Stiles C E, Tetteh-Wayoe E T, Bestwick J, Steeds R P, Drake W M
Queen Mary University of London, Department of Endocrinology, London.
Department of Endocrinology, St Bartholomew's Hospital, London.
J Clin Endocrinol Metab. 2018 Sep 11. doi: 10.1210/jc.2018-01071.
Cabergoline is first line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high-dose in Parkinson's disease has largely been abandoned, because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower doses for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist.
To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically-significant cardiac valvulopathy.
Full-text papers published up to and including January 2017 were found via PubMed and selected according to strict inclusion criteria.
All case-control studies were included where patients had received ≥6 months cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review papers and papers pertaining solely to Parkinson's disease were excluded. 13/76 originally selected studies met inclusion criteria.
A list of desired data were compiled and extracted from papers by independent observers. Each also independently graded for paper quality (bias) and met to reach consensus.
More tricuspid regurgitation was observed (OR 3.74; 95% CI 1.79-7.8 p<0.001) in the cabergoline treated patients compared to controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy.
Treatment with low dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this is unclear and requires further investigation. 51.
卡麦角林是大多数催乳素垂体瘤和高催乳素血症患者的一线治疗药物。由于其与一种特征性限制性心脏瓣膜病的发生有关，其在帕金森病高剂量治疗中的应用已基本被放弃。尽管有严格的超声心动图筛查监管建议，但尚不清楚接受较低剂量治疗高催乳素血症的患者是否会出现类似的瓣膜变化。
进行一项荟萃分析，探讨使用卡麦角林治疗高催乳素血症与具有临床意义的心脏瓣膜病之间的任何联系。
通过PubMed检索截至2017年1月（包括该月）发表的全文论文，并根据严格的纳入标准进行选择。
纳入所有病例对照研究，其中患者接受卡麦角林治疗高催乳素血症≥6个月。排除单例报告、既往荟萃分析、综述论文以及仅与帕金森病相关的论文。最初选择的76项研究中有13项符合纳入标准。
由独立观察员从论文中汇编并提取所需数据列表。每位观察员还独立对论文质量（偏倚）进行评分，并共同达成共识。
与对照组相比，卡麦角林治疗组患者观察到更多三尖瓣反流（比值比3.74；95%可信区间1.79 - 7.8；p<0.001）。没有患者因临床症状被诊断为三尖瓣功能障碍。其他任何瓣膜病均无显著增加。
低剂量卡麦角林治疗高催乳素血症似乎与三尖瓣反流患病率增加有关。其临床意义尚不清楚，需要进一步研究。 51
