美沙冬維持療法中男性患者之勃起功能障礙

Erectile Dysfunction among Male Patients in Methadone Maintenance Therapy

張簡德璋(Te-Chang Chang Chien) ； 朱元祥(Yuan-Hsiang Chu) ； 蔡景宏(Ching-Hong Tasi)

《人文社會電子學報》 11卷1期 (2015/09) Pp. 70-85

摘要

研究目的:美沙冬已經被證實是一種安全而有效的海洛因戒癮方法，此族群之性功能障礙是一個鮮為人關心的議題，因此我們若能了解美沙冬治療中男性患者之性功能障礙的實際盛行率，辨識臨床相關之共病，並推廣到臨床執業中加以處置，以期待能達到全人醫療的目標，或可增進其治療順從性。研究方法:本研究以橫斷面研究的設計，完整蒐集人口學及臨床變項，並以國際勃起功能指標量表(IIEF-5)、華人健康問卷(CHQ)、台灣人憂鬱量表(TDQ)、華人酒癮篩檢問卷(Chinese CAGE)等量表施測，探討勃起功能障礙的盛行率及其他臨床特徵分佈。結果:美沙冬維持療法門診中男性個案之勃起功能障礙之盛行率為55.7%，其中已接受治療半年以上者的盛行率為56.8%，未治療者則為52.0%。此外，接受美沙冬治療者比未治療者的年齡高、較高比例使用保險套、較高比例使用毒品助性。而HIV 感染者比非感染者無業的比例較高、其性伴侶使用毒品的比例較高。結論:在台灣此族群的勃起功能比例與國外文獻相似。未來若能再設計一個前瞻性研究，補齊研究工具的不足(如運用其他可納入無性行為者以評估的量表)，可進一步探詢造成勃起功能障礙之預測因子。

關鍵字

男性勃起功能障礙 ； 美沙冬維持治療 ； 危險性行為

並列摘要

Introduction: Methadone maintenance therapy is an effective treatment for patients of heroin use disorder. However, there are still some stigmatization and preoccupation from Chinese society, especially for those with Human Immunodeficiency Virus (HIV) infection. So we had little information about their sexual function, which could interfere adherence to treatment and quality of life. Because that heroin or even methadone might affect erectile function was hypothesized, we need to explore the actual prevalence of erectile dysfunction (ED) in Taiwan and associated clinical comorbidities in order to enhance their sexual right. Methods: 106 patients were recruited (including 13 patients with HIV infection) in the methadone clinic of E-Da Hospital, Kaohsiung City, Taiwan and were evaluated with International Index of Erectile Function-5 (IIEF-5), Taiwanese Depression Questionnaire (TDQ), Chinese Health Questionnaire (CHQ), Chinese CAGE screen for alcohol misuse, demographic data, HIV infection, risky sexual behaviors and substance use measures. Men who had no any sexual intercourse were excluded. Descriptive and inferential (by Chi-square test and T test) statistics were performed with SPSS. Results: The total prevalence of erectile dysfunction in our study was 55.7%, 56.8% in the treatment (for more than 6 months) group and 52.0% in the ＂new patient＂ group. There was no significant difference for demographic characteristics between the ＂new patient＂ group and the treatment group, except of more condom use and less sexual activities immediately after using drug in the treatment group. Similar findings were noted about the difference between HIV infection group and non-HIV group. HIV infection group had more sexual partners with drug use. As to mean scores of IIEF-5, CHQ and TDQ, no significant difference was detected between the ＂new patient＂ and the treatment groups. Conclusions: First, to the best of our knowledge, this is the first study, which focused on the ethnic Chinese patients with heroin use disorder, to demonstrate prevalence of ED in Taiwan. Second, our finding about the prevalence of ED is lower and closer to previous studies in comparison with another three China studies (using IIEF-5 also). That perhaps reflected we indeed excluded nonsexually active patients. Because those patients would be evaluated as having severe ED while scoring IIEF-5. Finally, we need to further detailed studies to prove the possible predictor of erectile dysfunction.

並列關鍵字

erectile dysfunction ； methadone maintenance therapy ； risky sexual behavior