催乳素抑制剂——治疗围产期心肌病的新靶点

Prolactin inhibitor as a new therapeutic agent for peripartum cardiomyopathy

围产期心肌病是孕产妇在围产期引发心力衰竭的一种特发性心肌病。尽管其发病率较低,但常常导致孕产妇死亡,目前其病因及发病机制尚不清楚。近十几年来,研究者发现围产期心肌病可能与氧化应激不平衡有关,在氧化应激的作用下,催乳素被裂解成具有抗血管生成和促细胞凋亡的16kDa片段,此片段可能是引起围产期心肌病的病因之一。溴隐亭为多巴胺受体激动剂,通过抑制催乳素的分泌可能用于围产期心肌病的治疗。在仅有的几个小规模临床实验和病例报道中,溴隐亭能改善疾病的预后,但仍需要大规模临床实验证实其治疗作用。

Peripartum cardiomyopathy （PPCM） is a disease of characterized by left ventricular systolic dys- function and symptoms of heart failure, which occurs in healthy women during the last month of pregnancy and the first five months after delivery. PPCM is a potentially life-threatening disease of unknown aetiology and pathogen- esis, although its incident rate is low. Inflammatory, infection and immune disorder could associate PPCM. Pro- laetin, a full-length 23 kDa hormone, is among the prominent in the peripartum phase, and large quantities of pro- lactin are released from the pituitary gland into the circulation during lactation. In recent years, researchers dis- covered that unbalanced oxidative stress linked to proteolytic cleavage of prolactin into an anti-angiogenic and pro- apoptotic 16 kDa subform as a potential pathomechanism for the development of PPCM. Bromocriptine, a dopa- mine receptor agonist, is a blockade of prolactin which may be used in the therapy of PPCM. In a few small pilot trials and case reports, it is found that bromocriptine could improve prognosis. However, larger randomized con- trol trial is still awaited to test its function in PPCM.