溴隐亭治疗垂体催乳素腺瘤的效果

Clinical effect of Bromocriptine treating pituitary prolactinoma

目的分析溴隐亭治疗垂体催乳素(PRL)腺瘤的使用方法和效果。方法选取2014年6月~2016年6月收治的垂体PRL腺瘤患者共47例为研究对象,其中垂体微腺瘤(肿瘤直径≤10 mm)27例,垂体大腺瘤(肿瘤直径>10 mm)20例;25μg/L≤PRL<100μg/L者5例,100μg/L≤PRL<200μg/L者22例,PRL≥200μg/L者20例。患者确诊后立即开始服用溴隐亭治疗。定期复查血清PRL水平和进行垂体MRI增强检查。分析治疗前后PRL水平和肿瘤大小的改变,并监测患者用药期间出现的不良反应,及时调整治疗方案。结果溴隐亭治疗后,3例患者出现严重的不良反应而更换为卡麦角林治疗。在持续服用溴隐亭药物治疗的44例患者中,症状好转率为70.5%。不同的肿瘤大小和不同PRL水平的治疗效果差异均无统计学意义(P>0.05)。治疗前后肿瘤直径变化差异有统计学意义(P<0.05)。36.2%(17例)的患者在服药期间出现不同程度的不良反应,多数可以逐渐耐受。结论溴隐亭对垂体PRL腺瘤患者的高PRL血症和肿瘤大小均有显著的治疗效果,但治疗期间可存在多种不良反应,治疗剂量应个体化。治疗无效的患者应首选更换为其他多巴胺受体激动剂。

Objective To analyze the usage and effect of Bromocriptine treating pituitary prolactinoma.nethods 47 patients with pituitary prolactinoma treated from June 2014 to June 2016 were selected as the subjects.Among them,there were 27 patients with pituitary microadenoma （tumor diameter ≤〈 10 mm）,20 patients with pituitary macroadenoma （tumor diameter〉10mm）;there were 5 cases with 25 μg/L≤PRL〈100 μg/L,22 cases with 100μg/L≤PRL〈200μg/L,20 cases with PRL≥200 μg/L.After the patients were diagnosed,they are treated with Bromocriptine immediately.Serum prolactin level was regularly reviewed and pituitary enhanced MRI scan was conducted.PRL level and tumor size change were analyzed before and after treatment and the adverse reactions during the period of medication were monitored,and the treatment plan was adjusted in time.Results After Bromocriptine treatment,3 patients had severe adverse reactions and were replaced with Cabergoline.Among 44 patients who continued to take Bromocriptine medication,the symptom improvement rate was 70.5%.There was no significant difference in the therapeutic effect between different tumor size and different PRL level （P〉0.05）.The changes of tumor diameter before and after treatment were statistically significant （P〈 0.05）.36.2% （17 patients） of patients in the medication had varying degrees of adverse reactions,the majority could be gradually tolerated.Conclusion Bromocriptine has a significant therapeutic effect on hyperprolactinemia and tumor size in patients with pituitary prolactinoma,but there are several adverse reactions during treatment,and the therapeutic dose should be individualized.Patients with ineffective treatment should be preferred to replace the other dopamine receptor agonists.