增加，这可能是导致 ED 的原因。相反，良好的血糖控制与勃起功能改善相关，这可能是由于更高的 FT 可用性和维生素 D 水平。Introduction: Type 2 diabetes mellitus (T2DM) is a well-established risk factor for erectile dysfunction (ED); the precise impact of glycemic control on male sexual function, including hormonal profiles, remains to be fully elucidated. This study aims to investigate the specific relationship between the degree of glycemic control in T2DM patients and the severity of both hormonal imbalances and ED.
Methodology: A comparative study between two arms - relatively controlled and uncontrolled type 2 diabetic men. We considered a relatively controlled diabetes mellitus (DM), patient with glycated hemoglobin (HbA1c) of 7.9 mmol/L or less. Laboratory results for type 2 diabetic men presenting with ED were studied after stratifying them into the two groups - relatively controlled DM (HBA1c of 7.9 mmol/L or less) and uncontrolled DM (HBA1c equal to or more than 8 mmol/L). Retrieved data include patient's demographics, body mass index (BMI), hormonal profile, Complete Blood Count (CBC), lipid profile, prostate-specific antigen (PSA), urate, Vitamin D level, and the severity of ED as assessed by the International Index of Erectile Function (IIEF) scores. Statistical analysis was done to compare between the two groups using SPSS version 20. P < 0.05 was considered statistically significant.
Results: This study found a significant association between poor glycemic control (HbA1c ≥8%) and ED in diabetic men (P < 0.0001). Longer diabetes duration correlated with both ED and poor glycemic control, suggesting a potential causal link. Well-controlled diabetics had lower BMI (P = 0.001), higher free testosterone (FT) (P = 0.0002), lower sex hormone-binding globulin (SHBG) (P = 0.0001), and higher IIEF scores (P < 0.0001) compared to the poorly controlled group, indicating better erectile function and potential benefits of weight management and improved testosterone availability. While follicle-stimulating hormone and luteinizing hormone levels were not significantly affected, Vitamin D levels were higher in the well-controlled group (P = 0.0002), suggesting a potential role for Vitamin D in ED, although further investigation is needed. Cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, PSA, thyroid-stimulating hormone, and T4 levels did not show significant differences but might warrant further exploration.
Conclusion: This study demonstrates an association between poor glycemic control and impaired erectile function in diabetic men. Lower FT levels, elevated SHBG, and increased BMI were observed in the poorly controlled group, potentially contributing to ED. Conversely, good glycemic control correlated with improved erectile function, potentially due to higher FT availability and Vitamin D levels.
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