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目的 探讨垂体催乳素腺瘤患者妊娠期服用溴隐亭药物治疗的临床治疗效果及服药时间的选择.方法 回顾性分析2001年1月至2014年5月期间北京协和医院神经外科门诊收治的230例未手术垂体催乳素腺瘤女性患者的临床资料,其中2001年1月至2007年12月期间120例为对照组,2008年1月至2014年5月期间110例为治疗组.对照组为发现妊娠后立即停用溴隐亭;治疗组为发现妊娠后继续按原剂量服用溴隐亭.结果 对照组胚胎停育率为16.7％ (20/120),与自然人群中胚胎停育率比较差异有统计学意义(P＜0.05),治疗组为0.91％(1/110),与自然人群中胚胎停育率比较差异无统计学意义(P＞0.05);两组致胚胎畸形率与正常怀孕人群比较差异无统计学意义(P＞0.05).结论 垂体催乳素腺瘤患者妊娠后不宜立即停药,应继续按原剂量规律服药至妊娠4个月,若为大腺瘤则应至胎儿出生全程服药.在服药期间每2周监测血催乳素、孕酮、人绒毛膜促性腺激素及视力视野情况,如果发现孕酮、人绒毛膜促性腺激素偏低应及时足量补充;如果催乳素升高过快同时视力视野障碍加重可适当增加溴隐亭的用量.妊娠期服用溴隐亭可大幅降低胚胎停育率同时不提高胚胎畸形率,所以妊娠期服用溴隐亭是安全的,也是必需的.

Objective To explore the therapeutic efficacies and the timing of taking bromocriptine during pregnancy in patients with pituitary prolactinoma.Methods The clinical data were analyzed retrospectively for 230 women with pituitary prolactinoma at our hospital from January 2001 to May 2014.During January 2001 to December 2007,120 cases were selected as control group.During January 2008 to May 2014,110 cases were recruited into treatment group.When found pregnant,the control group immediately withdrew while the treatment group continued the original dose of bromocriptine.Results The rate of embryo stopping was 16.7％ (20/120) in control group.As compared with the rate of natural population,the difference was statistically significant (P ＜ 0.05); the rate was 0.91％ (1/110) in treatment group.As compared with natural population,the difference had no significance (P ＞ 0.05).No significant inter-group difference existed in embryonic malformation rate (P ＞ 0.05).Conclusion Pituitary prolactinoma patients should continue the original dose of bromocriptine for at least 4 months instead of immediate withdrawal during pregnancy.For those with large adenoma,bromocriptine should be taken throughout pregnancy.Blood levels of prolactin,progesterone,human chorionic gonadotropin (HCG) and visual dysfunction should be monitored every 2 weeks.If the levels of progesterone and HCG are low,they should be timely supplemented.If prolactin rises too rapidly and visual dysfunction worsens,the dose of bromocriptine should be appropriately increased.Taking bromocriptine during pregnancy can significantly reduce the rate of embryo stopping without improving the rate of embryo deformity.Thus use of bromocriptine is both safe and necessary.