抗精神病药物所致高催乳素血症的研究进展

催乳素升高是抗精神病药物常见的不良反应,临床表现为男性乳房女性化、女性乳房胀痛、溢乳、月经失调症状、性功能障碍、骨质疏松及代谢障碍等,发生率为25%～89%。抗精神病药物所致高催乳素血症(HPRL)的发生与性别、年龄、药物种类及剂量等相关。发病机制可能是抗精神病药物阻断垂体前叶D2受体而减弱多巴胺抑制泌乳素细胞分泌的作用,导致催乳素水平升高。抗精神病药物所致HPRL须与严重应激或抑郁状态、妊娠、甲状腺功能减退症、肾衰竭、垂体肿瘤及卵巢病变等进行鉴别诊断。抗精神病药物所致HPRL的治疗包括停用致病药物,降低药物剂量,换用致HPRL风险较低的药物,也可给予多巴胺受体激动剂、中药或低频重复经颅磁刺激。

Progress in studies on hyperprolactinemia induced by antipsychotic drugs

Hyperprolactinemia is a common adverse effect of antipsychotic drugs. The clinical presentations of hyperprolactinemia are gynecomastia in men, and breast distending pain, galactorrhea, menstrual disturbance, sexual dysfunction, osteoporosis, and metabolic disturbance in women. The incidence of hyperprolactinemia is 25%-89%. The factors related to antipsychotic-induced hyperprolactinemia are gender, age, the type of antipsychotic drugs and dosage. The mechanism of antipsychotic-induced hyperprolactinemia may be related to blockade of dopamine D2 receptors on the anterior pituitary by antipsychotic drugs and reduction of dopamine inhibitory effect on prolactin secretion of prolactin cells, leading to prolactin elevation. Antipsychotic-induced hyperprolactinemia should be distinguished from hyperprolactinemia due to severe stress, depressive state, pregnancy, hypothyroidism, renal failure, pituitary tumor and ovarian disease. The treatment of antipsychotic-induced hyperprolactinemia includes discontinuing antipsychotic drugs, reducing antipsychotic drugs dosage, switching to a prolactin-sparing agent, prescribing a dopamine receptor agonist or Chinese herbal medicines, and using low-frequency repetitive transcranial magnetic stimulation.