【作者】 刘倩；

【导师】 王晓黎； 关海霞；

【作者基本信息】 中国医科大学 ， 内科学（专业学位）， 2021， 硕士

【摘要】 目的:探讨泌乳素(Prolactin,PRL)水平升高(>1000 m IU/L)血清中巨泌乳素血症的比例及其临床特征。研究方法:对连续500份PRL>1000 m IU/L血清进行巨泌乳素(Macroprolactin,MPRL)的检测。根据PEG处理后的PRL单体水平的参考区间及回收率确定其中巨泌乳素血症的血清及患者。并与真正高泌乳素血症患者进行PRL水平及临床特征的比较。结果:健康人聚乙二醇(Polyethylene glycol,PEG)沉淀处理后血清中PRL水平范围分别为83.2-370(男)、74.2-436 m IU/L(女)。根据40%的回收率标准,18.6%的血清样本(93/500)诊断为巨泌乳素血症。12.2%的血清样本(61/500)单体泌乳素水平正常。18.9%(69/365)的患者考虑为巨泌乳素血症,其中66.7%(46/69)的患者为单纯巨泌乳素血症患者。72.6%(265/365)为真性高泌乳素血症。较单纯巨泌乳素血症患者而言,真性高泌乳素血症患者中溢乳明显增多(P=0.01),其次是视力障碍(P=0.007)。212例(80.0%)真性高泌乳血症患者进行了进一步的影像学检查(MRI/CT),136例(63%)患者患有垂体腺瘤。完善影像信息的55例巨泌乳素血症患者中仅有15例(27.3%)提示存在腺瘤,其中单纯巨泌乳素血症组的35例患者中仅7例(20.0%)发现垂体腺瘤。结论:泌乳素水平升高的血清中巨泌乳素血症比例较高,仅凭临床特征难以进行辨别。利用PEG沉淀法进行MPRL筛查有利于医疗资源的合理安排。更多还原

【Abstract】 Objective : To determine the frequency of macroprolactinemia in patients with hyperprolactinemia and its clinical impact.Methods:Macroprolactin(MPRL)was detected in 500 consecutive sera with PRL>1000m IU/L.According to the reference interval and recovery rate of PRL monomer level after PEG treatment,the serum and patients with macroprolactinemia were determined.The PRL level and clinical characteristics were compared with those of patients with hyperprolactinemia.Results:PRL levels after precipitation with Polyethylene glycol(PEG)in healthy ranged from 83.2 to 370(males)and 74.2 to 436 m IU/L(females),respectively.Based on the recovery criterion of 40%,hyperprolactinemia was diagnosed in 18.6% of serum samples(93/500).Monomer prolactin levels were normal in 12.2% of serum samples(61/500).Hyperprolactinemia was considered in 18.9%(69/365)of the patients,and 66.7%(46/69)of the patients were macroprolactinemia.72.6%(265/365)cases were true hyperprolactinemia.Patients with true hyperprolactinemia had significantly more galactorrhea(P=0.01)than patients with macroprolactinemia,followed by visual impairment(P=0.007).Further imaging(MRI/CT)was performed in 212 patients(80.0%)with true hyperlactatemia and pituitary adenomas were present in 136 patients(63.0%).Only 15 cases(27.3%)of the 55 macroprolactinemia with complete imaging information suggested the presence of adenoma,and 7 cases(20.0%)of the 35 patients in the pure hyperprolactinemia group found pituitary adenomas.Conclusion:High frequency of MPRL was identified in patients with hyperprolactinemia.Using of PEG precipitation method for MPRL screening is beneficial to the reasonable arrangement of medical resources.更多还原