Krysiak Robert, Kowalcze Karolina, Okopień Bogusław
Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.
Department of Pediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Stefana Batorego 15, 41-902 Bytom, Poland.
J Clin Med. 2023 Apr 29;12(9):3208. doi: 10.3390/jcm12093208.
Although dopaminergic agents are the drugs of choice in treatment of prolactin excess, women who cannot be treated with these agents are recommended to receive estrogen preparations. The aim of this study was to compare cardiometabolic effects of both treatment options. The study population included three groups of young women. Subjects with mild-to-moderate hyperprolactinemia received either low-dose cabergoline or oral combined contraceptives (ethinyl estradiol plus desogestrel), while normoprolactinemic women were drug-naive. Plasma prolactin, glucose homeostasis markers, lipids, circulating levels of uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen and homocysteine, and the urinary albumin-to-creatinine ratio (UACR) were assessed at entry and six months later. Hyperprolactinemic women differed from normoprolactinemic ones in glucose homeostasis markers, high-density lipoprotein (HDL)-cholesterol, triglycerides, uric acid, hsCRP, fibrinogen, homocysteine and UACR. Cabergoline decreased total and monomeric prolactin levels, which was accompanied by normalization of glucose, insulin sensitivity, glycated hemoglobin, HDL-cholesterol, triglycerides, uric acid, hsCRP, fibrinogen, homocysteine and UACR. Despite a neutral effect on prolactin levels, combined contraceptives worsened insulin sensitivity and increased triglycerides, hsCRP, fibrinogen and UACR. At follow-up, cabergoline-treated women were characterized by a better cardiometabolic profile than women receiving ethinyl estradiol plus desogestrel. Our findings suggest that only cabergoline reduces cardiometabolic risk in young women with hyperprolactinemia.
尽管多巴胺能药物是治疗高催乳素血症的首选药物,但对于无法使用这些药物治疗的女性,建议使用雌激素制剂。本研究的目的是比较这两种治疗方案对心脏代谢的影响。研究人群包括三组年轻女性。患有轻度至中度高催乳素血症的受试者接受低剂量卡麦角林或口服复方避孕药(炔雌醇加去氧孕烯),而催乳素水平正常的女性未使用过药物。在入组时和六个月后评估血浆催乳素、葡萄糖稳态标志物、脂质、尿酸循环水平、高敏C反应蛋白(hsCRP)、纤维蛋白原和同型半胱氨酸,以及尿白蛋白与肌酐比值(UACR)。高催乳素血症女性在葡萄糖稳态标志物、高密度脂蛋白(HDL)胆固醇、甘油三酯、尿酸、hsCRP、纤维蛋白原、同型半胱氨酸和UACR方面与催乳素水平正常的女性不同。卡麦角林降低了总催乳素和单体催乳素水平,同时血糖、胰岛素敏感性、糖化血红蛋白、HDL胆固醇、甘油三酯、尿酸、hsCRP、纤维蛋白原、同型半胱氨酸和UACR也恢复正常。尽管复方避孕药对催乳素水平无影响,但却恶化了胰岛素敏感性,增加了甘油三酯、hsCRP、纤维蛋白原和UACR。在随访中,接受卡麦角林治疗的女性的心脏代谢状况优于接受炔雌醇加去氧孕烯治疗的女性。我们的研究结果表明,只有卡麦角林能降低年轻高催乳素血症女性的心脏代谢风险。