脂肪是驱动因素，而不是旁观者：肥胖相关勃起功能障碍的现代综合
Adipose as a Driver, Not a Bystander: A Modern Synthesis of Obesity-Related Erectile Dysfunction.
摘要(中文译文)
肥胖和勃起功能障碍（ED）越来越普遍，但脂肪组织通常被视为勃起障碍的次要因素，而不是主要驱动因素。评估一个以脂肪为中心的框架，在该框架中，特定脂肪库功能障碍调节勃起所必需的血管、神经内分泌和平滑肌过程。对机制、临床前和临床研究进行了叙述性综合，重点关注炎症、细胞衰老、细胞外囊泡信号传导、铁下垂、线粒体功能障碍和内脏、血管周围和前列腺周围脂肪库的糖萼损伤。功能失调的脂肪组织通过脂肪因子、细胞因子、细胞外囊泡和氧化脂质介质重塑全身和局部微环境。这些过程降低了一氧化氮的生物利用度，增加了血管硬度，破坏了神经内分泌信号传导，并促进了海绵体纤维化。血管周围脂肪组织对阴茎血流动力学产生局部影响。临床和遗传学证据支持中心性肥胖与ED之间的因果关系，而减肥和针对脂肪的干预措施可以改善勃起结果。脂肪组织是ED发病机制的上游调节因子。通过生活方式、药理学和新兴策略（如senolytics和细胞外囊泡调节）靶向脂肪功能障碍可能会改变疾病进展，而不是提供症状缓解。
Abstract
Obesity and erectile dysfunction (ED) are increasingly co-prevalent, yet adipose tissue is often viewed as a secondary contributor rather than a primary driver of erectile impairment. To evaluate an adipose-centric framework in which depot-specific adipose dysfunction regulates vascular, neuroendocrine, and smooth muscle processes essential for erection. A narrative synthesis of mechanistic, preclinical, and clinical studies was conducted, focusing on inflammation, cellular senescence, extracellular vesicle signaling, ferroptosis, mitochondrial dysfunction, and glycocalyx injury across visceral, perivascular, and periprostatic adipose depots. Dysfunctional adipose tissue remodels systemic and local microenvironments through adipokines, cytokines, extracellular vesicle cargo, and oxidized lipid mediators. These processes reduce nitric oxide bioavailability, increase vascular stiffness, disrupt neuroendocrine signaling, and promote cavernosal fibrosis. Perivascular adipose tissue exerts localized effects on penile hemodynamics. Clinical and genetic evidence supports a causal link between central adiposity and ED, while weight loss and adipose-targeted interventions improve erectile outcomes. Adipose tissue functions as an upstream regulator of ED pathogenesis. Targeting adipose dysfunction through lifestyle, pharmacological, and emerging strategies such as senolytics and extracellular vesicle modulation may modify disease progression rather than provide symptomatic relief.
如何引用
AMA
Ardie Barry Sailis, Muhamad Alfakri Mat Noh. Adipose as a Driver, Not a Bystander: A Modern Synthesis of Obesity-Related Erectile Dysfunction.. Diabetes, obesity & metabolism. 2026; doi:10.1111/dom.70818.
APA
Ardie Barry Sailis, Muhamad Alfakri Mat Noh (2026). Adipose as a Driver, Not a Bystander: A Modern Synthesis of Obesity-Related Erectile Dysfunction.. Diabetes, obesity & metabolism. https://doi.org/10.1111/dom.70818
GB/T 7714
Ardie Barry Sailis, Muhamad Alfakri Mat Noh. Adipose as a Driver, Not a Bystander: A Modern Synthesis of Obesity-Related Erectile Dysfunction.[J]. Diabetes, obesity & metabolism, 2026 doi:10.1111/dom.70818.
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