| 摘要: | 在過去的數十年裡，勃起功能障礙 (ED) 的患病率迅速增加，這是一種不尋常的狀況，人們無法獲得或維持陰莖勃起。生活方式改變、壓力、心理因素、肥胖年齡、糖尿病、心血管、荷爾蒙變化和代謝紊亂在增加，勃起功能障礙(ED) 發生頻率方面影響重要的作用。勃起功能障礙(ED )導致的個人、社會和經濟負擔不斷地增加，進而嚴重影響人際關係、信心和效率。因此，勃起功能障礙(ED)的正確處理和治療非常重要。目前可用的治療方法，如磷酸二酯酶抑製劑 5 (PDE-5i) 和陰莖植入物等已經治療了部分勃起功能障礙( ED)；然而，治療結果並不持久，反而與部分不良事件相關。此外，生活方式的改變在勃起功能障礙(ED)治療中僅提供溫和的功效。為了克服當前療法的這些限制，再生方法可能是一種有效的替代方法。最近，低能量體外衝擊波療法（Li-ESWT）已被用於治療 勃起功能障礙(ED)。低能量體外衝擊波療法Li-ESWT 將線性衝擊波應用於標的組織，導致細胞微創傷。因此，Li-ESWT 會產生微創傷，導致再生細胞的聚集、內皮毛細血管連接的增加、神經和軸突細胞的再生、膠原基質的改變以及炎症和氧化壓力的減少，因而導致 勃起功能障礙(ED)恢復。然而，透過應用富含血小板的血漿 (PRP)，一種血液衍生產品，可能會增強新生血管的形成和癒合。 PRP 的治療效果可歸因於含有血小板的生物活性生長因子，它促進血管生成、幹細胞增殖和組織生長。考慮到這一功效，PRP 和 Li-ESWT 的組合可能是治療 勃起功能障礙(ED)的有效方法。為了評估 PRP+Li-ESWT 的協同效應，我們將 7 ml 人血分離到 PLTenus PLUS 血小板濃縮分離器 (TCMBio) 中，離心後提供純 PRP。 Li-ESWT 的體外應用在第 1 天、第 8 天、第 15天、第 29 天、第 36 天和第 43 天同時進行。 IIEF-5 和 EHS 評分用於評估臨床結果。治療前組的IIEF-5評分為8.36±1.44。協同 PRP + Li-ESWT 治療 22±2 天后，評分顯著增加至 14.45±2.12 (p<0.028)。在治療 50±2 天和 78±2 天后，該分數分別進一步增加到 15.45±1.93 (p<0.008) 和 16.18±1.48 (p<0.001)。此外，平均治療前 EHS 記錄為 1.64 ±0.20 (p<0.002)，在 PRP + Li-ESWT 後第 22±2 天增加到 2.81±0.26 (p<0.002)。在第 50±2 天和第 78±2 天也注意到了增加，值為 3.09±0.25（p<0.0002）和 3.18±0.12（p<0.0000）。結論，我們的研究表明 PRP 和 Li-ESWT 的協同治療在改善性功能和勃起方面具有顯著效果。然而，需要大量的臨床研究來證實這些發現以達成共識。
The last few decades have witnessed a rapid increase in the prevalence of erectile dysfunction (ED), which is an unusual sexual condition in which the person fails to attain or sustain erectile penis. Lifestyle changes, stress, psychological factors, obesity age, diabetes mellitus, cardiovascular, hormonal changes, and metabolic disorders play a crucial role in increasing the frequency of ED. The personal, social, and economic burden due to ED is increasing and severely impacting personal relationships, confidence, and efficiency. Thus, the proper management and treatment of ED are highly important. Currently, available therapies such as phosphodiesterase inhibitors 5 (PDE-5i), and penile implants have provided relief from ED; however, therapeutic outcomes are not long-lasting and are associated with adverse events. Moreover, lifestyle modifications offer only mild efficacy in ED treatment. To overcome these limitations of current therapies, the regenerative approach could be an effective alternative. Recently, low-intensity extracorporeal shock wave therapy (Li-ESWT) has been implicated in the treatment of ED. Li-ESWT applies linear shockwaves to target tissues, leading to cellular microtrauma. Consequently, Li-ESWT develops microtrauma which causes recruitment of regenerative cells, increase in endothelial capillary connections, regeneration of nerve and axonal cells, collagen matrix alteration, and a decrease in inflammation and oxidative stress resulting in recovery from ED. However, the neovascularization and healing might be enhanced by applying platelet-rich plasma (PRP), a blood-derived product. The therapeutic impact of PRP could be attributed to platelet-contained bioactive growth factor which promotes angiogenesis, the proliferation of stem cells, and tissue growth. Considering this fact, the combination of PRP and Li-ESWT could be an effective therapeutic approach for ED. To assess the synergistic effect of PRP+Li-ESWT, we isolated the 7 ml human blood into PLTenus PLUS Platelet Concentrate Separator (TCMBio), which after centrifugation provided the pure PRP. The extracorporeal application of Li-ESWT was carried out simultaneously on days 1, 20, 50, and 78 days. IIEF-5 and EHS scores are used to assess the clinical outcomes. IIEF-5 score in the pre-treatment group was 8.36±1.44. After 22±2 days of synergistic PRP + Li-ESWT treatment, the score significantly accrued to 14.45±2.12 (p<0.028). This score was further increased to 15.45±1.93 (p<0.008) and 16.18±1.48 (p<0.001) after 50±2 days and 78±2 days of treatment, respectively. Further, the mean pre-treatment EHS was recorded as 1.64 ±0.20 (p<0.002), which was increased to 2.81±0.26 (p<0.002) on day 22±2 days after PRP + Li-ESWT. The increase was also noted on days 50±2 and 78±2 with values of 3.09±0.25 (p<0.0002) and 3.18±0.12 (p<0.0000). Conclusively, our study indicates the significant effectiveness of synergistic therapy of PRP and Li-ESWT in the terms of improved sexual function and erection. However, extensive clinical studies are required to confirm these findings to reach a consensus. |
