巨泌乳素随时间变化:对于血清泌乳素持续升高的人,是否有必要复查?

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Clinical Endocrinology Pub Date : 2024-03-27 DOI:10.1111/cen.15051
Mark Livingston, Syeda F. Hashmi, Sudarshan Ramachandran, Ian Laing, Adrian Heald
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引用次数: 0

摘要

目的和设计:巨泌乳素血症可能会影响对血清泌乳素水平的解释,这一现象自 1981 年以来就已得到认可。大泌乳素血症的程度随时间变化的描述较少。我们通过分析高催乳素血症患者 9 年间的连续测量结果,确定了大催乳素状态(基于聚乙二醇(PEG)沉淀)的变化情况:纳入了 1810 人的结果。从实验室信息系统中提取了2012年1月1日至2021年4月1日期间的所有血清总泌乳素结果(使用罗氏Cobas 8000分析仪测量)以及相关的患者人口统计学/检测数据。进行过巨泌乳素筛查试验的样本(泌乳素大于 700 miu/L 的样本)被纳入主要分析:在研究期间,共对 1810 名患者(599 名男性/2183 名女性,中位年龄:35 岁,四分位数范围:35 岁)进行了 2782 次巨泌乳素检查(占所有泌乳素检查的 12.5%):35岁,四分位数区间:25-47岁,范围:16-93岁):16-93岁)。对 465 名患者(1437 次测量结果)进行了多次巨泌乳素检查,其中 94 名患者(141 次测量结果)筛查结果呈阳性(结论:在这项研究中,仅有 19/465 名患者的巨泌乳素检测结果呈阳性:在这项研究中,根据 60% 的 PEG 恢复临界值计算,只有 19/465 名患者的宏观泌乳素状态发生了变化。在这 19 名患者中,大多数都在服用抗精神病/抗抑郁药物或患有泌乳素瘤;只有 7 名患者的单体泌乳素发生了显著变化。这表明,一旦确定了巨泌乳素的状态,临床决策就很少受到重复检查的影响。
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Macroprolactin over time: Is there any point in rechecking it in people with a persistently elevated serum prolactin?

Objective and Design

Macroprolactinemia may influence the interpretation of serum prolactin levels—a recognised phenomenon since 1981. The degree of macroprolactinaemia over time is less well described. We determined how macroprolactin status (based on polyethylene glycol (PEG) precipitation) varied by analysing serial measurements in hyperprolactinaemic individuals over a period of 9 years.

Patients and Measurements

Results from 1810 individuals were included. All serum total prolactin results (measured using Roche Cobas 8000 analyser) were extracted from the laboratory information system for the period 1 January 2012 to 1 April 2021, along with relevant patient demographic/test data. Samples with a macroprolactin screening test performed (on samples with prolactin > 700 miu/L) were included in the main analysis.

Results

During the study period, 2782 macroprolactin checks were performed (12.5% of all prolactin tests) in 1810 individuals (599 males/2183 females, median-age: 35, interquartile range: 25–47, range: 16–93 years). Multiple macroprolactin checks were carried out on 465 patients (1437 measurements) with 94 patients (141 measurements) screening positive (<60% recovery). Only 19 patients (18 female) had at least one result above and one below the 60% screening cut-off, with 10 of these patients having results close to the 60% cut-off; in 9 patients, results were clearly different between repeat samples. In seven cases, the adjusted monomeric prolactin showed a potentially clinically significant difference.

Conclusions

In this study, only 19/465 patients appeared to change macroprolactin status based on a 60% PEG recovery cut-off. The majority of these 19 patients were on antipsychotic/antidepressant medication(s) or had a prolactinoma; in only 7 did monomeric prolactin change significantly. This suggests that once macroprolactin status has been determined, clinical decision making is rarely affected by repeating it.

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来源期刊
Clinical Endocrinology
Clinical Endocrinology 医学-内分泌学与代谢
CiteScore
6.40
自引率
3.10%
发文量
192
审稿时长
1 months
期刊介绍: Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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