中医药治疗男性性功能障碍焦虑和抑郁的疗效
中医药治疗男性性功能障碍焦虑和抑郁的疗效：系统综述与荟萃分析
Efficacy of Chinese herbal medicine in the treatment of anxiety and depression in male sexual dysfunction: a systematic review and meta-analysis
——《性医学》第13卷第3期，2025年7月——
【摘要】背景：男性性功能障碍 (MSD)，包括勃起功能障碍 (ED) 和早泄 (PE)，其发病率与年龄相关，影响50%的40岁以上男性。除生理表现外，伴有焦虑和抑郁的MSD还会对社会心理产生深远的影响。越来越多的证据表明，中草药 (CHM) 可能具有治疗此类临床交叉疾病的潜力。目的：通过全面的系统综述和荟萃分析，系统地评估中草药对缓解 MSD 患者焦虑和抑郁的疗效。方法：本研究系统地检索了四个中文数据库（中国知网、万方数据库、中国生物医学数据库和维普数据库）以及四个国际数据库（PubMed、Web of Science、EMBASE 和 Cochrane Library）。纳入了探讨中草药干预MSD伴有焦虑和抑郁的随机对照试验 (RCT)。临床结果：主要结果集中于焦虑和抑郁症状的变化，次要结果涵盖男性性功能的整体改善。结果：通过整合来自12项RCT、涉及1050名参与者的数据，我们的研究结果首次提供了强有力的证据，表明中药（CHM）可显著缓解MSD患者的焦虑和抑郁，同时改善MSD的核心症状，例如早泄（PE）和勃起功能障碍（ED）。值得注意的是，CHM制剂在改善两种心理量表方面均表现出优于 SSRI 的疗效，包括焦虑自评量表 [MD=-9.11, 95% CI (-11.53, -6.70), P<.05]、抑郁自评量表 [MD=-9.85, 95% CI (-14.07, -5.63), P<.05]、汉密尔顿抑郁量表 (HAMD) [MD=-5.30, 95% CI (-11.61, 1.01), P>.05] 和汉密尔顿焦虑量表 [MD=-3.89, 95% CI (-4.52,-3.27), P<.05]，以及MSD特定指标，例如国际勃起功能指数-5 [MD=3.26, 95% CI (1.98, 4.53), P<?.05] 和阴道内射精潜伏期 [MD?=?1.60, 95% CI (0.82, 2.37), P<?.05]。值得注意的是，在我们分析中，HAMD评分缺乏统计学意义，这可能是由于PE和ED人群的治疗反应存在差异。临床意义：本研究为解决传统治疗中分离身心症状的局限性提供了循证支持，进一步证实了其在整合医学模式下的应用价值，并为设计个性化患者治疗方案探索了新的研究途径。优势与局限性：本研究首次进行了系统评价，以评估传统中药在缓解MSD患者焦虑和抑郁症状的同时改善性功能指标的综合疗效。有限的研究数量是其最大的局限性。结论：我们的研究结果首次提供了强有力的证据，表明中草药能够显著缓解MSD患者的焦虑和抑郁情绪，同时改善MSD的核心症状，例如早泄和勃起功能障碍。
【关键词】男性性功能障碍，中草药，焦虑，抑郁，系统评价，性心理健康
[Abstract] Background: Male Sexual Dysfunction (MSD), comprising erectile dysfunction (ED) and premature ejaculation (PE), exhibits an age-related prevalence affecting 50% of males beyond their fourth decade. Beyond physiological manifestations, MSD with comorbid anxiety and depression exerts profound psychosocial impacts. Emerging evidence suggests Chinese Herbal Medicine (CHM) may offer therapeutic potential for addressing this clinical intersection. Aim: To systematically assess the efficacy of CHM on alleviating anxiety and depression in patients with MSD via a comprehensive systematic review and meta-analysis. Methods: This study systematically searched four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, China Biomedical Database, and VIP Database) and four international databases (PubMed, Web of Science, EMBASE, and Cochrane Library). Randomized controlled trials (RCTs) investigating CHM interventions for MSD with comorbid anxiety and depression were identified. Outcomes: The primary outcome focused on changes in symptoms of anxiety and depression, while secondary outcomes encompassed overall male sexual function improvement. Results: By synthesizing data from 12 RCTs involving 1050 participants, our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD, while concurrently improving core symptoms of MSD, such as PE and ED. Notably, CHM formulations demonstrated superior efficacy over SSRIs in improving both psychological scales, including Self-Rating Anxiety Scale [MD?=?-9.11, 95% CI (-11.53, -6.70), P <?.05], Self-Rating Depression Scale [MD?=?-9.85, 95% CI (-14.07, -5.63), P <?.05], the Hamilton Depression Rating Scale (HAMD) [MD?=?-5.30, 95% CI (-11.61, 1.01), P >?.05], and the Hamilton Anxiety Rating Scale [MD?=?-3.89, 95% CI (-4.52,-3.27), P < .05], as well as MSD-specific metrics, such as International Index of Erectile Function-5 [MD?=?3.26, 95% CI (1.98, 4.53), P <?.05] and intravaginal ejaculation latency time [MD?=?1.60, 95% CI (0.82, 2.37), P <?.05]. Importantly, the lack of statistical significance in HAMD scores in our analysis may be attributed to the differences in treatment responses between the PE and ED populations. Clinical Implications: It provides evidence-based support to address the limitations of separating physical and mental symptoms in traditional treatment, further substantiates its application value within the integrated medical model, and explores new research avenues for designing personalized treatment plans for patients. Strengths and Limitations: A first-of-its-kind systematic evaluation was conducted to assess the comprehensive efficacy of traditional CHM in alleviating anxiety and depression symptoms while improving sexual function indicators among patients with MSD. The limited number of studies constitutes the most significant limitation. Conclusions: Our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD patients, while concurrently improving core MSD symptoms, such as PE and ED.
[Key words] male sexual dysfunction, Chinese herbal medicine, anxiety, depression, systematic review, psychosexual health
论文原文：Zhaozhan Xie, Jinxian Lu, Xuecheng Zhang, Hongling Jia, Yongchen Zhang (2025). Efficacy of Chinese herbal medicine in the treatment of anxiety and depression in male sexual dysfunction: a systematic review and meta-analysis. Sexual Medicine, Volume 13, Issue 3, July 2025.
https://doi.org/10.1093/sexmed/qfaf048
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