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

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Abstract Objective To explore diagnosis and treatment of antipsychotics induced by hyperprolactinemia in female psychotic patients.MethodsRetrospective 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 antipsychotic drugs.Patients were defined as PRL＜30 ng/L before medication group and PRL＞100 ng/L after medication group.Thyroid function indexes （TSH，FT3，FT4）of patients in PRL＜30 ng/L before medication group and PRL＞100 ng/L after medication group were compared.The correlation between PRL and thyroid function indexes in 30 patients of hospitalization time was more than 1 year，PRL ≤30 ng/L before medication，and PRL＞100 ng/L after medication were analyzed.Results A-mong 130 patients in group Ⅰ，82 cases of patients （82/130，63.1%）with normal menstruation，48 cases of patients （48/130，36.9%）with chronic AUB，30 cases of patients （30/130，23.1%）with galactorrhea.Among 120 patients in groupⅡ，5 cases of patients （5/120，4.2%）with normal menstruation，100 cases of patients （100/120，83.3%）with chronic AUB，15 cases of patients （15/120，12.5%）with acute AUB，80 cases of patients （80/120，66.7%）with galactorrhea.A-mong 30 patients in group Ⅲ，27 cases of patients （27/30，90.0%）with chronic AUB，3 cases of patients（3/30，10.0%）with acute AUB，28 cases of patients （28/30，93.3%）with galactorrhea.The total incidence of AUB in group Ⅱ （115/120，95.8%）and group Ⅲ （30/30，100%）were higher than that in the group Ⅰ （48/130，36.9%），the differences were statistically significant（P＜0.01）.The incidence of galactorrhe in group Ⅱ（80/120，66.7%）and group Ⅲ （28/30，93.3%）were higher than that in the group Ⅰ （30/130，23.1%），the differences were statistically significant（P＜0.01）.The level of TSH in PRL＞100 ng/L after medication group was higher than in the PRL＜30 ng/L before medication group （P＜0.01）.The level of FT4in PRL＞100 ng/L after medication group was lower than in the PRL＜30 ng/L before medication group（P＜0.05）.There was no significant difference existed in the level of FT3between PRL＜30 ng/L before medication group and PRL＞100 ng/L after medication group （P＞0.05）.The correlation between PRL and thyroid function indexes in 30 patients of hospitalization time was more than 1 year，PRL ≤30 ng/L before medication，and PRL＞100 ng/L after medication were analyzed.The PRL was positively correlated with TSH in 30 patients of hospitalization time was more than 1 year，PRL ≤30 ng/L before medication，and PRL＞100 ng/L （r=0.750，P＜0.01），it was found that there was a negative correlation between PRL and FT4 （r=-0.549，P＜0.01），and no correlation was derived between PRL and FT3 （r=0.276，P＞0.05）.The AUB was observed to occur in 193 cases of HPRL in female psychotic patients，among them including 175 cases of patients （175/193，90.7%）with chronic AUB and 18 cases of patients （18/193，9.3%）with acute AUB.It was suggested that 160 cases of patients （160/193，82.9%）needed to be with the regular follow-up，31 cases of patients（31/193，16.1%）were treated with medicinal therapy of hemostatics，estrogen，and progestogen，and 2 cases of patients（2/193，1.0%）with surgical curettage.Conclusion The number of female patients with total AUB is surveyed with the increase of level of PRL during the period of their taking of antipsychotic medications.Most of female psychotic patients with chronic AUB such as oligomenorrhea or infrequent menstruation are advised to be with the regular followup，and patients with acute AUB are recommended to be treated with medicinal therapy of hemostatics progestogen，sequential therapy of estrogen-progestogen or surgical curettage.Reduction of dosage or discontinuation of antipsychotic medications in HPRL patients result in decreasing or returning to normal the level of PRL.The level of PRL and TSH is shown to fluctuate readily in patients with HPRL and the level of thyroid hormones is not affected in a short term by HPRL which play an effect on the increase of the level of TSH but the decrease of FT4in a long period of time （PRL＞100 ng/L）.

Key words： Antipsychotics Hyperprolactinemia Abnormal uterus bleeding Treatment Female psychotic patients

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