抗糖尿病藥物對勃起功能障礙的影響：

系統綜述與薈萃分析

Effects of Anti-Diabetic Drugs on Erectile Dysfunction:

A Systematic Review and Meta-Analysis

——《糖尿病、代謝綜合徵與肥胖》2025年第18卷 ——

<Diabetes, Metabolic Syndrome and Obesity> Volume 18, 2025

【摘要】背景：勃起功能障礙 (ED) 被認為是糖尿病 (DM) 的併發症之一，影響約 35%至75%的糖尿病患者。研究表明，抗糖尿病藥物可能有助於緩解糖尿病患者的 ED，但不同類別藥物的作用機制尚不清楚。目的：本研究旨在探討不同抗糖尿病藥物對ED的影響。材料與方法：本研究遵循系統綜述和薈萃分析的優選報告項目 (PRISMA) 指南，開展了一項系統綜述和薈萃分析，重點關注抗糖尿病藥物與ED之間關聯的臨床研究。從 PubMed、Embase 和 Cochrane Library 數據庫中檢索相關研究。使用Review Manager 5.4.1進行薈萃分析和亞組分析，並使用Stata 15.1進行敏感性分析，以確保結果的穩健性。結果：初步檢索到3,906篇跨數據庫的文獻。在篩選了3906篇文章的標題和摘要，並對其中30篇文章進行全文審閱後，我們最終選擇了三項研究進行分析。我們最重要的發現是，胰高血糖素樣肽-1受體激動劑（GLP-1RAs）在改善糖尿病患者的勃起功能障礙方面優於二甲雙胍（Z=2.41，P=0.02），且在BMI較高或肥胖的患者中效果尤為顯著（Z=2.26，P=0.02）。這表明GLP-1RAs可能為該患者群體提供一種有前景的治療選擇。此外，噻唑烷二酮類藥物也可增強性功能，但其安全性和有效性尚需進一步證實。阿卡波糖、胰島素和鈉-葡萄糖協同轉運蛋白2抑製劑（SGLT-2i）也顯示出對治療勃起功能障礙（ED）產生積極影響的潛力，但還需要更多研究來確定其有效性。最後，二甲雙胍和磺酰脲類藥物對勃起功能障礙（ED）的影響仍不確定，現有研究的證據不一。結論：總而言之，GLP-1RAs在改善糖尿病患者勃起功能障礙方面優於二甲雙胍。其他抗糖尿病藥物也顯示出增強該人群勃起功能的潛力，但需要進一步開展廣泛的臨床試驗，以解決知識空白和安全問題。

【關鍵詞】抗糖尿病藥物，勃起功能障礙，肥胖，胰高血糖素樣肽-1受體激動劑，血管內皮功能

[Abstract] Background: Erectile dysfunction (ED) is considered one of the complications of diabetes mellitus (DM), affecting about 35–75% of diabetic patients. Studies suggest that anti-diabetic drugs could potentially alleviate ED in diabetics, yet the effects of different drug classes remain unknown. Objective: Our study aims to investigate the influence of various anti-diabetic drugs on ED. Materials and Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis were carried out, focusing on clinical research linking anti-diabetic drugs and ED. Relevant studies were sought from PubMed, Embase, and Cochrane Library databases. Review Manager 5.4.1 facilitated meta-analysis and subgroup analysis, while Stata 15.1 was employed for sensitivity analysis to ensure result robustness. Results: An initial search yielded 3,906 articles across databases. After screening the titles and abstracts of 3,906 articles and performing a full-text review of 30 selected articles, we selected three studies for analysis ultimately. Our most significant finding is that glucagon-like peptide-1 receptor agonists (GLP-1RAs) show an advantage over metformin in improving erectile dysfunction in diabetic patients (Z = 2.41, P = 0.02), with a particularly notable effect observed in patients with higher BMI or obesity (Z = 2.26, P = 0.02). This suggests that GLP-1RAs may offer a promising therapeutic option for this patient population. Additionally, thiazolidinediones may enhance sexual function, although their safety and efficacy require further confirmation. Acarbose, insulin, and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) also show potential for positively impacting ED, but more research is needed to establish their efficacy. Finally, the impact of metformin and sulfonylureas on ED remains uncertain, with mixed evidence from existing studies. Conclusion: In conclusion, GLP-1RAs demonstrate an advantage over metformin in improving erectile dysfunction in diabetic patients. Other antidiabetic drugs also show potential for enhancing erectile function in this population, but further extensive clinical trials are needed to address knowledge gaps and safety concerns.

[Key words] anti-diabetic drugs, erectile dysfunction, obesity, glucagon-like peptide-1 receptor agonists, vascular endothelial function

論文原文：Bo Yang, Huiqun Cheng, Yu Hu, et al. (2025). Effects of Anti-Diabetic Drugs on Erectile Dysfunction: A Systematic Review and Meta-Analysis. Diabetes, Metabolic Syndrome and Obesity, Volume 18, Pages 467–478.

https://doi.org/10.2147/DMSO.S503216

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