Особенности патогенеза, диагностики и лечения эректильной дисфункции у больных с гипогонадизмом

По разным данным, распространенность гипогонадизма и эректильной дисфункции (ЭД) колеблется от 1,7 до 35%. Роль андрогенов в регуляции эрекции у человека имеет большое значение и остается предметом изучения до настоящего времени. С помощью экспериментальных и клинических работ доказано, что при андрогенной депривации происходят дегенерация и апоптоз гладких мышечных клеток с последующим фиброзом кавернозных тел; снижение экспрессии эндотелиальной и нейрональной NO-синтазы; уменьшение артериального притока и увеличение венозного оттока от кавернозных тел; повышение чувствительности к медиаторам вазоконстрикции; снижение опосредованного NО расслаб­ления гладкой мускулатуры при сексуальной стимуляции; снижение экспрессии фосфодиэстеразы 5-го типа (ФДЭ-5). Обращает на себя внимание частая взаимосвязь гипогонадизма и ЭД с сердечно-сосудистыми заболеваниями, сахарным диабетом (СД), метаболическим синдромом (МС), дислипидемией, гиперхолестеринемией, гипертриглицеридемией и ожирением. Основной целью заместительной терапии тестостероном является достижение концентрации тестостерона в плазме, максимально приближенной к физиологическим значениям, а также коррекция клинических проявлений андрогенодефицита. Назначение препаратов тестостерона считается показанным только больным с клиническими и лабораторными признаками гипогонадизма. Широкое применение в современной клинической практике получили препараты тестостерона для внутримышечного введения. Заместительная терапия препаратами тестостерона способствует усилению либидо, увеличению количества утренних эрекций и повышению удовлетворенности от сексуальной жизни в целом. Следует отметить, что терапия препаратами тестостерона переносится хорошо. Контроль над проведением заместительной гормональной терапии препаратами тестостерона подразумевает оценку клинического ответа и достижение целевого уровня тестостерона в плазме крови. Необходимо провести исследование простатоспецифического антигена, пальцевое ректальное исследование и определить уровень гематокрита перед началом лечения, через 3 и 6 мес, а затем - каждые 6 мес. Таким образом, андрогены являются естественными стимуляторами и поддерживают половую функцию у мужчин. При наличии у больных ЭД и гипогонадизма более обоснованным можно считать проведение комбинированной терапии с применением андрогенов и ингибиторов ФДЭ-5.

гипогонадизм, эректильная дисфункция, тестостерон, заместительная гормональная терапия, рак простаты

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