女性精神病患者服用抗精神病药物致高泌乳素血症的临床诊治  

Clinical diagnosis and treatment of hyperprolactinemia induced by antipsychotics in female psychotic patients

作　　者：余云香 李宇晨 李雪梅 YU Yun-xiang;LI Yu-chen;LI Xue-mei(Department of Gynecology, Xianyue Hospital in Xiamen City, Fujian Province, Xiamen 361012, China;Department of Psychiatry, Xianyue Hospital in Xiamen City, Fujian Province, Xiamen 361012, China)

机构地区：[1]厦门市仙岳医院妇科,福建厦门361012 [2]厦门市仙岳医院精神科,福建厦门361012

出　　处：《中国当代医药》2019年第4期15-20,共6页China Modern Medicine

摘　　要：目的探讨服用抗精神病药物期间女性精神病患者出现高泌乳素血症的临床诊治。方法回顾性分析2013年6月～2018年6月在我院住院或妇科门诊就诊的280例女性精神病患者服用抗精神病药物期间出现高泌乳素血症患者的临床资料,B超检查提示子宫及附件正常,检测甲状腺功能三项正常:促甲状腺激素(TSH)、游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4),检查性激素:促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)、孕激素(P)、睾酮(T)水平正常,PRL升高(PRL>30 ng/L),诊断为高泌乳素血症。将280例高泌乳素血症女性精神病患者,按不同的PRL水平分为3组,组Ⅰ:30 ng/L<PRL≤100 ng/L,130例;组Ⅱ:100 ng/L<PRL≤200 ng/L,120例;组Ⅲ:PRL>200 ng/L,30例。观察三组患者的月经、异常子宫出血(AUB)总发生率、泌乳及随访治疗情况。另外从本研究的280例高泌乳素血症女性精神病患者中筛选30例,患者的住院时间>1年,服用与泌乳素相关抗精神病药物前PRL≤30 ng/L,甲状腺功能正常,住院服用与泌乳素相关抗精神病药物后PRL>100 ng/L,将其作为用药前PRL<30 ng/L组和用药后PRL>100 ng/L组。比较用药前PRL<30 ng/L组和用药后PRL>100 ng/L组患者的甲状腺功能指标(TSH、FT3、FT4)变化,分析30例住院时间>1年、用药前PRL<30 ng/L、用药后PRL>100 ng/L患者的PRL与甲状腺功能指标的相关性。结果组Ⅰ的130例患者中,82例患者(82/130,63.1%)月经正常;48例患者(48/130,36.9%)出现慢性AUB;30例患者(30/130,23.1%)伴泌乳。组Ⅱ的120例患者中,5例(5/120,4.2%)患者月经正常,100例(100/120,83.3%)患者慢性AUB;15例(15/120,12.5%)患者急性AUB;80例(80/120,66.7%)患者伴泌乳;组Ⅲ的30例患者中,27例(27/30,90%)患者出现慢性AUB;3例(3/30,10%)患者急性AUB;28例(28/30,93.3%)患者伴泌乳。组Ⅱ、组Ⅲ的AUB总发生率(115/120,95.8%),(30/30,100%)高于组Ⅰ的AUB总发生率(48/130,36.9%),差异有统计学意义(P<0.01)。组ⅡObjective To explore diagnosis and treatment of antipsychotics induced by hyperprolactinemia in female psychotic patients. Methods Retrospective analysis of the data of 280 cases of hyperprolactinemia induced by antipsychotics in female psychotic patients who visited the gynecology clinic or hospitalized in our hospital during the period from June in 2013 to June in 2018, their age were from 18 to 45 years old, and their sex hormones including prolactin (PRL), follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progestin (P) and testosterone (T) as well as thyroid hormones such as thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were also measured in this paper. Moreover;B-ultrasonography of uterus,accessories and endometrial thickness of these patients were conducted during this period. It was shown from the data collected that ultrasonic inspection of uterus and accessories, level of thyroid hormones (thyroid stimulating hormone [TSH], free triiodothyroid acid [FT3], free thyroxine [FT4]) were normal and sex hormones (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol [E2], progesterone [P], testosterone [T]) were also normal. These patients were diagnosed to be hyperprolactinemia (HPRL) when the level of PRL among them was >30 ng/L. According to the different level of PRL, 280 cases of female psychotic patients were then divided into three groups: Group Ⅰ(30 ng/ml<PRL<100 ng/ml), 130 cases;Group Ⅱ(100 ng/ml<PRL<200 ng/ml), 120 cases;Group Ⅲ(PRL>200 ng/ml), 30 cases. The total incidence of menstruation, abnormal uterine bleeding (AUB), lactation and follow-up treatment in the three groups were observed. In addition, 30 patients were screened from 280 female mental patients of HPRL in this study. The patients′ hospitalization time was more than 1 year, PRL ≤30 ng/L before were given prolactin-associated antipsychotic drugs, thyroid function was normal, and PRL>100 ng/L after inpatient were given prolactin-associated

关 键 词：抗精神病药物 高泌乳素血症 异常子宫出血 治疗 女性精神病患者 

分 类 号：R971.4[医药卫生—药品]