| Objective:Objective To observe the clinical characteristics,classification and brain functional network characteristics of patients with premature ejaculation(PE),and analyze the changes of brain functional network in patients with premature ejaculation before and after dapoxetine treatment.Patients with lifelong premature ejaculation(LPE)and acquired premature ejaculation(APE)had a jacking of the brain functional networks.Objective indexes,TCM constitution distribution and brain function network identification of patients with lifelong premature ejaculation and acquired premature ejaculation were discussed.Method:Clinical experiment 1:physical distribution characteristics of patients with different types of premature ejaculationAll the patients in this clinical study were from outpatients who received diagnosis and treatment of premature ejaculation in Jiangsu Hospital of Traditional Chinese Medicine and Yangzhou Hospital of Traditional Chinese Medicine from October 2020 to February 2022.All the patients met the diagnostic criteria of premature ejaculation,including 117 primary premature ejaculation patients and 99 secondary premature ejaculation patients,a total of 216 patients.The Nine Basic Constitutions classification Scale of TRADITIONAL Chinese Medicine is developed by Academician Wang Qi of Beijing University of Traditional Chinese Medicine,using the Self-Test Table for Classification and Judgment of Traditional Chinese Medicine(Adult version)issued by China Association of Traditional Chinese Medicine.The scale is divided into nine constitutions,namely,peace constitution,Yang deficiency constitution and Yin deficiency constitution.The constitution scoring software was developed by the Constitution Branch of the World Federation of Traditional Chinese Medicine,the Constitution Branch of the China Association of Traditional Chinese Medicine,and Beijing Traditional Chinese Medicine Jiuhe Medical Technology Co.,LTD.Patients fill in the paper scale independently,log in relevant programs to answer questions independently,or fill in questions one by one with the assistance of specialists in our department.The paper version adopts grade 5 scoring according to the calculation method of constitution scoring software,namely the Classification and Determination of TCM Constitution,to calculate the original score and conversion score.If the conversion score is ≥60 and the conversion score of the other 8 constitutions is<30,it is judged as peaceful quality;if the conversion score is ≥60 and the conversion score of the other 8 constitutions is<40,it is judged as basically peaceful quality,and the former two are not satisfied as biased constitution.≥40 points or ≥30 points were used as the critical value to determine the condition of constitution.The constitution scoring software automatically generates the relevant constitution,which is recorded by specialist physicians.Clinical trial 2:brain functional network differences between patients with premature ejaculation and normal controlsA total of 24 patients with lifelong premature ejaculation,23 patients with acquired premature ejaculation,and 44 healthy controls(HC)with matched age and education levels were enrolled.This study was approved by the Ethics Committee of Jiangsu Provincial Hospital of Traditional Chinese Medicine(Affiliated Hospital of Nanjing University of Chinese Medicine).The 3.0T superconducting magnetic resonance instrument made by Siemens in Germany was used.First,the imaging doctors who did not know the condition of the subjects completed the mri plain scan of the subjects’ heads,and the brain functional and structural imaging was carried out for those who had no structural abnormalities.Mri scans were performed in a resting state.① Mri scan of anatomical positioning image brain structure:Pulse repetition time(TR)=1900ms,echo time(TE)=2.48ms,field of vision(FOV)=250mm × 250mm,Matrix(Matrix)=256×246,flip Angle(FA)=9°.176 layers were scanned with layer thickness of 1mm.②Functional magnetic resonance scan of brain:TR=3000ms,TE=40ms,FOV=240mm ×240mm,Matrix=64×64,layer thickness 4mm.The MRI data were preprocessed by DPARSF 2.0 software based on MATLAB platform developed by Zang Yufeng et al.,including:①format conversion;②Remove the first 6 time points;③Time correction;④Head movement correction;⑤Space standardization.Then,the brain functional network was constructed:(1)Node definition of brain functional network:All subjects’ brains were divided into 90 symmetrical cortical and subcortical regions by anatomical automatic labeling template(AAL),corresponding to 90 nodes of brain functional network;(2)Definition of edge of brain structural network:90 functional connection values of brain interval were calculated,which were defined as edges between nodes of brain functional network,and brain functional weighted network was constructed based on functional connection values.Calculation of topology attribute values of Brain functional network Refer to the calculation method of network topology attribute of Rubinov et al in 2010,and calculate the local and global attribute values of Brain network by using Brain Connectivity Toolbox(BCT),and analyze the topology connection mode and information processing efficiency attribute of Brain network.Clinical trial 3:Differences in brain functional networks between lifelong premature ejaculation and acquired premature ejaculation patientsA total of 46 participants(30 patients with lifelong premature ejaculation and 16 patients with acquired premature ejaculation)were recruited for this study,which was approved by the Ethics Committee of Jiangsu Provincial Hospital of Traditional Chinese Medicine(Affiliated Hospital of Nanjing University of Chinese Medicine).The image and data processing methods were the same as those of clinical experiment 2.Clinical trial 4:Differences in cerebral functional network of premature ejaculation before and after dapoxetine treatmentA total of 39 PE patients were recruited for this study,which was approved by the Ethics Committee of Jiangsu Provincial Hospital of Traditional Chinese Medicine(Affiliated Hospital of Nanjing University of Chinese Medicine).The image and data processing methods were the same as those of clinical experiment 2.Result:Clinical Trial Ⅰ:There were 216 PE patients in this group,including 117 lifelong premature ejaculation patients and 99 acquired premature ejaculation patients.The age of the whole group was 20-43 years old,29.21±6.81.Lifelong premature ejaculation patients were 20-42 years old,27.08±5.63 years old,172.7±5.7cm tall.Body weight:66.1±7.59Kg,sexual frequency:4.44±3.7 times/month,medical history:48.8±50.6 months,IELT:63.8±54.0s;Acquired premature ejaculation patients were 22-43 years old,31.73±7.46,height 173.2±5.2cm,weight 74.0±12.69Kg,sexual frequency 4.87±3.59 times/month,medical history 36.2±35.8 months,IELT125.0±93.8s.There were 26 patients(12.6%)with mild physique,including 16 patients(14.0%)with Lifelong premature ejaculation and 10 patients(10.1%)with acquired premature ejaculation.There were 28 cases(13.0%)with mild constitution and partial constitution tendency,10 cases(8.5%)with Lifelong premature ejaculation and 2 cases with one constitution tendency,8 cases with two constitutions,5 cases with Yang deficiency,6 cases with dampness and heat,4 cases with qi stagnation,and 3 cases with other constitutions(Yin deficiency,phlegm dampness and special report).There were 18 cases(18.2%)of acquired premature ejaculation combined with one physical tendency,2 cases combined with two constitutions,16 cases combined with dampness and heat,6 cases of phlegm dampness,5 cases of qi stagnation,4 cases of Yang deficiency,and 11 cases of other constitutions.There were 162 cases of biased constitution(75.0%),91 cases of lifelong premature ejaculation,71 cases of acquired premature ejaculation,6 cases of single biased constitution(3.7%),2 cases of dampness and heat(1 case of lifelong premature ejaculation and 1 case of acquired premature ejaculation respectively),1 case of Yang deficiency,special intrinsic condition,qi stagnation and blood stasis respectively.There were 20 cases of Yang deficiency(22.0%),17 cases of damp-heat(18.7%),13 cases of qi deficiency(14.3%)and 12 cases of Yin deficiency(13.2%)in the primary preempt constitution.There were 21 cases of dampness and heat(29.6%),14 cases of Yang deficiency(19.7%),12 cases of qi stagnation(16.9%)and 9 cases of phlegm-dampness(12.7%)in the main partial constitution of acquired premature ej aculation.Clinical Trial Ⅱ:Compared with HC group,PE group enhanced the connection strength of right globus pallidus(F=0.01,P=0.041),left thalamus(F=4.41,P=0.024)and right thalamus(F=7.81,P=0.023).The medial centricity of left anterior central gyrus(F=13.86,P=0.027),right central sulcus lid(F=4.1,P--0.007),right medial and paracingcingulate gyrus(F=7.56,P=0.046)and left precuneus(F=10.78,P=0.005)increased in PE group.However,the medial centrality of left posterior cingulate gyrus(F=3.62,P=0.046),right putamen(F=14.98,P=0.046),left transverse temporal gyrus(F=10.4,P=0.042)and left middle temporal gyrus(F=7.59,P=0.046)decreased.The clustering coefficient of left thalamus nodes in PE group(F=3.91,P=0.03)was increased.The local efficiency of left thalamus(F=3.95,P=0.032)and right thalamus(F=8.76,P=0.033)nodes was increased in PE group.The global efficiency of left thalamus(F=3.34,P=0.05)and right thalamus(F=4.84,P=0.043)nodes increased in PE group,but there was no significant difference in node path length of each brain region in PE group.Clinical Trial Ⅲ:Compared with the lifelong premature ejaculation(LPE)group,the connection strength of the left cuneus(F=5.54,P=0.023)was increased in the acquired premature ejaculation(APE)group.APE group left orbital superior frontal gyrus(F=8.41,P=0.019),right olfactory cortex(F=4.13,P=0.046),left anterior cingulate gyrus(F=10.03,P=0.009),right rectangular fissure(F=18.95,P=0.008),right parietal gyrus(F=24.04,F=24.04)P=0.005)and right inferior temporal gyrus(F=11.49,P=0.004),but right anterior central gyrus(F=33.79,P=0.026)increased in APE group.The clustering coefficients of left cuneus(F=3.2,P=0.046),right cuneus(F=3.83,P=0.045)and right inferior temporal gyrus(F=1.08,P=0.021)were increased in APE group.APE group left anterior central gyrus(F=1.23,P=0.039),left medial orbital superior frontal gyrus(F=4.42,P=0.048),right anterior cingulate gyrus(F=2.69,P=0.044),left suproccipital gyrus(F=1.44,P=0.034),right inferior temporal gyrus(F=0.27,F=0.027)P=0.045)Node path length shortened:The local efficiency of left cuneus(F=3.85,P=0.046),right cuneus(F=3.41,P=0.049)and right inferior temporal gyrus(F=0.79,P=0.021)was improved in APE group.APE group left anterior central gyrus(F=0.51,P=0.037),right anterior cingulate gyrus(F=1.27,P=0.042),left cuneus(F=1.93,P=0.045),right cuneus(F=0.31,P=0.041),right inferior temporal gyrus(F=0.02,P=0.044)global efficiency was also significantly improved.Clinical Trial IV:Compared to before treatment,After treatment,PE patients had left inferior frontal gyrus of insular cover(t=2.05,P=0.047),left inferior frontal gyrus of triangle(t=2.23,P=0.032),right inferior frontal gyrus of triangle(t=2.56,P=0.014),left medial orbital superior frontal gyrus(t=2.18,P=0.036),right straight gyrus(t=2.13,P=0.04),right insula(t=2.35,P=0.024)and right inferior temporal gyrus(t=3.16,P=0.003)decreased significantly,but left middle occipital gyrus(t=-2.36,P=0.023)strengthened.The media-centrality of the right lorando shell lid(t=2.33,P=0.025),the right suproccipital gyrus(t=2.15,P=0.038)and the left transverse temporal gyrus(t=3.29,P=0.002)was weakened,but the right olfactory cortex(t=2.10,P=0.043),the right rectangular fissure(t=-2.31,P=-2.31),P=0.026)intermediate centrality increased;The clustering coefficients of right triangular inferior frontal gyrus(t=2.21,P=0.033)and right inferior temporal gyrus(t=2.85,P=0.007)decreased.On the left side of the triangle of inferior frontal gyrus(t=2.33,P=0.025),the right side of the triangle of inferior frontal gyrus(t=2.47,P=0.018),the ministry of the left medial orbitofrontal last time(t=2.14,P=0.039),straight back on the right side(t=2.10,P=0.039),the left side of the insula(t=2.21,P=0.033),right insula(t=-2.72,P=0.010),right cuneus(t=-2.32,P=0.026)and right inferior temporal gyrus(t=-2.90,P=0.006)were longer than before treatment.Left triangular inferior frontal gyrus(t=2.11,P=0.042),right triangular inferior frontal gyrus(t=2.33,P=0.025),left medial orbital superior frontal gyrus(t=2.09,P=0.043),right straight gyrus(t=2.08,P=0.045),right insula(t=2.17,P=0.036)and the right inferior temporal gyrus(t=2.97,P=0.005).Left dorsolateral superior frontal gyrus(t=2.37,P=0.023)left triangular inferior frontal gyrus(t=2.05,P=0.048),right triangular inferior frontal gyrus(t=2.40,P=0.021),left olfactory cortex(t=2.85,P=0.007),left medial orbital superior frontal gyrus(t=2.08,P=0.044),right insula(t=2.25,P=0.030),right middle cingulate gyrus(t=2.10,P=0.043),left inferior parietal gyrus(t=2.34,P=0.024)and right inferior temporal gyrus were also reduced.Furthermore,the topological properties of different brain regions in patients with primary and secondary premature ejaculation were analyzed before and after treatment,and the topological properties of multiple brain regions were significantly different before and after treatment.Conclusion:Premature ejaculation patients than normal healthy people in the field of brain function network has obvious difference,mooring paxil and reach the brain function network has obvious difference before and after the treatment,patients with lifelong premature ejaculation,acquired premature ejaculation is the main classification of premature ejaculation,it has different physical distribution,neuroimaging characteristics,The differences in topological properties of brain regions in patients with different types of premature ejaculation suggest that dapoxetine may not only increase the concentration of 5-HT in the synaptic cleft by inhibiting the reuptake of 5-HT by 5-HT transporters in patients with premature ejaculation,especially in patients with primary premature ejaculation,but also play a therapeutic role in delaying ejaculation. |
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