高催乳素血症患者体外受精-胚胎移植妊娠结局的临床分析

目的分析无症状的高催乳素血症（hyperprolactinemia,HPRL）患者接受体外受精-胚胎移植（IVF-ET）助孕治疗时的妊娠结局。方法回顾性分析217例确诊高催乳素血症患者接受IVF-ET助孕治疗的临床资料,同期121例输卵管因素行IVF而血清催乳素水平正常的患者为对照组,比较分析卵泡数、获卵数、受精率、临床妊娠率、胚胎着床率及妊娠结局等。结果两组间促性腺激素使用刺激时间、促性腺激素用量、获卵数、HCG日内膜厚度、受精率差异无统计学意义（P〉0.05）。高催乳素血症患者的临床妊娠率及着床率显著低于对照组（P〈0.05）。血清催乳素水平低于50 ng/ml的患者,经多巴胺受体激动剂治疗进入IVF周期前血清泌乳素水平高于25 ng/ml组,与血清催乳素水平正常组比较,获卵数、受精率、临床妊娠率、着床率和妊娠结局差异无统计学意义（P〉0.05）。结论高催乳素血症会对IVF结局产生不利影响。血清催乳素水平低于50 ng/ml可以进入IVF周期,不影响促排卵和妊娠结局。     

清肝袋泡剂治疗高催乳素血症临床与实验研究

目的：进一步观察清肝袋泡剂对高催乳素血症（ＨＰＲＬ）患者的临床疗效,探讨其作用机制。方法：随机将患者分为治疗组１２０例（清肝袋泡剂）,对照组４０例（溴隐亭）。观察血中催乳素（ＰＲＬ）和相关激素水平及症状变化情况,进行疗效对比。同时通过动物实验对内分泌水平及卵巢、子宫、乳腺的组织形态变化进行同步观察。结果：清肝袋泡剂可显著降低患者血清ＰＲＬ水平,对相关激素有良性调节作用,临床疗效良好,与对照组比较无显著性差异（Ｐ＞０．０５）;动物实验证明能促进卵泡发育,使子宫内膜出现各动情周期的变化,抑制乳腺腺体增生。结论：清肝袋泡剂可有效治疗ＨＰＲＬ。     

Effect of Chronic Hyperprolactinemia Induced by Sulpiride on Plasma Dehydroepiandrosterone (DHA) in Normal Men

In order to elucidate the relationship between plasma dehydroepiandrosterone (DHA) and sulpiride-induced hyperprolactinemia (of 60 day duration) in normal men, five normal men (aged 27-46) were administered daily 300 mg of sulpiride orally for 60 days to induce hyperprolactinemia. Plasma levels of prolactin, DHA and cortisol were measured by radioimmunoassay before sulpiride treatment, at day 14 and day 60 after initiation of the treatment. Plasma levels of prolactin after the administration rose significantly (P less than 0.001) to 71.6-95.3 ng/ml in four out of the five subjects compared with those of the controls. In the same four subjects the mean DHA values in plasma were elevated significantly (P less than 0.05) to 877 +/- 160 ng/dl from the mean baseline values (669 +/- 91 ng/dl). The elevated values remained during sulpiride treatment. Plasma levels of cortisol did not change significantly during sulpiride administration in all subjects. Our results suggest that sulpiride-induced hyperprolactinemia sustained at least 14-60 days in normal men stimulates the adrenal cortex to secrete DHA.     

促排卵治疗对高催乳素血症不孕患者疗程的影响

目的:探讨高催乳素血症(hyperprolactinemia,HPRL)不孕患者药物治疗方案及效果.方法:回顾分析垂体微腺瘤引起的HPRL不孕患者70例,根据治疗方案不同分为两组.溴隐亭组38例单用溴隐亭治疗,初始剂量1.25 mg/d,后加量使催乳素水平正常后逐渐减量至溴隐亭维持量为1.25～2.5 mg/d,不用促...     

Hyperprolactinemia: pathophysiology and therapeutic approach

Abstract

Prolactin (PRL) is a hormone, mainly secreted by lactotroph cells of the anterior pituitary gland. Recent studies have shown it may also be produced by many extrapituitary cells. Its well-recognized PRL plays an important role in lactation during pregnancy, but it is involved in other biological functions such as angiogenesis, immunoregulation and osmoregulation. Hyperprolactinemia is a typical condition producing reproductive dysfunction in both sexes, resulting in hypogonadism, infertility and galactorrhea. It may be also asymptomatic. Lactotroph adenomas (prolactinoma) is one of the most common cause of PRL excess, representing approximately 40% of all pituitary tumors. Several other conditions should be excluded before a clear diagnosis of hyperprolactinemia is made. Hyperprolactinemia may be secondary to pharmacological or pathological interruption of hypothalamic–pituitary dopaminergic pathways or idiopathic. Stress, renal failure or hypothyroidism are other frequent conditions to exclude in patients with hyperprolactinemia. We will review biochemical characteristics and physiological functions of that hormone. Clinical and pharmacological approach to hyperprolactinemia will also be discussed.     

Retrograde Ejaculation Accompanying Hyperprolactinemia

A patient, 38 years of age with 10 years of infertility, suffered from an ejaculation disorder for 2 years. Based on a diagnosis of retrograde ejaculation, sperm retained in the bladder was collected and homologous artificial insemination was carried out, but pregnancy was not achieved. The subject was examined at the Department of Urology and hormone tests were conducted showing hyperprolactinemia, hypogonadotropinemia, and hypotestosteronemia. A CT scan showed a pituitary tumor. Administration of 7.5 mg/day of bromocriptine was initiated to treat this tumor. Antegrade ejaculation recurred 1 month after administration, and pregnancy was achieved from normal sexual intercourse 5 months after administration.     

Current treatment options for hyperprolactinemia

Introduction: Hyperprolactinemia is a prevalent cause of oligo-amenorrhea, and prolactinomas are the most common type of functional pituitary tumor. Untreated hyperprolactinemia can lead to bone loss and impair gonadal function and fertility. Normalization of prolactin improves bone mass and restores gonadal function in a majority of patients.

Areas covered: This article contains an overview of hyperprolactinemia with an emphasis on pharmacologic, surgical and radiation treatment options. Discussion focuses on the efficacy and safety of available treatments and comments on new and emerging therapies.

Expert opinion: Dopamine agonists, usually cabergoline, remain the primary choice for initial treatment of hyperprolactinemia. Surgery may also be an appropriate alternative in certain circumstances. Monotherapy with dopamine agonists is often successful at controlling prolactin levels and tumor size, but adjunctive treatments may be necessary for resistant or aggressive prolactinomas.     

逍遥散加减方对高催乳激素血症大鼠卵巢颗粒细胞增殖和细胞周期的影响

目的:探讨以肝脾为核心,运用逍遥散加减方治疗高催乳素血症(HPRL)模型大鼠,观察逍遥散加减方对体外培养HPRL大鼠卵巢颗粒细胞增殖及细胞周期的影响。方法:选用SD雌性大鼠120只,随机分为正常组、模型组、阳性药溴隐亭组(1 mg·kg^-1)、逍遥散加减方高、中、低剂量组(55,22.5,13.75 g·kg^-1)。采用ip甲氧氯普胺,制作HPRL大鼠模型。给药30 d后,采用MTT检测各组细胞培养24,48,72,96 h细胞增殖情况;采用流式细胞仪分析细胞周期各时相的变化及细胞凋亡指数。结果:与正常组比较,模型组24,48,72,96 h大鼠卵巢颗粒细胞增殖明显降低,细胞凋亡指数显著增高,S期的细胞增殖明显降低,G₀/G₁期细胞相对比例明显增加(P<0.05);与模型组比较,溴隐亭组、逍遥散加减方高、中、低剂量组明显增加大鼠卵巢颗粒细胞增殖(P<0.05),逍遥散加减方高剂量组降低卵巢细胞凋亡指数,使S期的细胞增殖显著增多,G₀/G₁期细胞相对比例减少(P<0.05),其中加味逍遥散高剂量组的作用与溴隐亭组相近。结论:逍遥散加减方促进卵巢颗粒细胞增殖,降低细胞凋亡指数,其作用机制可能是通过促进颗粒细胞从G₀期向S期转化,増加S期细胞比例完成。     

利培酮合并小剂量阿立哌唑治疗女性精神分裂症对照研究

目的：探讨利培酮联合小剂量阿立哌唑治疗女性精神分裂症的疗效及对泌乳素的影响。方法：70例女性精神分裂症患者随机分为利培酮联合小剂量阿立哌唑治疗组和利培酮治疗组。治疗前及治疗后第2、4、8周末采用PANSS评定临床疗效。采用TESS评定药物不良反应。结果：利培酮联合小剂量阿立哌唑治疗组有效率为85.7%,利培酮组治疗有效率为88.6%,无显著性差异;两组不良反应（包括高泌乳素血症相关的泌乳、闭经）差异无统计学意义。结论：利培酮联合小剂量阿立哌唑治疗女性精神分裂症疗效及耐受性均好,未出现高泌乳血症相关症状,利培酮治疗女性精神分裂症时不必要预防应用阿立哌唑。