Antipsychotic-induced hyperprolactinemia inhibits the hypothalamo-pituitary-gonadal axis and reduces bone mineral density in male patients with schizophrenia
Antipsychotic-induced hyperprolactinemia inhibits the hypothalamo-pituitary-gonadal axis and reduces bone mineral density in male patients with schizophrenia
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DOI：
10.4088/jcp.v69n0307
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发表时间：
2008-03-01
影响因子：
5.3
通讯作者：
Kashima, Haruo
中科院分区：
文献类型：
--
作者：
Kishimoto, Taishiro;Watanabe, Koichiro;Kashima, Haruo
目的：高催乳素血症对下丘脑-垂体-性腺轴的抑制作用被认为是精神分裂症患者骨质流失的机制之一，但尚未得到证实。本研究于2005年2月至5月在日本东京进行，我们研究了男性精神分裂症患者骨密度（BMD）降低的可能原因。方法：采用双能x线骨密度仪测量74例符合DSM-IV精神分裂症诊断标准的男性患者（31-78岁）桡骨骨密度。同时测定催乳素（PRL）、促卵泡激素（FSH）、促黄体生成素（LH）、睾酮、雌二醇和1,25-二羟基维生素D （VitD）的水平。计步器被用来测量运动的影响。结果：与健康人的参考值相比，所有年龄组的研究对象的骨密度都较低。低、中、高运动组的Z得分无显著差异。87%的受试者有高泌乳素血症，除1例外，其余受试者维生素d水平均正常。与正常PRL组相比，高PRL组FSH、LH水平较低，雌二醇水平较低（p < 0.05）。高PRL组治疗时间与Z评分呈显著负相关（p < 0.05）。结论：与运动量和维生素d水平无关，男性精神分裂症患者的骨密度均低于正常人。结果支持了高催乳素血症对下丘脑-垂体-性腺轴的抑制参与骨质流失机制的假设，并提示高催乳素血症持续时间越长，骨密度降低越大。
Objective: An inhibitory effect of hyperprolactinemia on the hypothalamo-pituitary-gonadal axis has been suggested as a mechanism of bone loss in schizophrenia, but this has not been confirmed. In this study, which was conducted in Tokyo, Japan, from February to May 2005, we examined the possible causes of reduced bone mineral density (BMD) in male patients with schizophrenia.Method: The BMD of the radius of 74 male patients (aged 31-78 years) who met the diagnostic criteria for DSM-IV schizophrenia was measured by dual-energy x-ray absorptiometry. Levels of prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, and 1,25-dihydroxy vitamin D (VitD) were also measured. Pedometers were used to measure the impact of exercise.Results: Study subjects showed lower BMD in all age groups compared with reference values in healthy persons. There was no significant difference in the Z score among low, medium, and high exercise groups. 87% of the subjects had hyperprolactinemia, and VitD levels were normal in all subjects except 1. The high PRL group had lower levels of FSH and LH, and significantly lower levels of estradiol (p < .05), compared with the normal PRL group. In the high PRL group, there was a significant negative correlation between the duration of treatment and the Z score (p < .05).Conclusion: Male patients with schizophrenia had lower BMD than normal individuals irrespective of the amount of exercise or the level of VitD. The results support the hypothesis that inhibition of the hypothalamo-pituitary-gonadal axis by hyperprolactinemia contributes to the mechanism of the bone loss and suggest that the longer the duration of hyperprolactinemia, the greater the reduction in BMD.