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西地那非的药物性能研究
勃起功能障碍（Ｅｒｅｃｔｉｌｅｄｙｓｆｕｎｃｔｉｏｎ，ＥＤ）是指不能达到或保持足够的勃起程度而获得满意的性交。动脉、平滑肌和纤维组织的损伤是ＥＤ发生的主要原因。肾脏疾病、动脉硬化和其他血管性疾病等慢性疾病经常导致ＥＤ的发生。著名的ＭＭＡＳ（ＭａｓｓａｃｈｕｓｅｔｔｓＭａｌｅ
ＡｇｉｎｇＳｔｕｄｙ）研究认为，ＥＤ与高血压、心脏病和糖尿病等血管性疾病高度相关。ＥＤ已成为影响男性健康的世界性问题，据估计，１９９５年ＥＤ患者已达１．５２亿，到２０２５年，ＥＤ患者可能增至３．２２亿，而且在非洲、亚洲、南美等发展中国家有可能大幅度增长。
因此，ＥＤ成为世界医学界关注的焦点，各种治疗ＥＤ的口服药物应运而生。西地那非是其中研究较多的一种，它是由美国辉瑞公司研制生产的一种磷酸二脂酶５（ｐｈｏｓｐｈｏｄｉｅｓｔｅｒａｓｅ５，ＰＤＥ５）抑制剂，２０００年７月以商品名万艾可在中国大陆上市。本文就其起效时间和作用维持时间作一综述，以求在临床上更好地应用西地那非。
一、西地那非的作用机制
研究发现，在性刺激时，副交感神经、非肾上腺素能非胆碱能神经（ＮＡＮＣ）末梢和血管内皮细胞，在一氧化氮合酶（ｎｉｔｒｉｃ
ｏｘｉｄｅｓｙｎｔｈａｓｅ，ＮＯＳ）的作用下释放一氧化氮（ＮＯ），在血管中，通常由ＮＯ激活可溶性的鸟苷酸环化酶（ｓｏｌｕｂｌｅｇｕａｎｌｙｌｙｌｃｙｃｌａｓｅ，ｓＧＣ），ｓＧＣ作用于三磷酸鸟苷而产生环磷酸鸟苷ｃＧＭＰ 。阴茎海绵体内的ｃＧＭＰ通过降低阴茎海绵体血管平滑肌细胞内的Ｃａ2+浓度而产生强大的舒张血管作用，使阴茎海绵体血管平滑肌松弛，阴茎海绵体内血流量增加而诱发勃起。在体内ｃＧＭＰ由ＰＤＥ５降解失活。
Tobacco Education: Emphasizing Impotence as a Consequence of Smoking
Tobacco use is well-known to be a outstanding health concern. Nevertheless, millions of men and women around the world keep up to use tobacco products. Most antitobacco education and advertising efforts have focused on the historic warnings of lung cancer, heart disease, and pregnancy complications. However, in the last two decades, the element between smoking and impotence has been described by various authors.[1-12] Undeterred by this, impotence is not well recognized by the general public or even by general realistically medical providers as a potential consequence of smoking. Pharmacists and other healthfulness professions are missing an opportunity to teach smokers about another godly reason to kick the habit.
Literature regarding smoking and inadequacy describes various mechanisms for the link. McVary et al.[1] published a inclusive review in 2001 that examined clinical and scientific studies. The investigators found sign that impotence can be caused directly by smoking-induced reductions in nitric oxide concentrations, which injure endothelium-dependent relaxation of arteries, and indirectly by smoking-induced atherosclerosis.
The distinct possibility of impotence or erectile dysfunction (ED) in men who smoke has also been described by individual authors. The review by McVary et al.[1] indicated that smoking may proliferating the risk of moderate or complete impotence by two times that of nonsmokers and that smoking cessation may taper off impotence risk. Austoni et al.[9] found that after adjustment for confounding variables, Italian men who smoked more than 10 cigarettes per day and former smokers had significantly higher risks (odds correlation [OR] 1.4 and 1.3, respectively; both p < 0.0001) for ED. Shiri et al.[11] demonstrated almost identical but nonsignificant findings in Finnish men: OR 1.4 for smokers (95% CI, 0.9–2.3) and 1.3...
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