男性健康方案教学教程.pptVIP

* * GTP：三磷酸鸟酐； GMP：磷酸鸟酐； cGMP:环磷酸鸟酐； PDE5：磷酸二酯酶5型； Guanylate cyclase ：鸟氨酸环化酶 现已知，阴茎海绵体内非肾上腺素能非胆碱能（NANC）神经元和血管内皮细胞上有一氧化氮合成酶（NOS），当性刺激时，NOS催化L—精氨酸和氧分子反应生成NO，NO与鸟苷酸环化酶中的血红素结合形成亚酰血红素，亚酰血红素，激活鸟苷酸环化酶，使三磷酸鸟苷（GTP）转化为环磷酸鸟苷（cGMP），cGMP刺激血管平滑肌上的cGMP依赖蛋白激酶，调节磷酸二酯酶和离子通道，使细胞内钙离子浓度增高，影响Na+－Ca2+交换，从而使血管松弛扩张，血流灌入阴茎海绵体使阴茎勃起。与此同时，5－磷酸二酯酶（PDE5）活化，活化的PDE5有降解阴茎海绵体内cGMP的作用，阴茎海绵体血管平滑肌不能松弛扩张，阴茎勃起障碍。万艾可的作用是选择性抑制PDE5活化，提高cGMP的浓度有利于海绵体小动脉平滑肌松弛扩张血液灌注，加上性刺激，能提高阴茎海绵体NO－cGMP勃起效应，达到治疗ED的目的。 ? * NOTES As epidemiological data on sexual dysfunction are relatively scant for both women and men, the prevalence and risk of experiencing sexual dysfunction across various social groups was assessed. Therefore, an analysis was performed of data from the National Health and Social Life Survey, a study of sexual behavior in a cohort of US adults (1749 women and 1410 men aged 18 to 59 years). There was a significant 3-fold increased prevalence of “lack of interest in sex” in aging men as compared to young men. Low sexual desire in men was also associated with not being married, daily alcohol consumption, poor to fair health, negative sexual experiences and emotional problems or stress.1 This study confirms findings from a previous study in 220 men in which libido decreased with increasing age.2 Testosterone deficiency dose-dependently decreases libido. However, the threshold level of testosterone under which libido problems start to occur is relatively low (estimated at around 10 nmol/L).3 Reduced libido in aging men is associated with deficiency of bioavailable testosterone2,4, but not of total testosterone.4 References 1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States. JAMA 1999;281:537-5442. Davidson JM, Chen JJ, Crapo L, Gray GD, Greenleaf WJ, Catania JA. Hormonal changes and sexual function in aging men. J Clin Endocrinol Metab 1983;57:71-773. Buena F, Swerdloff RS, Steiner BS, Lutchmansingh P, Peterson MA, Pandian MR, Galmarini M, Bhasin S. Sexual function does not change whe