高泌乳素血症的成因及辨证思路

高泌乳素血症的发生主要与肝、脾、肾三脏功能失调有关。发病机理是肝郁及肾、肝肾精血亏矗,气血逆乱,血不循常道下注血海为月经,而随肝气上逆乳房为乳汁,即出现闭经溢乳。肝火上冲或气血大虚都可形成本病。治疗中多用疏肝、清肝之剂。     

利培酮引起高催乳素血症的预防

目的:研究维生素B6预防抗精神病药所致高催乳素血症的效果。方法:在服用抗精神病药同时预防性应用维生素B612周,以阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定,并则定血清催乳素值,与对照组进行比较。结果:治疗4周预防组血清催乳素值显著低于对照组,生殖系统不良反应明显少于对照组。治疗8、12周时两组差异有统计学意义(P<0.01)。结论:早期应用维生素B6可有效预防药源性高催乳素血症的发生。     

Using aripiprazole to reduce antipsychotic-induced hyperprolactinemia: meta-analysis of currently available randomized controlled trials

Background

Hyperprolactinemia (HPL) is a common side effect of antipsychotic medications. Recent reports suggest that aripiprazole can ameliorate antipsychotic-induced HPL, but results are inconsistent and the single available systematic review only considered five studies.

Aim

Conduct an updated meta-analysis of all randomized controlled trials (RCTs) about the efficacy and safety of aripiprazole as an adjunctive treatment for antipsychotic-induced hyperprolactinemia.

Methods

English and Chinese databases were searched for RCTs about the use of aripiprazole in treating antipsychotic-induced HPL published by January 20, 2015. Studies were selected using pre-defined inclusion and exclusion criteria. The Cochrane Risk of Bias tool was used to evaluate risk of biases, the Cochrane GRADE measure was used to assess the quality of evidence, and Review Manager 5.3 software was used for data analysis.

Results

A total of 21 studies, 19 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 8 of the studies with a pooled sample of 604 individuals found that compared to the control condition adjunctive aripiprazole significantly increased the proportion of participants who experienced HPL recovery (risk ratio [RR]=19.2, 95%CI=11.0-33.5). The proportion who experienced any adverse effect during follow-up did not differ between the two groups, but the aripiprazole group was more likely to report somnolence (RR=2.76, 95%CI=1.34-5.69) and headaches (RR=2.31, 95%CI=1.08-4.92). High-dose aripiprazole (>5mg/day) was more effective than low-dose (<5mg/day) aripiprazole (RR=30.0, 95%CI=10.2-120.7 v. RR=15.1, 95%CI=8.1-28.1), but this difference was not statistically significant. The risk of bias in the studies was rated as ‘high’ in 6 of the studies and ‘unclear’ in 15 studies, and the quality of evidence was rated as ‘high’ for only 7 of the 57 outcome measures assessed.

Conclusions

This study systematically reviewed and evaluated all relevant RCTs and found that adjunctive aripiprazole is effective and safe to use in the treatment of antipsychotic-induced HPL. However, the low quality of some of the studies, the incomplete methodological information provided for most of the studies, and the relatively short follow-up time of the studies raises question about the validity of the results. Further work that resolves these methodological and reporting issues is needed.     

阿立哌唑对抗精神病药物致女性精神分裂症患者高催乳素血症的影响

目的：探讨阿立哌唑对抗精神病药物所致女性精神分裂症患者高催乳素血症的影响。方法对48例抗精神病药物所致高催乳素血症的女性精神分裂症患者,在维持原用抗精神病药物治疗的基础上联合小剂量阿立哌唑治疗,观察8周。采用阳性与阴性症状量表评定精神症状,副反应量表评定不良反应,同时检测患者血清催乳素水平的变化。结果本组患者治疗后阳性与阴性症状量表及副反应量表评分与治疗前比较差异均无显著性（P＞0．05）,而血清催乳素水平较治疗前呈持续性下降,治疗第4周、8周末与治疗前比较差异均有极显著性（ t ＝4．12、6．32,P＜0．01）。结论阿立哌唑能显著改善抗精神病药物所致女性精神分裂症患者的高催乳素血症,疗效显著,不增加不良反应。     

Hyperprolactinemia in Asymptomatic Patients is Related to High Molecular Weight Posttranslational Variants or Glycosylated Forms

Circulating human Prolactin (PRL) exists in different variants related to posttranslational modifications, dimerization or association with other serum proteins. Compared to monomeric prolactin these variants usually have little or no biologic activity and include BigBig (BB PRL), Big (B PRL), and Glycosylated forms (G PRL). The aim of the present study was to assess levels of BB PRL, B PRL, little PRL (L PRL) and G PRL in hyperprolactinemic patients with no menstrual alterations or galactorrhea. L PRL, B PRL, and BB PRL were identified by gel filtration chromatography on Sephadex G-100; G PRL and NG PRL were identified by chromatography on Concanavalin A Sepharose. PRL was measured by IRMA DPC. Eleven women, aged 22–50 yrs, were studied for: breast dysplasia (1), controlled hypothyroidism (3), dysmenorrhea (3), microadenoma follow-up (2), and gynecological control (2). Pituitary MRI was normal in all but one patient, who had a microadenoma discovered by Magnetic Resonance Imaging. Six patients had normal L PRL levels, and their hyper PRL was due to excess BPRL or BB PRL. Five patients had increased L PRL levels, but excess G PRL. Patients harboring molecular PRL variants do not present the symptoms typical of the hyperprolactinemic syndrome. Furthermore in patients with clinically controlled prolactinomas the presence of PRL variants should be ruled out to avoid an unnecessary increase of dopamine agonist dosage.     

高催乳素血症对性腺内分泌功能的影响

对比观察高催乳素血症对性腺内分泌功能的影响。用放射免疫分析（ＲＩＡ）法检测高催乳素血症患者血浆中的睾酮（Ｔ，男性共５２人）或孕酮（Ｐ，女性４６人）水平，并与催乳素水平正常者相比较，发现前者的Ｔ或Ｐ均明显下降（Ｐ＜０．０１）。提示，高催乳素血症能抑制性腺功能，可能在男性性功能障碍及女性黄体功能不健中起着一定的作用     

Subcutaneous mastectomy as ultimate treatment of galactorrhea.

Galactorrhea, caused by hyperprolactinemia can successfully be treated by bromocriptine. Continuous long-term use of this drug is not always desirable or possible because of side-effects. In cases of hyperprolactinemia with severe galactorrhea, where surgical or radiological therapy is not possible and long-term treatment with bromocriptine is not acceptable, subcutaneous mastectomy might be considered as an ultimate solution.     

闭经,溢乳患者4种血清生殖激素检测149例分析

对１４９例闭经，溢乳患者采用放免分析检测４种血清生殖激素。结果发现，催乳素〉１００ｍＩＵ／Ｌ５４，其中垂体肿瘤４例，可疑垂体微型腺瘤４例，功能性高催乳素血症４６例；ＰＲＬ〈１００ｍＩＵ／Ｌ者９５例。本组闭经，溢乳均与垂体促性腺激素和卵巢雌激素水平的改变有关。     

溴隐亭治疗高泌乳素血症119例

１９８７年至１９９３年我院妇科内分泌门诊治疗１１９例高泌乳素血症。其中垂体腺瘤４６例，空泡蝶鞍２例，功能性高泌乳素血症７１例。１１９例均用溴隐亭治疗，其中９例行垂体腺瘤手术切除，术后继服溴隐亭。结果血清泌乳素值迅速下降至正常范围者占８８．２４％，泌乳明显减少或停止者占８７．６１％，月经复潮者为８０．６７％，妊娠率为６０．２０％。