以光體積變化描記儀作為男性勃起功能及陰莖血液動力學及性功能客觀指標之探討;Probing penile hemodynamics by using photoplethysmography as objective indicators for male erection quality and sexual function

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Title:	以光體積變化描記儀作為男性勃起功能及陰莖血液動力學及性功能客觀指標之探討;Probing penile hemodynamics by using photoplethysmography as objective indicators for male erection quality and sexual function
Authors:	彭元宏;Pong, Yuan-Hung
Contributors:	生醫科學與工程學系
Keywords:	光體積變化描記;近紅外光譜測定;勃起功能障礙;陰莖血流超音波;男性性功能;photoplethysmography;near infrared;erectile dysfunction;penile doppler;male sexual function
Date:	2021-09-22
Issue Date:	2021-12-07 11:32:12 (UTC+8)
Publisher:	國立中央大學
Abstract:	男性勃起功能障礙(erectile dysfunction)在全世界影響很多人，造成勃起功能障礙最主要的原因之一就是陰莖血液的灌流不足，在過去二十年間，近紅外光譜測定儀(near-infrared spectroscopy, NIRS)可被用於測量不同血紅素的濃度及動態變化，然而，光體積變化描記儀(photoplethysmography, PPG)可記錄不同血紅素的動態變化但至今仍未應用於監測陰莖勃起狀態及血流動力學，我們的研究主要研究評估光體積變化描記儀紀錄(PPG)的訊號與陰莖勃起時的硬度，男性性功能及血液動力學之間的相關性，本實驗針對六個月以上診斷為血管性性功能障礙需要做陰莖血流超音波的病患，並排除過去陰莖創傷史、接受賀爾蒙療法者、曾經裝置人工陰莖者、靜脈漏型勃起功能障礙及神經性勃起功能障礙，針對血管性性功能障礙這類患者同時接受陰莖血流超音波及光體積變化描記儀(PPG)紀錄，過程中光體積變化描記儀(PPG)紀錄的訊號皆被整合成一個代表波形進行訊號分析及波型分析，波型分析包括勃起間末期震幅差(amplitude difference index, APD index)、波形反射時間指標(reflection time index, RTI)、擴張指標(augmentation index)及灌流指標(perfusion index)，我們發現勃起末期的振幅與勃起硬度(erection hardness score, EHS)及阻力係數(resistive index, RI)呈反向關係(p < 0.05)，勃起間末期震幅差(APD index)與勃起硬度(EHS),國際勃起功能量表指數(international index of erectile function-5 ,IIEF)及阻力係數(resistive index, RI)呈正向關係(p < 0.05)，波形反射時間指標(RTI)及擴張指標(AI)與國際勃起功能量表指數(IIEF)及阻力係數(RI)呈反向關係(p < 0.05)，就我們所知，這是第一個分析光體積變化描記儀(PPG)紀錄與陰莖勃起狀態及血流動力學關係之研究，以上發現可支持光體積變化描記儀(PPG)可以做為一個非侵入性、安全、可持續監測陰莖勃起狀態及血循動力學的好工具。 ;Erectile dysfunction (ED) influences a large population worldwide. The failure of sustaining penile rigidity is mostly due to the lack of blood flow into the penis. In the past 20 years, near-infrared spectroscopy (NIRS) was used in measuring the concentrations and temporal dynamics of different hemoglobin types. However, the dynamics of the light absorption (photoplethysmography; PPG) have not been applied to survey penile hemodynamics and erection quality. Our study is to evaluate the correlations between PPG and penile hemodynamics and erection quality. We compared the use of photoplethysmography (PPG) to study vascular ED with standard penile Doppler ultrasonography. Men diagnosed with vascular ED for at least 6 months and nominated for penile ultrasonography were included. Otherwise, patients were excluded with previous penile trauma, history of hormone replacement therapy, post-penile prosthesis, venous leak-type ED, and neurological ED. The PPG signals were collected during the ultrasound examination. All beat-to-beat PPG waveforms were aligned with the peak and averaged to one representative template waveform for feature analysis, including amplitude differences (APD) index, reflection time index (RTI), augmentation index (AI), and perfusion index (PI). An inverse correlation was found between end-erection amplitude and both erection hardness score (EHS) and resistive index (RI) (p < 0.05). APD index and EHS as well as the international index of erectile function-5 (IIEF) and RI were positively correlated (p < 0.05). RTI and AI were inversely correlated to IIEF and RI (p < 0.05). PI was positively correlated to RI (p < 0.05). To the best of our knowledge, we are the first analyzed the dynamics of arterial PPG monitored via NIRS and derived several waveform characteristics and present several findings. These findings support that the PPG may be useful as a non-invasive, novel technique to evaluate erection quality and men’s health given advantages such as low-cost, transportability, continuous data acquisition, and safety.
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