Факторы риска развития эректильной дисфункции: известные и неожиданные факты (обзор литературы)

Распространенность эректильной дисфункции (ЭД) среди мужчин старше 50 лет составляет 31-51 %. Ожидается, что к 2025 г. число пациентов с ЭД во всем мире увеличится до 322 млн. В России, по данным академика Д.Ю. Пушкаря, ЭД страдает до 89,9 % мужчин.

В связи с этим представляется весьма важным установление причин возникновения данного состояния. Целью настоящего обзора является представление современных данных литературы по вопросу, касающемуся факторов риска, приводящих к ЭД или ассоциированных с развитием ЭД.

Представленные работы показывают, что в возникновении ЭД играют роль хорошо известные факторы: неблагоприятное состояние окружающей среды, вредные факторы образа жизни, хроническая интоксикация, ожирение, генетическая предрасположенность, дефицит половых гормонов и витаминов, заболевания сердечно-сосудистой системы, предстательной железы и уретры, а также препараты для их лечения. В обзоре также рассмотрены новые показатели лабораторных и инструментальных исследований, изменяющиеся при ЭД.

Помимо работ, посвященных известным факторам риска, встречаются оригинальные работы, содержащие весьма неожиданные факты.

В настоящее время изучается взаимосвязь ЭД с репродуктивными нарушениями, псориазом, периодонтитом, инфицированностью вирусом иммунодефицита человека и приемом нестероидных противовоспалительных средств, что представлено в настоящем обзоре.

1. Johannes C.B., Araujo A.B., Feldman H.A. et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000;163(2):460-3. DOI: 10.1016/s0022-5347(05)67903-7.

2. Laumann E.O., Paik A., Rosen R.C. et al. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281(6):537-44. DOI: 10.1001/jama.281.6.537.

3. Selvin E., Burnett A.L., Platz E.A. et al. Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007;120(2):151-7. DOI: 10.1016/j.amjmed.2006.06.010.

4. Ayta I.A., McKinlay J.B., Krane R.J. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999;84(1):50-6. DOI: 10.1046/j.1464-410x.1999.00142.x.

5. Rosen R.C., Fisher W.A., Eardley I. et al. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin 2004;20(5):607-17. DOI: 10.1185/030079904125003467.

6. Пушкарь Д.Ю., Камалов А.А., Аль-Шукри С.Х. и др. Анализ результатов эпидемиологического исследования распространенности эректильной дисфункции в Российской Федерации. Урология 2012;6:5-9.

7. Wang X.M., Bai Y.J., Yang Y.B. et al. Alcohol intake and risk of erectile dysfunction: a dose-response metaanalysis of observational studies. Int J Impot Res 2018;30(6):342-51. DOI: 10.1038/s41443-018-0022-x.

8. Pizzol D., Demurtas J., Stubbs B. et al. Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Mens Health 2019;13(6):1557988319892464. DOI: 10.1177/1557988319892464.

9. Zhao S., Deng T., Luo L. et al. Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017;14(10):1209-19. DOI: 10.1016/j.jsxm.2017.08.010.

10. Ismail S.B., Noor N.M., Hussain N.H.N. et al. Angiotensin Receptor Blockers for Erectile Dysfunction in Hypertensive Men: A Brief Meta-Analysis of Randomized Control Trials. Am J Mens Health 2019;13(6):1557988319892735. DOI: 10.1177/1557988319892735.

11. Akdemir A.O., Karabakan M., Aktas B.K. et al. Visceral adiposity index is useful for evaluating obesity effect on erectile dysfunction. Andrologia 2019;51(6):e13282. DOI: 10.1111/and.13282.

12. Bohm M., Baumhakel M., Teo K. et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation 2010;121(12):1439-46. DOI: 10.1161/CIRCULATIONAHA. 109.864199.

13. Dong J.Y., Zhang Y.H., Qin L.Q. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 2011;58(13):1378 -85. DOI: 10.1016/j.jacc.2011.06.024.

14. Schouten B.W., Bohnen A.M., Bosch J.L. et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res 2008;20(1):92-9. DOI: 10.1038/sj.ijir.3901604.

15. Nehra A., Jackson G., Miner M. et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012;87(8):766-78. DOI: 10.1016/j.mayocp.2012.06.015.

16. Batty G.D., Li Q., Czernichow S. et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol 2010;56(23):1908-13. DOI: 10.1016/j.jacc.2010.04.067.

17. Ning L., Yang L. Hypertension might be a risk factor for erectile dysfunction: a meta-analysis. Andrologia 2017;49(4). DOI: 10.1111/and.12644.

18. Osondu C.U., Vo B., Oni E.T. et al. The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis. Vasc Med 2018;23(1):9-20. DOI: 10.1177/1358863X17725809.

19. Chokesuwattanaskul R., Thongprayoon C., Pachariyanon P. et al. Erectile dysfunction and atrial fibrillation: A systematic review and meta-analysis. Int J Urol 2018;25(8):752-7. DOI: 10.1111/iju.13725.

20. Fan Y., Hu B., Man C. et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol 2018;36(10):1681-9. DOI: 10.1007/s00345-018-2318-3.

21. Besiroglu H., Otunctemur A., Ozbek E.J. The relationship between metabolic syndrome, its components, and erectile dysfunction: a systematic review and a meta-analysis of observational studies. J Sex Med 2015;12(6):1309-18. DOI: 10.1111/jsm.12885.

22. Wang X., Yang X., Cai Y. et al. High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis. J Sex Med 2018;15(7):935-41. DOI: 10.1016/j.jsxm.2018.05.007.

23. Liu Q., Zhang Y., Wang J. et al. Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis. J Sex Med 2018;15(8):1073-82. DOI: 10.1016/j.jsxm.2018.05.016.

24. Kellesarian S.V., Malignaggi V.R., Feng C. et al. Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res 2018;30(3):129-140. DOI: 10.1038/s41443-018-0017-7.

25. Ye T., Li J., Li L. et al. Computed tomography cavernosography combined with volume rendering to observe venous leakage in young patients with erectile dysfunction. Br J Radiol 2018;91(1091):20180118. DOI: 10.1259/bjr.20180118.

26. Kostis J.B., Dobrzynski J.M. The effect of statins on erectile dysfunction: a metaanalysis of randomized trials. J Sex Med 2014;11(7):1626-35. DOI: 10.1111/jsm.12521.

27. Elgendy A.Y., Elgendy I.Y., Mahmoud A.N. et al. Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Med 2018;131(4):387-94. DOI: 10.1016/j.amjmed.2017.10.043.

28. Liu C., Lu K., Tao T. et al. Endothelial nitric oxide synthase polymorphisms and erectile dysfunction: a meta-analysis. J Sex Med 2015;12(6):1319-28. DOI: 10.1111/jsm.12896.

29. Yao H.X., Ma F.Z., Tan Y.Y. et al. Endothelial nitric oxide synthase gene polymorphisms and risk of erectile dysfunction: An updated meta-analysis of genetic association studies. Int J Surg 2018;54(Pt A):141-8. DOI: 10.1016/j.ijsu.2018.04.012.

30. Zhang T., Li W.L., He X.F. et al. The insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene and erectile dysfunction risk: a meta-analysis. Andrology 2013;1(2):274-80. DOI: 10.1111/j.2047-2927.2012.00029.x.

31. Mulhall J.P., Trost L.W., Brannigan R.E. et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol 2018;200(2):423-32. DOI: 10.1016/j.juro.2018.03.115.

32. Huang Y.P., Liu W., Chen S.F. et al. Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone. Int J Impot Res 2019;31(2):132-8. DOI: 10.1038/s41443-018-0090-y.

33. Zuniga K.B., Margolin E.J., De Fazio A. et al. The association between elevated serum oestradiol levels and clinically significant erectile dysfunction in men presenting for andrological evaluation. Andrologia 2019;51(9):e13345. DOI: 10.1111/and.13345.

34. Wei Y., Chen P., Chen Q. et al. Serum vitamin D levels and erectile dysfunction: A systematic review and meta-analysis. Andrologia 2019;51(3):e13211. DOI: 10.1111/and.13211.

35. Li H.J., Kang D.Y. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis. World J Urol 2016;34(7):1009-17. DOI: 10.1007/s00345-015-1720-3.

36. Corona G., Tirabassi G., Santi D. et al. Sexual dysfunction in subjects treated with inhibitors of 5a-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 2017;5(4):671-8. DOI: 10.1111/andr.12353.

37. Favilla V., Russo G.I., Privitera S. et al. Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alphablockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/ BPH: a systematic review with metaanalysis. Aging Male 2016;19(3):175-81. DOI: 10.1080/13685538.2016.1195361.

38. Kallidonis P., Russo G.I., Privitera S. et al. Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis. Aging Male 2016;19(3):175-81. DOI: 10.1080/13685538.2016.1195361.

39. Vasudeva P., Kumar N., Kumar A. et al. Impact of monopolar TURP, bipolar TURP and photoselective vaporization of prostate for enlarged prostate on erectile function. Low Urin Tract Symptoms 2019;11(1):24-9. DOI: 10.1111/luts.12189.

40. Gaither T.W., Awad M.A., Osterberg E.C. et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14(9):1071-8. DOI: 10.1016/j.jsxm.2017.07.010.

41. Zhou J.T., Fang D.M., Xia S. et al. The incidence proportion of erectile dysfunction in patients treated with cryotherapy for prostate cancer: a metaanalysis. Clin Transl Oncol 2019;21(9):1152-8. DOI: 10.1007/s12094-019-02036-8.

42. Blaschko S.D., Sanford M.T., Cinman N.M. et al. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 2013;112(5):655-63. DOI: 10.1111/j.1464-410X.2012.11741.x.

43. Lotti F., Maggi M. Sexual dysfunction and male infertility. Nat Rev Urol 2018;15(5):287-307. DOI: 10.1038/nrurol.2018.20.

44. Kizilay F., §ahin M., Altay B. Do sperm parameters and infertility affect sexuality of couples? Andrologia 2018;50(2). DOI: 10.1111/and.12879.

45. Coward R.M., Stetter C., Kunselman A. et al. Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility. J Urol 2019;202(2):379-84. DOI: 10.1097/JU.0000000000000205.

46. Corona G., Rastrelli G., Limoncin E. et al. Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2015;12(12):2291-300. DOI: 10.1111/jsm.13041.

47. Liu L.H., Li E.M., Zhong S.L. et al. Chronic periodontitis and the risk of erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res 2017;29(1): 43-8. DOI: 10.1038/ijir.2016.43.

48. Zhang F.B., Wu B.C., Xie L.B. et al. [Correlation of psoriasis with erectile dysfunction: A meta-analysis. (In Chinese)]. Zhonghua Nan Ke Xue 2017;23(3):256-61.

49. Wu T., Duan X., Chen S. et al. Association Between Psoriasis and Erectile Dysfunction: A Meta-Analysis. J Sex Med 2018;15(6):839-47. DOI: 10.1016/j.jsxm.2018.04.630.

50. Zhao S., Wang J., Xie Q. et al. High prevalence of erectile dysfunction in men with psoriasis: evidence from a systematic review and meta-analysis. Int J Impot Res 2019;31(2):74-84. DOI: 10.1038/s41443-018-0093-8.

51. Luo L., Deng T., Zhao S. et al. Association Between HIV Infection and Prevalence of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017;14(9):1125-32. DOI: 10.1016/j.jsxm.2017.07.001.

52. Li T., Wu C., Fu F. et al. Association between use of aspirin or nonaspirin non-steroidal anti-inflammatory drugs and erectile dysfunction: A systematic review. Medicine (Baltimore) 2018;97(28):e11367. DOI: 10.1097/MD.0000000000011367.

53. Aslan A., Kaya Y., Cirakoglu A. et al. Neutrophil-Lymphocyte Ratio Could Be a Marker for Erectile Dysfunction. Urol J 2019;16(2):216-20. DOI: 10.22037/uj.v16i2.5011.

54. Ren Z.J., Ren P.W., Yang B. et al. Mean platelet volume, platelet distribution width and platelet count in erectile dysfunction: A systematic review and meta-analysis. Andrologia 2017;49(10). DOI: 10.1111/and.12777.

55. Yang G., Muzepper M. Platelet indices and erectile dysfunction: A systematic review and meta-analysis. Andrologia 2019;51(5):e13248. DOI: 10.1111/and.13248.

56. Sansone A., Cignarelli A., Sansone M. et al. Serum Homocysteine Levels in Men with and without Erectile Dysfunction: A Systematic Review and Meta-Analysis. Int J Endocrinol 2018;2018:7424792. DOI: 10.1155/2018/7424792.