Volavka Jan, Czobor Pal, Cooper Thomas B, Sheitman Brian, Lindenmayer Jean-Pierre, Citrome Leslie, McEvoy Joseph P, Lieberman Jeffrey A
Nathan Kline Institute, Orangeburg, NY 10982, USA.
J Clin Psychiatry. 2004 Jan;65(1):57-61. doi: 10.4088/jcp.v65n0109.
Prolactin levels are elevated to varying degrees by antipsychotics. Prolactin elevations may result in sexual and other adverse effects, and they may be related to antipsychotic effects. We used the data collected in a trial of antipsychotics to study the differential effect of these drugs on prolactin level, to explore the relation between clinical effects and prolactin level, and to determine the relationship between plasma levels of antipsychotics and prolactin level.
Treatment-resistant patients (133 men, 24 women) diagnosed with DSM-IV schizophrenia or schizoaffective disorder participated in a double-blind, randomized, 14-week trial comparing clozapine (N = 40), olanzapine (N = 39), risperidone (N = 41), and haloperidol (N = 37). Plasma levels of prolactin and antipsychotics were determined at baseline and at weeks 5, 8, 10, 12, and 14 during the trial. Clinical effects were measured with the Positive and Negative Syndrome Scale and the Extrapyramidal Symptom Rating Scale. Statistical analyses were limited to the 75 men for whom repeated prolactin levels were available. Data were gathered from June 1996 to December 1999.
Risperidone caused significant elevation of prolactin levels (p <.05) that appeared to be dose-dependent. Clozapine and olanzapine were associated with decreases of prolactin, whereas haloperidol led to a minor, nonsignificant increase. Plasma olanzapine and prolactin levels were correlated. Prolactin levels were not related to clinical improvement or extrapyramidal side effects.
Antipsychotics show major differences in their effects on prolactin, and risperidone has clearly the most robust effect.
抗精神病药物可使催乳素水平不同程度升高。催乳素升高可能导致性功能及其他不良反应，且可能与抗精神病作用有关。我们利用抗精神病药物试验中收集的数据，研究这些药物对催乳素水平的差异作用，探讨临床疗效与催乳素水平之间的关系，并确定抗精神病药物血浆水平与催乳素水平之间的关系。
133名男性和24名女性难治性患者，被诊断为DSM-IV精神分裂症或分裂情感性障碍，参与了一项双盲、随机、为期14周的试验，比较氯氮平（N = 40）、奥氮平（N = 39）、利培酮（N = 41）和氟哌啶醇（N = 37）。在试验的基线期以及第5、8、10、12和14周测定催乳素和抗精神病药物的血浆水平。用阳性和阴性症状量表及锥体外系症状评定量表测量临床疗效。统计分析仅限于75名有重复催乳素水平数据的男性。数据收集于1996年6月至1999年12月。
利培酮使催乳素水平显著升高（p <.05），且似乎呈剂量依赖性。氯氮平和奥氮平与催乳素降低有关，而氟哌啶醇导致轻微的、无显著意义的升高。血浆奥氮平和催乳素水平相关。催乳素水平与临床改善或锥体外系副作用无关。
抗精神病药物对催乳素的作用存在主要差异，利培酮的作用最为明显。
