Parra Adalberto, Ramírez-Peredo Jorge, Hidalgo Rocío, Morales-Toquero Amelia, Velásquez-Ramírez Gabriela, Ruiz-Argüelles Alejandro, Ruiz-Argüelles Guillermo J
Department of Endocrinology, Instituto Nacional de Perinatología, Mexico City, Mexico.
Biol Blood Marrow Transplant. 2006 May;12(5):566-72. doi: 10.1016/j.bbmt.2005.12.035.
We compared the functional status of the hypothalamic dopaminergic tone in patients given an allogeneic hematopoietic stem cell transplantation (allo-HSCT) with chronic graft-versus-host disease (GVHD) with that observed in patients with allo-HSCT without chronic GVHD and in healthy controls. The effect of acute dopaminergic blockade with intravenous metoclopramide on serum prolactin (PRL) concentrations was evaluated. Twenty volunteers, 20 to 52 years of age, seronegative for both hepatitis C virus and the human immunodeficiency virus, were studied: (1) 10 clinically healthy men (group 1), and (2) 9 patients with leukemia, and 1 patient with refractory aplastic anemia who underwent allo-HSCT, 5 of whom (3 men and 2 women) developed chronic GVHD (group 2), and 5 (3 men and 2 women) who did not develop chronic GVHD (group 3). Serum PRL concentrations were measured both fasting and after intravenous administration of metoclopramide (10-mg bolus). The area under the PRL curve was calculated. Patients in group 2 were older than those in groups 1 and 3 (P<.018), but their body mass index was similar. Fasting serum PRL concentrations were similar among the 3 groups; however, group 2 had higher PRL concentrations throughout the test (P<.001) and a greater area under the PRL curve than groups 1 and 3 (P<.001), without differences between the last 2 groups. The differences remained significant after adjustment for age (P<.01). Our results in a small group of patients with chronic GVHD after allo-HSCT suggest the existence of an increased functional level of their hypothalamic dopamine tone, which would favor a tendency toward a diminished endogenous production, release of pituitary PRL, or both. This could represent an adaptive mechanism aiming to maintain circulating PRL concentrations within a physiological range.
我们比较了接受异基因造血干细胞移植（allo-HSCT）并患有慢性移植物抗宿主病（GVHD）的患者下丘脑多巴胺能张力的功能状态，与未患慢性GVHD的allo-HSCT患者以及健康对照者的情况。评估了静脉注射甲氧氯普胺进行急性多巴胺能阻滞对血清催乳素（PRL）浓度的影响。研究了20名年龄在20至52岁之间、丙型肝炎病毒和人类免疫缺陷病毒血清学均为阴性的志愿者：（1）10名临床健康男性（第1组），以及（2）9名白血病患者和1名接受allo-HSCT的难治性再生障碍性贫血患者，其中5名（3名男性和2名女性）发生了慢性GVHD（第2组），5名（3名男性和2名女性）未发生慢性GVHD（第3组）。在空腹和静脉注射甲氧氯普胺（10毫克推注）后测量血清PRL浓度。计算PRL曲线下面积。第2组患者比第1组和第3组患者年龄更大（P<0.018），但他们的体重指数相似。3组空腹血清PRL浓度相似；然而，第2组在整个测试过程中PRL浓度更高（P<0.001），且PRL曲线下面积比第1组和第3组更大（P<0.001），后两组之间无差异。在调整年龄后差异仍然显著（P<0.01）。我们对一小群allo-HSCT后患有慢性GVHD患者的研究结果表明，他们下丘脑多巴胺能张力的功能水平升高，这可能有利于内源性垂体PRL产生或释放减少的趋势，或两者兼而有之。这可能代表一种旨在将循环PRL浓度维持在生理范围内的适应性机制。
