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什么是高泌乳素血症？如何检查治疗？

发布日期：2024-07-03 09:55:00编辑：秩名


女性6项性激素中的泌乳素（PRL）是相对稳定的，在整个月经周期中不会有大的变化。如果泌乳素升高，超过一定的数值就会造成各种问题。在男性身上，主要表现为阳痿；在女性身上则表现为月经失调、溢乳及不孕。在医学上，把过高的泌乳素称为高泌乳素血症，又称溢乳—闭经综合征。
 
当你发现自己黄体功能不足，出现无排卵月经、月经稀发或闭经，同时用力挤压双侧乳房，有溢乳现象出现时，就要高度怀疑自己泌乳素超标了，
 
这时应该去医院检查激素水平。
 
若泌乳素超过30ng/ml，就可以认为是泌乳素超标了，有些医院把标准定在25ng/ml。由于泌乳素受到许多因素的影响，如体力活动、睡眠、进餐或情绪紧张等，因此第一次检查发现其超标，但是超得不多时，可以复查一次，一般在上午10点左右取血测定最能反映真实水平。
 
当你拿到激素检查报告后，首先要注意泌乳素是否超标，当泌乳素在正常范围内，再看其他激素；如果发现泌乳素高了，其他激素通常不会正常。
 
泌乳素水平升高，对下丘脑促性腺激素释放激素有抑制作用，导致垂体促性腺激素水平下降，因此使卵泡刺激素（FSH）及黄体生成素（LH）处于正常低限或低于正常水平，导致卵泡发育受阻，从而降低卵巢中激素的合成，最
 
终的结果必然是雌激素水平低下。
 
使泌乳素升高的原因很多，其中最重要最常见的是垂体泌乳素瘤，瘤体直径超过1厘米称为大腺瘤；瘤体直径小于1厘米称为微腺瘤。垂体泌乳素瘤占患者的1/3～1/2。当患者血清中泌乳素>75ng/ml时，就要高度怀疑是这个原因；当泌乳素>100ng/ml时，患者垂体肿瘤的可能是57%；当泌乳素>160ng/ml时，垂体肿瘤的可能增加至89%了，当血清中泌乳素>300ng/ml时，几乎100%的患者是垂体肿瘤！
 
除了垂体泌乳素瘤外，其他下丘脑垂体肿瘤或疾病（包括空泡蝶鞍），甲状腺功能低下；肾脏疾病，某些药物（影响多巴胺受体和多巴胺生成的药物），甚至未发现任何原因的下丘脑功能失调，都会使泌乳素升高。所以，一定要查明原因，才能对症采取措施。
 
泌乳素升高是因为泌乳素抑制因子（PIF）即多巴胺的产生和转运受阻，使垂体泌乳素细胞失去抑制性控制造成的。垂体泌乳素细胞是产生泌乳素的源头，而下丘脑神经原产生的多巴胺通过神经末梢进入垂体门静脉对垂体泌乳素细胞产生抑制性控制，使泌乳素维持在正常水平。所以，多巴胺相当于调节水库水量的大坝，作用是相当大的。
 
高泌乳素血症应对症下药：吃药引起的，停药后症状都能自行消失；甲状腺功能低下，肾功能不全或颅内病变导致者，则应采取相应的内外科手段积极治疗原发病；除了以上病因，对于其他大量的特发性高泌乳素血症及垂体泌乳素瘤的患者，几乎都可以用“溴隐亭”来进行治疗。
 
“溴隐亭”是突发性高泌乳素血症的首选药品，它直接作用于垂体，抑制催乳素细胞的增殖，使垂体瘤缩小；刺激中枢神经系统的多巴胺受体，降低多巴胺在体内的转化，促进泌乳素的代谢。所以对高泌乳素血症是十分有效的。
 
“溴隐亭”服药1周后，血清泌乳素浓度即可下降；服药2周后，一般溢乳现象就可以解决；服药4周后，95%的闭经者可以恢复月经，90%的患者可以恢复排卵功能；当溢乳和闭经症状消失，血清泌乳素浓度下降以后，嗅隐亭的服用量就可以减少，但是请不要马上停药，突然停药有可能会引起反弹！
 
有些姐妹不适应溴隐亭，服用以后反应极大，恶心呕吐不止。这时候应该改变给药方式，可以将“溴隐亭”塞入阴道深处。由于生殖道上皮来自副中肾管，对药物有良好的吸收作用，而且阴道的酸性条件有利于吸收，所以阴道给药后99%进入全身血液循环，避免了直接通过肝脏代谢，能更好地发挥药物的作用，也明显减轻了胃肠反应。
 
除了“溴隐亭”，另外有效的药物有左旋多巴和维生素B6。左旋多巴在体内代谢为多巴胺，多巴胺直接作用于垂体，降低泌乳素的水平，缓解症状。维生素B6起到了辅酶的作用，增加下丘脑中多巴向多巴胺的转化率，因而抑制了垂体泌乳素细胞的分泌。只是维生素B6的服用量要较大，而且要较长期服用才有效。
 
泌乳素降低之后，从理论上说，内分泌就会恢复正常，但是由于个体差异极大，恢复正常排卵功能的时间就有迟有早。高泌乳素患者在治疗的同时， 如果发现排卵功能恢复不快或者黄体功能不足而影响受孕时，应及时使用药物促排，争取尽早怀孕。
 

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