复方口服避孕药对青春期女性骨矿物质密度的影响

目的:观察16～18岁女性应用妈富隆和炔雌醇醋酸环丙孕酮对骨矿物质密度(BMD)的影响。方法:选择376例16～18岁青春期女性,其中127例女性应用妈富隆,134例应用炔雌醇醋酸环丙孕酮,115例应用非激素避孕(对照组),应用双能X线吸收法测量腰椎和股骨颈BMD,比较口服复方避孕药者与对照组女性BMD的改变。结果:用药24个月,应用妈富隆的女性腰椎、股骨颈BMD与基础值相比轻度降低,但差异无统计学意义(P>0.05);而应用炔雌醇醋酸环丙孕酮的女性腰椎和股骨颈BMD与基础值相比轻度增高,差异无统计学意义(P>0.05);与对照组相比,腰椎和股骨颈BMD增加幅度减小。应用妈富隆和炔雌醇醋酸环丙孕酮者与对照组女性相比,腰椎和股骨颈BMD没有明显差异(P>0.05)。结论:16～18岁青春期女性应用妈富隆或炔雌醇醋酸环丙孕酮2年对BMD没有不利影响,但是继续应用是否影响BMD峰值的获得有待进一步研究。

Effect of combined oral contraceptives on bone mineral density in adolescent women

Objective: To compare bone mineral density(BMD) among users of Ethinylestradiol/Desogestrel,Ethinylestradiol/Cyproterone Acetate and nonhormonal control subjects in women aged 16-18.Methods:376 women aged 16-18 were selected.127 women used Ethinylestradiol/Desogestrel,134 women used Ethinylestradiol/Cyproterone Acetate and 115 women using nonhormonal contraception were selected as control subjects.BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry,to compare mean BMD changes.Results:After 24 months of treatment,lumbar spine and femoral neck BMD in women who used Ethinylestradiol/Desogestrel were slightly lower compared with baseline,but there were no statistical differences(P=0.837 and P=0.630,respectively),while the mean lumbar spine and femoral neck BMD values in women who used Ethinylestradiol/Cyproterone Acetate were slightly higher compared with baseline,there were no statistical differences(P=0.789 and P=0.756,respectively).The increase in mean percent change in lumbar spine and femoral neck BMD in the Ethinylestradiol/Cyproterone Acetate group were smaller than those of control group(0.20% vs 1.88% and 0.49% vs 1.10%,respectively).There were no significantly differences in BMD of the lumbar spine and femoral neck among the users of Ethinylestradiol/Desogestrel,Ethinylestradiol/Cyproterone Acetate and nonusers(P>0.05).Conclusion:Two years of combined oral contraceptive(COCs) use has no significant effect on BMD but it remains unknown whether longer than two years of use has a significant adverse effect on the attainment of peak BMD.