Department 'A' of Internal Medicine, Coimbra University Hospital Centre, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Clin Rheumatol. 2019 May;38(5):1263-1270. doi: 10.1007/s10067-018-04415-y. Epub 2019 Jan 11.
The sexual dimorphic prevalence of autoimmunity represents one of the most alluring observations among the mosaic of autoimmunity. Sex hormones are believed to be a mainstay of this asymmetry. The greater prevalence of autoimmunity among fertile women, disease onset/relapses during pregnancy, and postpartum are some of the points that support this theory. Undeniably, motherhood represents one of the most remarkable challenges for the immune system that not only has to allow for the conceptus but also deal with extraordinary hormonal alterations. Prolactin has a recognized immune-stimulatory effect, mainly inhibiting the negative selection of autoreactive B lymphocytes. In accordance, hyperprolactinemia has been associated with several autoimmune diseases, interfering with its pathogenesis and activity. During the pregnancy and lactation period, assorted autoimmune patients experience relapses, suggesting an active interference from increased levels of prolactin. This association was found to be significant in systemic lupus erythematosus, rheumatoid arthritis, and peripartum cardiomyopathy. Furthermore, treatment with bromocriptine has shown beneficial effects specially among systemic lupus erythematosus patients. In this review, we attempt to provide a critical overview of the link between prolactin, autoimmune diseases, and motherhood, emphasizing whether breastfeeding should be avoided among women, both with diagnosed disease or high risk for its development.
自身免疫的性别二态性流行是自身免疫复杂性中最吸引人的观察结果之一。性激素被认为是这种不对称的主要因素。生育期女性自身免疫的更高流行率、妊娠期间的疾病发作/复发和产后是支持这一理论的一些要点。不可否认，母亲身份代表了免疫系统面临的最显著挑战之一，它不仅必须允许胎儿存在，还必须应对特殊的激素变化。催乳素具有公认的免疫刺激作用，主要抑制自身反应性 B 淋巴细胞的阴性选择。因此，高催乳素血症与几种自身免疫性疾病有关，干扰其发病机制和活性。在妊娠和哺乳期，各种自身免疫性疾病患者会出现复发，表明催乳素水平升高会对其产生积极的影响。这种关联在系统性红斑狼疮、类风湿关节炎和围产期心肌病中被发现具有显著意义。此外，溴隐亭治疗已显示出对系统性红斑狼疮患者的有益效果。在这篇综述中，我们试图对催乳素、自身免疫性疾病和母亲身份之间的联系提供批判性的概述，强调患有确诊疾病或有发展该病高风险的女性是否应该避免母乳喂养。
