Toldy Erzsébet, Löcsei Zoltán, Szabolcs István, Kneffel Pál, Góth Miklós, Szöke Dominika, Kovács L Gábor
Vas Megye és Szombathely MJV Markusovszky Kórháza, Központi Laboratórium, Szombathely.
Orv Hetil. 2003 Oct 26;144(43):2121-7.
Biologically active prolactin and the inactive fraction of macroprolactin can be present in hyperprolactinaemic sera. The reaction of routinely used prolactin assays with macroprolactin is variable.
The present study was undertaken to analyse the leading clinical signs of hyperprolactinemia in macroprolactinemia and true hyperprolactinemia and to assess the prevalence of macroprolactinemia in hyperprolactinemic females.
1571 consecutive female patients were investigated for hyperprolactinemia. Prolactin was measured before and after precipitation of macroprolactin by polyethylene glycol in 285 hyperprolactinemic (> 520 mlU/l) patients. Since not a single case of macroprolactinemia (recovery < 40%) was found in the range of 520-700 mlU/l, only in women with prolactin > 700 mlU/l (N = 254) entered the study.
In 59 patients (23%) macroprolactinemia was found. In women, the occurrence of macroprolactinemia increased with advancing age (p < 0.05). "A priori" clinical signs indicating hyperprolactinemia occurred less frequently in patients with macroprolactinemia than in those with true hyperprolactinemia. Pituitary microadenoma was found in 9.8% of macroprolactinemia vs. 31.6% in true hyperprolactinemia (p < 0.01); galactorrhea: 4% in macroprolactinemia vs. 19% in true hyperprolactinemia, (p < 0.05); infertility: 17% in macroprolactinemia vs. 44% in true hyperprolactinemia (p < 0.05). In 8 out of 59 women with macroprolactinemia, true hyperprolactinemia appeared simultaneously (15.3%). Occurrence of polycystic ovaries syndrome was more frequent in the true hyperprolactinemia (12%) that in macroprolactinemia (4.5%).
It has been shown that macroprolactin does not occur in mild hyperprolactinemia. In women, the occurrence of macroprolactinemia increases with age. "A priori" clinical signs indicating hyperprolactinemia and pituitary abnormality are less frequent in macroprolactinemia than in true hyperprolactinemia. The diagnosis of macroprolactinemia should be used only, when the PRL levels fall to the normal range after precipitation. To avoid diagnostic and therapeutic pitfalls the screening for macroprolactin of all patients with prolactin > 700 mlU/L is recommended.
生物活性催乳素和大分子催乳素的无活性部分可存在于高催乳素血症血清中。常规使用的催乳素检测方法与大分子催乳素的反应各不相同。
本研究旨在分析大分子催乳素血症和真性高催乳素血症中高催乳素血症的主要临床体征，并评估高催乳素血症女性中大分子催乳素血症的患病率。
对1571例连续的女性患者进行高催乳素血症调查。在285例高催乳素血症（>520 mIU/l）患者中，用聚乙二醇沉淀大分子催乳素前后测定催乳素。由于在520 - 700 mIU/l范围内未发现一例大分子催乳素血症（回收率<40%），因此仅纳入催乳素>700 mIU/l的女性（N = 254）进入研究。
59例患者（23%）发现大分子催乳素血症。在女性中，大分子催乳素血症的发生率随年龄增长而增加（p < 0.05）。提示高催乳素血症的“先验”临床体征在大分子催乳素血症患者中比在真性高催乳素血症患者中出现得少。大分子催乳素血症患者中垂体微腺瘤的发生率为9.8%，而真性高催乳素血症患者中为31.6%（p < 0.01）；溢乳：大分子催乳素血症患者中为4%，真性高催乳素血症患者中为19%（p < 0.05）；不孕：大分子催乳素血症患者中为17%，真性高催乳素血症患者中为44%（p < 0.05）。59例大分子催乳素血症女性中有8例同时出现真性高催乳素血症（15.3%）。真性高催乳素血症中多囊卵巢综合征的发生率（12%）高于大分子催乳素血症（4.5%）。
已表明轻度高催乳素血症中不存在大分子催乳素。在女性中，大分子催乳素血症的发生率随年龄增加。提示高催乳素血症和垂体异常的“先验”临床体征在大分子催乳素血症中比在真性高催乳素血症中少见。仅当催乳素水平在沉淀后降至正常范围时，才应诊断为大分子催乳素血症。为避免诊断和治疗陷阱，建议对所有催乳素>700 mIU/L的患者进行大分子催乳素筛查。
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