多巴胺受体激动剂治疗催乳素瘤患者冲动控制障碍的发生比例及临床特征分析  

The incidence and clinical characteristics of impulse control disorders in patients with prolactinoma receiving dopamine agonist

作　　者：柏悦恬 鹿斌 苏亮 叶红英 季立津 Bai Yuetian;Lu Bin;Su Liang;Ye Hongying;Ji Lijin(Department of Endocrinology and Metabolism,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Psychiatry,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040 [2]复旦大学附属华山医院精神科,上海200040

出　　处：《中华内分泌代谢杂志》2022年第11期970-975,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81800692)。

摘　　要：目的了解催乳素瘤患者中多巴胺受体激动剂(dopamine agonist,DA)治疗相关冲动控制障碍(impulse control disorders,ICDs)的比例及临床特征。方法连续纳入2019年12月至2020年6月在复旦大学附属华山医院内分泌科门诊随访的的催乳素瘤患者,收集一般临床资料。采用帕金森病冲动性强迫障碍评分量表(QUIP)进行ICDs筛查;Barratt冲动人格量表(BIS-11)评价3种不同维度的冲动人格;SF-36健康调查量表(SF-36)评价生活质量。结果共纳入111例催乳素瘤病例,男性44例,女性67例,平均年龄(34.74±9.05)岁,平均病程(66.69±50.70)个月,起病时中位数催乳素水平147.25(89.97,470)ng/mL,大腺瘤比例46.8%。其中90例患者正在接受DA治疗,21例未用药。DA治疗组和未治疗对照组相比,QUIP量表筛查合并任一ICDs的比例分别为24.4%和14.3%;BIS-11量表的情绪冲动评分在DA组中显著升高(23.32±3.67对21.71±2.55,P=0.022)。DA治疗的催乳素瘤中,最常见的ICDs症状为性欲亢进及冲动购物,分别占到40.9%;伴有任一ICDs筛查阳性的患者非计划冲动评分升高(21.05±5.03对19.15±3.38,P=0.047),生活质量评估中社会功能(69.32±24.62对83.08±17.11,P=0.021)、情感职能(50.00±45.72对71.10±40.68,P=0.043)和精神健康(55.27±22.75对64.59±17.53,P=0.048)的评分更低。DA治疗组ICDs阳性者与阴性者相比,起病时催乳素水平更高[470.00(130.00,3770.00)ng/mL对140.29(79.50,465.59)ng/mL,P=0.028],男性比例更高(68.2%对38.2%,P=0.014);男性是ICDs的独立危险因素(OR值为3.46,95%CI 1.24~9.61,P=0.017);而多巴胺受体激动剂的治疗时间、最大治疗剂量及累积剂量均无显著差异。结论在接受DA治疗的催乳素瘤患者中可能出现冲动控制障碍且影响生活质量,内分泌科医师应提高认识,重视对冲动控制障碍的筛查。Objective To understand the incidence and clinical characteristics of dopamine agonist(DA)therapy-related impulse control disorders(ICDs)in prolactinoma patients.Methods Outpatients diagnosed with prolactinoma from the Department of Endocrinology in Huashan Hospital from December 2019 to June 2020 were consecutively included and clinical data were collected.Impulse control disorders were screened with Questionnaire for Impulsive-Compulsive Disorders in Parkinson′s Disease(QUIP).Barratt Impulsiveness Scale 11(BIS-11)was used to evaluate personality construct of impulsiveness from three sub-factors.Health related quality of life was evaluated by the MOS 36-Item Short Form Health Survey(SF-36).Results Among the 111 cases included,40 were male and 53 were female,with an average age of(34.74±9.05)years and an average disease duration of(66.69±50.70)months.The initial prolactin level was 147.25(89.97,470)ng/mL and the percentage of macroadenoma was 46.8%.Ninety cases received DA while 21 cases didn′t.According to the QUIP,any ICD was screened positive in 22 cases(24.7%)in the DA group and 3 cases(14.3%)in the untreated group.The attention impulsiveness scores of BIS-11 in the DA group were higher than the untreated group(23.32±3.67 vs 21.71±2.55,P=0.022).Among the ICDs positive cases in the DA group,the most common disorders were pathological gambling(40.6%)and hypersexuality(40.6%).Compared with the negative group,the non-planning impulsiveness scores of BIS-11 in the positive group were higher,while the scores of social function(69.32±24.62 vs 83.08±17.11,P=0.021),role emotional(50.00±45.72 vs 71.10±40.68,P=0.043)and mental health(55.27±22.75 vs 64.59±17.53,P=0.048)in SF-36 scale were lower in the positive group.Besides,the percentage of male(68.2%vs 38.2%,P=0.014)and initial prolactin level[470.00(130.00,3770.00)vs 140.29(79.50,465.59)ng/mL,P=0.028]in the positive group were higher.Male was an independent risk factor of the presence of ICDs(OR=3.46,95%CI 1.24-9.61,P=0.017).No significant difference was

关 键 词：多巴胺受体激动剂 催乳素瘤 冲动控制障碍 

分 类 号：R736.4[医药卫生—肿瘤]