The Clinical Study On Platelet Parameters And Vascular Erectile Dysfunction

Erectile dysfunction(ED),defined as the recurrent or consistent inability to attain or maintain the penile erection required for sufficient sexual performance for at least 6 months,is one of the most common diseases in males.It usually affects physical and psychosocial health in affected males and may have a significant impact on their and their partner's quality of life.A Meta-Analysis Consortium study reported that ED was present in nearly 17%of all European males in 2004 and that it will affect 322 million by 2025.ED is a complicated interaction between the etiology of vascular,neurogenic,hormonal,psychogenic,iatrogenic,and anatomic causes,which plays an important role in the occurrence of ED.Through the continuous study on the anatomical structure of the penis and the pathophysiological mechanism of penis erection,vascular factors have received more attention than before because the penis has a special vascular webbing.It is estimated that vascular factors account for about 25%-70%of ED patients.Several pathological factors that a? ect the blood vessels,such as atherosclerosis,endothelial dysfuncton and in fl ammatory,can lead to vasculogenic ED through the important role that endothelial cells play in vascular homeostasis.Based on the vascular involvement,there are three types of vasculogenic ED:arterial insufficiency,venous leakage,or a combination of the two.A change in platelet activity is common in thrombosis and vascular inflammatory reactions.In addition,recent studies have evaluated platelet parameters in patients with ED and found that mean platelet volume(MPV)and platelet distribution width(PDW)are potential indicators to predict ED.Although many researchers investigated the relationship between vasculogenic ED and platelet parameters,there has been no di? erentiation between arteriogenic,venous leakage,and mixed vascular insufciency.Te current study investigated the relationship between arteriogenic ED and platelet parameters,and we analyzed platelet parameters in patients with arteriogenic ED or venous leakage to determine the potential platelet parameters that may predict arteriogenic ED.ObjectiveThe aim of our study was to investigate the role of platelet parameters including mean platelet volume(MPV)and platelet count(PC)in the pathogenesis of penile arteriogenic erectile dysfunction(ED)and to evaluate the association between the platelet parameters and arteriogenic ED by the relationship between platelet parameters and penile color Doppler ultrasonography parameters was analyzed in arterial ED patients.Finding a simple,less invasive test to replace penile color Doppler ultrasonography.Materials and methods1.Study subjects and inclusive and exclusive criteriaPatients who were admitted to the Urology Department at the Second Hospital of Shandong University(Jinan,China)for ED from January 2014 to September 2017 were considered for this study.All patients were required to complete the international questionnaire score for erectile function(IIEF-5),and patients with score less than or equal to 21 were considered to have ED.During the same period,60 healthy men(IIEF-5>21C)randomly selected from the health management center of our hospital and matched with the ED group in age,married and sexually active were treated as the control group.To avoid the influence of age and other diseases on platelet activity,we selected young and middle-aged patients aged 20-50 years.Exclusion criteria were as follows:stroke,depression,diabetes mellitus,metabolic syndrome,tumor,alcoholism,inflammatory conditions,past pelvic surgery or trauma,cardiovascular and/or hematologic(such as leukocytosis and thrombocytopenia)diseases,psychogenic reasons,hormonal disorders(hyperprolactinemia,hypogonadism),neurological disorders(multiple sclerosis and seizure),failure to obtain their hemograms,or the use of medications that may affect the blood cell count.2.Study design244 patients and 60 healthy controls underwent a detailed clinical investigation including medical history and physical examination,laboratory investigation,Patients with ED collected NPT data,those with normal NPT results(n=24)were excluded,and those with abnormal NPT results were further examined by penile artery doppler ultrasound(pDUS).Data included initial arterial blood flow,5-min PSV,5-min EDV,10-min PSV and 10-min EDV.ED patients were divided into arteriogenic ED(n=99),venous ED(n=37),mixed ED and non-vascular ED(n=84)according to pDUS.2.Data collectionThe General information of the subjects,including age,International Index of Erectile Function([IIEF]-5),nocturnal penile tumescence(NPT),penile color Doppler ultrasonography(pDUS)were recorded.Venous blood was collected and common clinical laboratory indicators,including FBG,TG,TC,LDL,HDL,estradiol,FSH,LH,PRL,progesterone,testosterone,PC,MPV,PDW were measured and recorded.3.Statistical analysisSPSS statistical software for Windows version 23(SPSS Inc.,Chicago,IL,USA)was used for statistical analysis.Result1.Laboratory evaluations among the 3 groupsAll parameters in these three groups showed no significant di? erence except for high? density lipoprotein(HDL),but HDL in the control group was higher than that of others with the demonstrated by the Sche? e post hoc multiple comparison test.2.The relationship of platelet parameter among control group,arterial erectile dysfunction and venous leakage groupTotal platelet counts were higher in the arteriogenic ED group compared with the venous leakage and control groups.MPV was significantly higher in the arterial erectile dysfunction group than in the venous leakage and control group(P<0.01).Multiple comparisons of the MPV were performed using the Games-Howell test and MPV was significantly higher in the arteriogenic ED group compared with the venous leakage group(P<0.01)and control groups(P<0.01).No statistically significant difference was observed between the venous leakage and control groups(P=1.0).3.The relationship between platelet parameter and pDUS in arterial erectile dysfunction and venous leakage groupPC and MPV had negative effects on 10? min PSV in arteriogenic ED groups(RPC=-0.46,P<0.01;RMPV=-0.34,P<0.01),but there was no significant correlation with EDV(r=-0.12,P =0.22).PC and MPV were not related to the PSV and the EDV in venous leakage group(P>0.05).4.The relationship of the diagnostic efficacy between platelet parameter and arterial erectile dysfunctionROC regression analysis identified MPV>9.65 fl as a cut-off value for potential arteriogenic ED(area under the curve[AUC]:0.707),95%CI:0.628-0.786)with a sensitivity of 47.5%and specificity of 91.7%.There was no statistically significant diagnostic value for PC(AUC = 0.414)ConclusionsMPV values,which demonstrate thrombocyte activity,were found to be significantly higher in ED patients compared with healthy subjects,and MPV in arteriogenic ED patients was larger compared with nonarteriogenic ED patients.According to the obvious negative correlation between MPV and PSV in arterial ED patients and the area under the ROC curve of MPV,we speculate MPV could potentially be monitored as a useful marker to predict and diagnose arteriogenic ED.