RU2767881C2 - Method for detection of patients with erectile dysfunction of organic origin at the stage of screening examination - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology, and can be used to identify patients with erectile dysfunction of organic origin at the screening stage. At the initial appointment, the patient's age, duration of erectile dysfunction (ED), body weight, as well as the presence or absence of abdominal obesity, cardiovascular diseases, and a history of type I/II diabetes mellitus are determined. Express age in years, duration of ED in months, body weight in kilograms. The processing of the obtained data is carried out using the statistical software package SPSS Statistics 21, by building a diagnostic model:

where: A is the patient's age, years; B - duration of ED, month; C is the patient's body weight, kg; D - qualitative variable: 0 - the presence of abdominal obesity; 1 - no obesity; E - qualitative variable: 0 - presence of cardiovascular diseases; 1 - no disease; F - qualitative variable: 0 - presence of type I/II diabetes mellitus, 1 - absence of diabetes. If the value of the logistic function f(z)>0.331, then the patient has a high probability of detecting ED of organic origin and is recommended to undergo a comprehensive laboratory and instrumental urological examination to confirm the final diagnosis.

EFFECT: method provides the possibility of identifying patients with ED of organic origin at the stage of screening examination, which will improve the efficiency of diagnosis and treatment of ED in conditions of limited opportunities for obtaining specialized medical care, through the use of the above clinical and anamnestic parameters for use in the developed diagnostic model.

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Description

The invention relates to medicine, namely to urology, and can be used at the screening stage to identify patients with vasculogenic and endocrine (hypogonadism) organic factors in the development of erectile dysfunction (ED).

By definition, erectile dysfunction is characterized by an inability to achieve or maintain an erection sufficient for sexual intercourse lasting more than three months.

Among the causal factors in the development of ED, there are: organic, which cause the development of the organic form of ED, and psychogenic, causing psychogenic erectile dysfunction, not associated with organic factors.

Research data indicate a high prevalence of ED worldwide. In the Russian Federation, erectile dysfunction was absent in 10.1% of the men surveyed (IIEF-5), while mild ED was noted in 71.3%, moderate ED in 6.6%, and severe ED in 12% of respondents (Pushkar D.Yu., Kamalov A.A., Al-Shukri S.Kh., Erkovich A.A., Kogan M.I., Pavlov V.N., Zhuravlev V.N., Bernikov A.N. Epidemiological study of the prevalence of erectile dysfunction in the Russian Federation. Breast cancer No. 3 of 02/07/2012, p. 112).

It is known that cardiovascular diseases (CVD) have the same risk factors with the development of ED, among which significant are smoking, dyslipidemia, high blood pressure, carbohydrate metabolism disorders (diabetes mellitus), metabolic syndrome, overweight. A significant correlation was noted between the development of ED of organic origin and cardiovascular diseases (Tyuzikov I.A. Interdisciplinary interaction in the early diagnosis of urological diseases in men: clinical luxury or an urgent need for preventive and pathogenetic medicine of the XXI century? / I.A. Tyuzikov // Medical Alphabet Theme of issue: Hospital - everything for health care facilities - 2013. - V. 2, No. 13. - P. 42–47 Modern view on the problem of erectile dysfunction in patients after surgical correction of cardiovascular diseases / O.I. Apolikhin, T.S. Lukash, E.A. Efremov, S.S. Krasnyak // Experimental and Clinical Urology - 2015. - No. 1. - P. 72–76).

It is worth noting that many of the above risk factors are modifiable, the elimination of which can reduce the severity of ED and improve treatment outcomes, as well as prevent the development of diabetes, myocardial infarction, stroke and other cardiovascular diseases.

At the moment, there are no diagnostic models developed in urology that allow separating patients with ED of organic origin from patients whose ED is not associated with organic factors at the screening stage.

In the studied scientific medical and available patent literature, we did not find any sources suggesting to identify patients with ED of organic origin by using a diagnostic model.

The technical result is aimed at developing a method for identifying patients with ED of organic origin at the screening examination stage, which will improve the efficiency of diagnosing and treating ED in conditions of limited opportunities for obtaining specialized medical care.

The technical result is solved by determining the patient's age, the duration of erectile dysfunction (ED), body weight, as well as the presence or absence of abdominal obesity, cardiovascular diseases, type I/II diabetes mellitus in history at the initial appointment, expressing age in years , duration of ED in months, body weight in kilograms, further processing of the obtained data is carried out using the statistical software package SPSS Statistics 21, by building a diagnostic model:

where:

f(z) is the logistic function;

e is the base of the natural logarithm, equal to 2.718;

-z - variable, which is calculated by the formula:

where:

A - patient's age, years;

B - duration of ED, month;

C is the patient's body weight, kg;

D - qualitative variable: 0 - the presence of abdominal obesity; 1 - no obesity;

E - qualitative variable: 0 - presence of cardiovascular diseases; 1 - no disease;

F - qualitative variable: 0 - presence of type I/II diabetes mellitus, 1 - absence of diabetes,

and if the value of the logistic function f(z) >0.331, then the patient has a high probability of detecting ED of organic origin and is recommended to undergo a comprehensive laboratory and instrumental urological examination to confirm the final diagnosis.

The method is carried out as follows.

At the initial appointment, the patient's age, duration of ED, body weight, as well as the presence or absence of abdominal obesity, cardiovascular diseases, type I/II diabetes mellitus in history are determined, expressing age in years, duration of ED in months, body weight in kilograms. . Then the developed diagnostic model is used:

where:

f(z) is the logistic function;

e is the base of the natural logarithm, equal to 2.718;

-z - variable, which is calculated by the formula:

where:

A - patient's age, years;

B - duration of ED, month;

C is the patient's body weight, kg;

D - qualitative variable: 0 - the presence of abdominal obesity; 1 - no obesity;

E - qualitative variable: 0 - presence of cardiovascular diseases; 1 - no disease;

F - qualitative variable: 0 - presence of type I/II diabetes mellitus, 1 - absence of diabetes.

If the value of the logistic function f(z) >0.331, then the patient has a high probability (89.5%) of detecting ED of organic origin and is recommended to undergo a comprehensive laboratory and instrumental urological examination to confirm the final diagnosis.

The proposed method for identifying patients with ED of organic origin confirms the analysis of the results of 465 patients, of which 319 with confirmed ED of organic origin and 146 with ED not associated with organic factors.

The selection criteria for the group of patients in whom ED was not associated with organic factors were history data (sudden onset of ED, the presence of spontaneous erections, problems in relationships with a partner), the absence of somatic diseases (carbohydrate metabolism disorders, cardiovascular diseases, obesity) , as well as the absence of deviations from the reference values according to the results of a comprehensive laboratory and instrumental examination.

The selection criteria for patients with ED of organic origin were the causal factors identified during a comprehensive laboratory and instrumental examination associated with the development of organic ED (dyslipidemia, hyperglycemia, hyperhomocysteinemia, hormonal profile disorders, penile hemodynamic disorders and the state of the veno-occlusive mechanism), as well as the presence of a history of somatic diseases that cause the development of organic ED.

According to the results of applying the developed diagnostic model in the study group of patients with organic ED, in 93% (297) cases, the presence of organic ED was confirmed. In the group of patients in whom ED was not associated with organic factors, after applying this diagnostic model, 24% (35) of cases were identified when there is a possibility of ED of organic origin.

Thus, the sensitivity and specificity of the developed diagnostic model were 93.1% (95% CI=89.7%-95.5%) and 76.0% (95% CI=68.5%-82.3%), respectively. . The predictive accuracy of a positive result is 89.5% (95% CI=85.7%-92.4%), negative - 83.5% (95% CI=76.2%-88.9%).

The developed diagnostic model is characterized as having "excellent discrimination ability" - AUROC=0.957 (CI 0.94; 0.973).

Clinical example 1

Patient K., 45 years old, came to the clinic with complaints of a decrease in the quality of erectile function. These complaints are noted within 14 months. According to the results of the survey, the score on the IIEF-5 scale was 12 points, which corresponds to a moderate degree of ED. Of the bad habits of smoking (more than 20 years of experience, use up to 20 cigarettes per day). Does not drink alcoholic beverages. The presence of a previously diagnosed hypertension, for which the patient is observed by a therapist, was noted. Carbohydrate metabolism disorders (type I/II diabetes mellitus) were not previously identified. According to the results of physical examination: the waist circumference is 106 cm, which corresponds to the abdominal form of obesity, while the body weight is 86 kg.

The obtained clinical and anamnestic parameters were used to apply the developed diagnostic model, where the result was 1,000. According to the decision rule condition ( f(z) >0.331), the patient has a high (89.5%) probability of having ED of organic origin. Given this, the patient underwent a comprehensive laboratory and instrumental examination, the results of which were: total cholesterol 6.9 mmol/l, LDL-C 5.1 mmol/l, HDL-C 0.9 mmol/l, triglycerides 2 mmol/l , glucose 5.5 mmol/l, glycated hemoglobin 4.9%, homocysteine 18.1 µmol/l, total testosterone 18 nmol/l. According to the ultrasound pharmacodopplerographic study of the vessels of the penis with intracavernous administration of prostaglandin E1, a decrease in the parameter of the peak systolic blood flow velocity (less than 30 cm/sec) in both cavernous arteries was noted, with the parameter value of the final diastolic blood flow velocity less than 5 cm/sec. In the projection of the right and left cavernous arteries, the resistance index was within the reference values. According to the results of a non-invasive study of the systemic function of the endothelium, a low reactive hyperemia index (IRH) of less than 1.67 was obtained, which indicates the presence of endothelial dysfunction.

Diagnosis: erectile dysfunction of organic origin.

The patient was given appropriate treatment recommendations.

Clinical example 2

Patient N., aged 25, came to the clinic with complaints of a decrease in the quality of erection for 7 months. Not married, but has a permanent sexual partner. In the initial survey, the score on the IIEF-5 scale was 17 points, which corresponds to a mild degree of ED. From bad habits smoking (experience 5 years, use up to 10 cigarettes per day). Does not drink alcoholic beverages. In the anamnesis, the patient has no data for the presence of previously diagnosed cardiovascular diseases, as well as disorders of carbohydrate metabolism. According to the results of the physical examination, the waist circumference is 92 cm, and the body weight is 90 kg. The obtained clinical and anamnestic data were used to apply the developed diagnostic model, where the result was 0.08089. According to the decision rule condition ( f(z) ≤0.331), the patient has a low (16.5%) probability of having ED of organic origin.

Diagnosis: erectile dysfunction, not associated with organic factors.

The patient was given recommendations for lifestyle correction and elimination of risk factors (to give up smoking, regular adequate physical activity, normalization of work and rest) with subsequent follow-up.

The proposed method allows for high sensitivity and high specificity in the detection of patients with ED of organic origin at the screening stage, determining further treatment and diagnostic tactics, thereby reducing the percentage of direct financial costs for the patient.

Claims (9)

A method for identifying patients with erectile dysfunction of organic origin at the screening examination stage, characterized in that at the initial appointment, the patient's age, duration of erectile dysfunction (ED), body weight, as well as the presence or absence of abdominal obesity, cardiovascular diseases, diabetes mellitus are determined I/II type in history, expressing age in years, duration of ED in months, body weight in kilograms, further processing of the obtained data is carried out using the statistical software package SPSS Statistics 21, by building a diagnostic model:

where: A - patient's age, years; B - duration of ED, month; C is the patient's body weight, kg; D - qualitative variable: 0 - the presence of abdominal obesity; 1 - no obesity; E - qualitative variable: 0 - presence of cardiovascular diseases; 1 - no disease; F - qualitative variable: 0 - presence of type I/II diabetes mellitus, 1 - absence of diabetes, and if the value of the logistic function f(z) >0.331, then the patient has a high probability of detecting ED of organic origin and is recommended to undergo a comprehensive laboratory and instrumental urological examination to confirm the final diagnosis.