抗精神病药物致高催乳素血症的作用机制、危险因素、临床特征与治疗策略

Mechanism of Action,Risk Factors,Clinical Characteristics,and Treatment Strategies of Antipsychotic-Induced Hyperprolactinemia

高催乳素血症是患者在接受抗精神病药物治疗过程中经常出现的不良反应,长期的催乳素水平升高容易使患者出现性功能障碍、骨质疏松、月经不调甚至闭经等不良后果。催乳素是垂体前叶的催乳素细胞分泌的一种激素,多巴胺通过与催乳素细胞膜上的多巴胺D2受体结合,防止催乳素的过度分泌。抗精神病药物通过阻断这些受体,使多巴胺失去对催乳素分泌的抑制作用,导致高催乳素血症的发生。同时,抗精神病药物透过血脑屏障能力的强弱、与多巴胺D2受体亲和力的高低以及对多巴胺受体是抑制作用还是激动作用都会导致催乳素水平的不同。目前的治疗方法包括减少抗精神病药物的剂量、停用抗精神病药物、换用另一种不易引起高催乳素血症的抗精神病药物,或联用阿立哌唑、多巴胺受体激动剂(卡麦角林和溴隐亭)、二甲双胍和中草药等。本文对高催乳素血症的发病机制、危险因素、临床特征以及目前的常用治疗策略做一综述,旨在为今后高催乳素血症患者的治疗、康复和管理提供指导。

Hyperprolactinemia(HPRL)is a common adverse effects that occurs in patients receiving antipsychotic drug therapy.Prolonged high levels of prolactin can lead to adverse consequences such as sexual dysfunction,osteoporosis,menstrual disorders,and even amenorrhea.Prolactin is a hormone secreted by lactotroph cells in the anterior pituitary gland,and dopamine prevents excessive secretion of prolactin by binding to dopamine D2 receptors on lactotroph cell membranes.Antipsychotic drugs block these receptors,causing dopamine to lose its inhibitory effect on prolactin secretion,leading to the occurrence of HPRL.In addition,the ability of antipsychotic drugs to cross the blood-brain barrier,their affinity for dopamine D2 receptors,and whether they have inhibitory or excitatory effects on dopamine receptors can also affect prolactin levels.Current treatment methods include reducing the dosage of antipsychotic drugs,discontinuing antipsychotic drugs,switching to another antipsychotic drug that is less likely to cause HPRL,and combining drugs such as aripiprazole,dopamine agonists(cabergoline and bromocriptine),metformin,and traditional Chinese medicine.In this article,we summarize the pathogenesis,risk factors,clinical features,and current common treatment strategies of HPRL,with the aim of providing guidance for the treatment,rehabilitation,and management of HPRL patients in the future.