抗精神病藥物引起高泌乳素血症的臨床危險因子分析

研究目的：本研究主要目的在了解以抗精神病藥物治療的思覺失調症患者其出現高泌乳素血症的臨床危險因子。研究方法及資料：本研究策略採用回朔性研究(retrospective study)。收錄童綜合醫院經精神科日間病房與慢性病房中57位思覺失調症患者參與此研究，而且所有患者都經過血液檢查泌乳激素濃度 (serum prolactin level)，以得知個案是否患有高泌乳素血症。這57位患者分成二組：(一) 33位罹患高泌乳素血症及（二）另外24位個案血液中泌乳激素濃度正常。所有個案由病歷資料中蒐集相關臨床因子，並比較兩組之差異性，包括性別、年齡、發病年齡、病程、身高體重、使用抗精神病藥物的種類、是否併用抗乙醯膽鹼藥物、錐體外症狀嚴重度(Simpson-Angus Extrapyramidal Side Effects Scale, SAS之施測)。分析方法以SPSS for windows 22.0版套裝軟體進行統計分析。研究結果：在第一組有高泌乳素血症的個案中，女性比例為57.6% (19/33)，而第二組沒有高泌乳素血症的個案中，女性占比16.7% (4/24)，統計上具有顯著意義(p=0.003)，顯示女性個案較容易在抗精神病藥物的治療中出現高泌乳素血症。在抗精神病藥物的選擇上，第一組個案使用prolactin-elevated類抗精神病藥物的比例較高，另外一組泌乳激素正常的個案中，使用prolactin-spare類抗精神病藥物的比例較高，兩者在統計上具有顯著意義(p<0.001)。評估個案錐體外症狀嚴重度的量表SAS，高泌乳素血症組分數為10.0±5.5，泌乳激素正常組的個案分數為6.8±6.0，兩者達顯著意義(p<0.05)，顯示高泌乳素血症與個案錐體外症候群嚴重度相關。結論與建議：抗精神病藥物導致高泌乳素血症的機率不低但常被忽略，女性及錐體外症候群嚴重度與泌乳激素升高有一定相關性，為了佐證以上結論。未來，我們應該要執行較長期，較大型，較完整地研究。

Objective: The main purpose of this study is to understand the clinical risk factors for hyperprolactinemia in schizophrenia treated with antipsychotics.Methods: The research strategy use retrospective study. 57 schizophrenia patients from psychiatric day care and chronic psychiatric ward of Tong’s hospital were included in the study, and all patients have a blood test for serum prolactin level, to find out the case has hyperprolactinemia or not. These 57 patients are divided into 2 groups: (1) 33 patients with hyperprolactinemaia and (2) in the 24 cases, the serum prolactin level is normal. All cases were collected relevant clinical factors from medical record information, including sex, age, age of onset, disease course, height and weight, type of antipsychotic drug, whether to add anticholinergic drugs or not, and severity of extra-pyramidal symptoms (EPS) by Simpson-Angus Extrapyramidal Side Effects Scale(SAS). Then we try to find out association between above clinical factors and hyperprolactinemia. This study is analyzed with the SPSS for windows 22.0 version.Results: In the first group of cases with hyperprolactinemia, the proportion of female is 57.6% (19/33), in the second group without hyperprolactinemia, female accounted for 16.7% (4/24). It shows that female cases are high risk for hyperprolactinemia with antipsychotic drugs treatment. On the choice of antipsychotic drugs, the first group of cases has a high proportion of using prolactin-elevated antipsychotics, prolactin normal group of cases has high proportion of using prolactin-spare antipsychotics.Score of SAS in hyperprolactinemia group is higher than normal prolactin group (mean±SD : 10.0±5.5 VS. 6.8±6.0, p<0.05). This result shows that hyperprolacinemia is associated with severity of EPS. Conclusion: Individuals with antipsychotic drugs usage have high risk of hyperprolactinemia, but are often ignored. In this study, female and severity of EPS are risk factors of hyperprolactinemia. In order to support the above conclusions, we need longer, larger, prospective, and extended study in the future.