Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment
Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment
复制标题
DOI：
10.1530/eje-12-0121
复制
发表时间：
2012-07-01
影响因子：
5.8
通讯作者：
Zacharieva, Sabina
中科院分区：
文献类型：
--
作者：
Elenkova, Atanaska;Shabani, Rabhat;Zacharieva, Sabina
背景：与卡麦角林相反，关于溴隐亭在催乳素瘤患者中可能的促纤维化作用的循证信息非常有限。目的：评估长期使用溴隐亭或卡麦角林治疗的患者瓣膜病变的发生率。设计：病例对照研究。方法：对334例患者进行经胸超声心动图评价，分为4组：卡麦角林组103例，溴隐亭组55例，初治组74例，对照组102例。结果：临床相关瓣膜反流在所有研究组中同样普遍，而在溴隐亭和卡麦角碱治疗的患者中，亚临床瓣膜纤维化明显更频繁（40% vs 43.6 vs 21.6 vs 23.5%； P=0.004）。与未暴露于多巴胺激动剂（DAs）的受试者相比，卡麦角林组发生瓣膜纤维化的比值比（OR）为2.27 (95% CI 1.17-4.41； P=0.016)，溴啡亭组为2.66 （95% CI 1.22-5.78； P=0.014）。与卡麦角碱治疗的患者相比，服用溴隐亭的患者肺动脉压明显升高，治疗时间也相应延长。结论：卡麦角林和溴隐亭的长期治疗似乎与临床上显著的瓣膜疾病的风险增加无关，但可能出现亚临床病变是应该预料到的。超声心动图检查建议在开始和治疗期间定期使用DAs作为5-羟tryamine 2B受体（卡麦角林和溴隐亭）的全部或部分激动剂。溴隐亭似乎不是接受卡麦角林治疗的患者的安全选择，这些患者先前存在或诊断为瓣膜、间质性心肌或肺纤维化的异常。需要进一步研究DA治疗对肺动脉压的可能影响。
Background: In contrast to cabergoline, evidence-based information about a possible profibrotic effect of bromocriptine in prolactinoma patients is extremely limited.Objective: To assess the prevalence of valvular lesions among patients on long-term bromocriptine or cabergoline therapy.Design: Case-control study.Methods: A transthoracic echocardiographic evaluation was performed in 334 subjects divided into four groups: 103 cabergoline treated, 55 bromocriptine treated, 74 naive patients, and 102 controls.Results: Clinically relevant valve regurgitations were equally prevalent in all investigated groups whereas subclinical valve fibrosis was significantly more frequent in both bromocriptine- and cabergoline-treated patients (40 vs 43.6 vs 21.6 vs 23.5%; P=0.004). The odds ratio (OR) for developing valvular fibrosis was 2.27 (95% CI 1.17-4.41; P=0.016) for cabergoline and 2.66 (95% CI 1.22-5.78; P=0.014) for bromocriptine groups compared with subjects not exposed to dopamine agonists (DAs). A significantly higher pulmonary arterial pressure corresponding to the longer treatment duration was observed among patients taking bromocriptine compared with cabergoline-treated subjects.Conclusions: Long-term treatment with cabergoline and bromocriptine seems not to be associated with an increased risk of clinically significant valve disease but possible subclinical lesions should be expected. An echocardiographic examination is recommended at the beginning and periodically during therapy with DAs acting as full or partial agonists of 5-hydroxytrytamine 2B receptors (cabergoline and bromocriptine). Bromocriptine seems not to be a safe alternative for patients receiving cabergoline treatment who have preexisting or diagnosed abnormalities suggesting valvular, interstitial myocardial, or pulmonary fibrosis. Further studies are needed to investigate the possible impact of DA treatment on pulmonary arterial pressure.