我国短效口服避孕药有效性、常见副反应和续用率的系统评估

目的:评估0、1、2号片、复方左炔诺孕酮单相片和复方左炔诺孕酮三相片的有效性、常见副反应和续用率。方法:见“我国常用口服避孕药和宫内节育器系统评估的方法概述”(中国计划生育学杂志2005年1期17页)。结果:共检索到10篇相关文献,4篇入选。在比较1号片、复方左炔诺孕酮单相片和复方左炔诺孕酮三相片的随机对照临床试验中,3组6个月累计妊娠率均小于1.1每百妇女,6个月累计续用率均大于80每百妇女,且3组相似。复方左炔诺孕酮三相片点滴出血、月经延长和缩短发生率均低于1号片,其它常见副反应发生率三者相似。在一项0号片的现况调查中,妊娠的发生率为0,突破性出血达16%以上。未检索到有关2号片有效性和续用率的文献。结论:1号片、复方左炔诺孕酮单相片和复方左炔诺孕酮三相片的有效性及续用率相近;1号片的常见副反应发生率高于复方左炔诺孕酮三相片。现有的资料不足以对0、2号片的有效性和续用率进行系统评估。     

我国长效口服避孕药的系统评估

目的:评估复方炔诺孕酮和复方左炔诺孕酮两种长效口服避孕药的有效性、安全性和可接受性。方法:见“我国常用口服避孕药和宫内节育器系统评估方法概述”(中国计划生育学杂志, 2005年1期17页)。结果:一项随机对照临床试验的结果显示,复方左炔诺孕酮的失败率(校正Pearl指数:1 1 /100妇女年)显著低于复方炔诺孕酮(2 3 /100妇女年) (P<0 05),复方左炔诺孕酮和复方炔诺孕酮1年续用率分别为82 05 /100妇女和73 62 /100妇女,副反应和月经紊乱是两种长效药停用的主要原因;其他研究提示,复方炔诺孕酮的1年失败率2 0 /100妇女,恶心、头昏和白带增多等副反应发生率超过50%,且白带增多不随服药周期的增加而减少,其它副反应,如恶心、头昏、头痛和经量改变等随使用周期的延长而减少;部分研究的临床和实验室检测结果显示,复方左炔诺孕酮和复方炔诺孕酮对血压、血脂和肝功能等指标有影响。结论:已有的数据表明长效口服避孕药的有效性低于其它长效激素类避孕方法和短效口服避孕药。长效口服避孕药中雌激素含量是目前使用的短效口服药中1个月炔雌醇合计量的4 8倍,基于现有资料和已被证实的长期使用高剂量雌激素的危险性,建议临床不提倡使用长效口服避孕药。     

低剂量口服避孕药与妇女高血压关系的研究

对连续服用国产低剂量复方炔诺酮(1号片)和低剂量复方18-甲基炔诺酮(复方18甲)5～25年及同期使用宫内节育器(IUD)的健康妇女457例进行动脉压测定,对血压均值、高血压患病的危险性及其影响因素进行分析。结果表明:与同期IUD对照比较,长期服用低剂量复方避孕片(COC)有升高血压的作用,且1号片大于复方18甲(P<0.01)。分层分析表明连续使用低剂量口服避孕药(OC)15年以上增加患高血压的危险性,1号片组的相对危险度(RR)为3.36(95％CI1.62,6.97 P<0.01),复方18甲组的RR值为2.27(95％CI 1.05,4.88 P<0.05)。Logistic回归分析提示:从事农业生产劳动、有心脑疾患家族史、体质指数、使用COC及长期摄入COC的总剂量为高血压有显著意义的影响因素。研究结果还表明该人群中确诊高血压者已知血压高的比例较低,仅15％～30％。建议在服OC妇女中定期监测血压,在血压达正常高限的妇女中开展高血压一级预防,降低高血压患病危险性。     

炔诺酮口服避孕药与妇女出血型脑卒中的关系

目的:明确目前我国不同配方的国产低剂量复方口服避孕药(Combined oral contraceptives,COC)与出血型脑卒中的关系,以降低COC严重不良反应的发生,提高妇女的生殖健康水平。方法:前瞻观察1997年7月～2000年6月江苏省太仓和如东两县的25个乡镇使用COC妇女和同期使用宫内节育器妇女。结果:①与从未使用者相比,当前国产含炔诺酮的低剂量COC使用者出血型脑卒中发病率明显升高,但未发现梗塞型脑卒中发病率升高;②含炔诺酮的低剂量COC停用5年内仍然存在较高的出血型脑卒中发病危险性(RR=3.55,1.43～8.85),但停用5年以上者出血型脑卒中发病危险性明显降低(RR=1.27,0.59～2.74);③复方炔诺酮片与出血型脑卒中的关系明确,但不能排除其他配方的国产避孕药对出血型脑卒中的影响;④低剂量COC使用者中高血压仍然是出血型脑卒中最重要的危险性因素。结论:国产低剂量复方炔诺酮与出血型脑卒中有关,其对出血型脑卒中发病危险性的影响可持续到停用以后,但该作用可逆。应加强对其它国产COC严重不良反应的监测和研究,对COC使用者进行血压筛查和医学监护。     

咨询门诊

安徽倪珊问:我刚刚结婚不久,服了两三个月的避孕药(每月22粒),停药后现身怀有孕,不知此药对胎儿有无影响? 答:根据你的来信,估计你服用的避孕药是复方18甲基炔诺酮片,此药是我国妇女较为广泛使用的短效口服避孕药。妇女停用短效避孕药后而怀孕所生出的婴儿畸形     

宫内节育器与口服避孕药临床效果评估

目的评估宫内节育器与口服避孕药的临床效果。方法选取本校附院2010年8月—2012年8月要求避孕的122例妇女,分为口服避孕药组和宫内节育器组,每组61例。其中口服避孕药组服用复方炔雌醚片30例,服用去氧孕烯炔雌醇片31例;宫内节育器组使用母体乐31例,30例吉尼环。结果宫内节育器组的意外怀孕、不良反应率均明显高于口服避孕药组(P<0.05),具有统计学意义。     

新型口服避孕药可能增加血栓风险

<正>对服用任何复方口服避孕药(含有雌激素与孕激素)的妇女来说,其血栓的总体风险仍然相对较低,每1万名服用药物的妇女中,每年额外增加6~14例病例。但近日,英国一项大型研究表明,服用新型口服避孕药的人群发生血栓的风险更高。静脉血栓栓塞(VTEs)在服用雌激素药物的妇女中更为常见,如果血栓移动并运行到心脏、大脑或肺部则有可能是致命的。新型复方避孕药包括孕激素屈螺酮、去氧孕烯、孕二烯酮或环丙孕酮,与包括左炔诺孕酮与炔诺酮在内的老款药物相比,新型     

国产探亲避孕药的评估

目的:评估我国5种探亲避孕药的有效性、副反应、安全性及可接受性。方法:检索相关文献并对纳入评估系 统的探亲避孕药进行数据分析。结果:共检索到50篇相关文献,11篇文献被纳入本评估,其中4篇为无对照的临床 试验,7篇为一期临床试验。根据有限的资料分析,探亲避孕片1号及53号探亲抗孕片早期服用方案的避孕失败率 在3.5～16.4/100妇女年之间。一期临床试验显示服用53号探亲抗孕片后并不能完全抑制排卵。53号探亲抗孕片 还可能抑制乳汁分泌。未检索到探亲避孕片1号及53号探亲抗孕片现用方案及炔诺孕酮速效避孕片、左炔诺孕酮速 效避孕片和炔诺酮探亲丸临床资料。结论:建议在较短时间内逐渐停止使用探亲避孕药。如果需要保留部分探亲避 孕药,需要对其有效性、副反应、安全性重新进行研究。     

短效口服避孕药：三利与三弊

今年是短效复方口服避孕药诞生50周年。到今天,全球大约有1亿女性使用复方口服避孕药,是使用最为广泛的避孕方式之一。短效口服避孕药服用正确有效性几乎100％,具有效果肯定、安全性好、作用可逆等优点,是育龄女性常规避孕首选方法之一。     

人工流产者对可逆避孕方法认知及可能影响因素

目的:探讨意外妊娠行人工流产者对可逆避孕方法认知及相关影响因素。方法:选取2017年3月—2018年5月本院收治的270例意外妊娠人工流产者,问卷调查获取可逆避孕认知情况。结果:调查对象宫内节育器知识得分(42.9±25.2分)高于左炔诺孕酮宫内节育系统(6.6±3.4分)和复方短效口服避孕药(6.0±3.4分)(P0.001);不同年龄、居住年限、婚姻状况、人均月收入、本次医疗付费方式、妊娠次数、现有子女数、人工流产次数、今后生育计划、是否已避孕及使用过可逆避孕等知识得分存在差异(P0.05)。多元回归分析,年龄和婚姻状况是避孕知识得分的影响因素(P0.05)。结论:意外妊娠并行人工流产者对可逆避孕方法认知水平较低,主要受年龄和婚姻的影响,医疗机构应加强对流产后妇女相关知识宣传及避孕措施落实,降低重复流产率。     

Metabolic effects of implantable steroid contraceptives for women

The metabolic impact of progestin-only contraceptives is less than that of combined oral contraceptives. Subdermal contraceptive implant systems that provide a sustained release of low levels of progestins are now becoming widely available. This review evaluates the metabolic effects of currently available products that release the progestins levonorgestrel (Norplant, Jadelle, and their Chinese equivalents); etonogestrel (Implanon); nomegestrol acetate (Uniplant); and Nestorone, formally called ST-1435 (Nestorone implant/Elcometrine). Data on liver, kidney, and renal function; carbohydrates and insulin release; hemostasis; blood pressure; and lipids are considered. The metabolic effects reported for these methods as a whole were minimal. Any changes were generally within the normal range for the populations studied and, therefore, are unlikely to be of clinical significance. However, all published studies have been conducted in healthy populations of women. To inform clinical practice, the field would be well served to have additional empiric data from well-designed, well-implemented, and well-reported trials in women who are deemed to be at elevated risk for certain diseases including cardiovascular disease and diabetes.     

Effects of high- and low-isoflavone soyfoods on blood lipids,oxidized LDL,homocysteine, and blood pressure in hyperlipidemic men and women

BACKGROUND: Many of the benefits of soy have been attributed to soy isoflavones. OBJECTIVE: The objective was to determine the effects of high- and low-isoflavone soy-protein foods on both lipid and nonlipid risk factors for coronary artery disease (CAD). METHODS: Forty-one hyperlipidemic men and postmenopausal women participated in a study with three 1-mo diets: a low-fat dairy food control diet and high- (50 g soy protein and 73 mg isoflavones daily) and low- (52 g soy protein and 10 mg isoflavones daily) isoflavone soyfood diets. All 3 diets were very low in saturated fat (< 5% of energy) and cholesterol (< 50 mg/d). Fasting blood samples were drawn and blood pressure was measured at the start and end of each diet. RESULTS: No significant differences were seen between the high- and low-isoflavone soy diets. Compared with the control diet, however, both soy diets resulted in significantly lower total cholesterol, estimated CAD risk, and ratios of total to HDL cholesterol, LDL to HDL cholesterol, and apolipoprotein B to A-I. No significant sex differences were observed, except for systolic blood pressure, which in men was significantly lower after the soy diets than after the control diet. On the basis of blood lipid and blood pressure changes, the calculated CAD risk was significantly lower with the soy diets, by 10.1 +/- 2.7%. CONCLUSION: Substitution of soyfoods for animal products, regardless of isoflavone concentration, reduces the CAD risk because of both modest reductions in blood lipids and reductions in oxidized LDL, homocysteine, and blood pressure.     

Long-term effects of combined oral contraceptives on markers of endothelial function and lipids in healthy premenopausal women

The aim of this prospective cross-over study was to investigate the effect of two low-dosed oral contraceptives on markers of endothelial function and plasma lipids. Twelve healthy, nonsmoking women (mean age: 21.7 years) were recruited from the family planning clinic of the university hospital Zurich. For 6 months the participants received a treatment with two contraceptive pills containing 30 microg ethinyl estradiol/150 microg levonorgestrel (three cycles) and 30 microg ethinyl estradiol/75 microg gestodene (three cycles). Plasma levels of endothelin-1, nitric oxide, cholesterol, and HDL were measurement before and during treatment with both oral contraceptive treatments.No significant changes in the plasma levels of nitric oxide and endothelin-1, both important regulators of the vascular tone, were observed during oral contraceptive use. A significant negative correlation was found between nitric oxide and endothelin-1 and nitric oxide and cholesterol. There was a positive correlation between endothelin-1 and cholesterol. In conclusion, the investigated contraceptive pills did not cause major changes in circulating nitric oxide and endothelin-1 plasma levels.     

Menopause-related changes in lipoproteins and some other cardiovascular risk factors

Changes in lipids, lipoproteins and other cardiovascular risk factors associated with the occurrence of menopause have been examined in a cross-sectional study of 435 healthy white women, aged 45-54 years not using sex hormones. Univariate analysis showed that total cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein A1, apolipoprotein B, triglycerides, systolic blood pressure and fibrinogen were significantly higher in post menopausal women than in premenopausal women. High density lipoprotein (HDL) cholesterol, diastolic blood pressure and blood glucose did not change with menopausal status. After controlling for the effects of confounding variables (age, body mass index and smoking status), total cholesterol, LDL cholesterol, triglycerides, apolipoprotein B and systolic blood pressure remained significantly increased in postmenopausal women as compared with premenopausal women. Our findings add to epidemiological evidence that menopause adversely affects the lipid and lipoprotein metabolism and thus, may increase the risk of coronary heart disease.     

The effect of vaginal administration of low-dose oral contraceptive tablets on human ovulation

The effect of vaginal administration of a low dose combined oral contraceptive pill containing 0.15 mg levonorgestrel and 0.03 mg ethinyl oestradiol was studied in twenty women for a total of 58 cycles. Ovulation was suppressed in all treatment cycles in women receiving two pills daily. Failure of suppression of ovulation occurred in four out of 26 treatment cycles in women receiving one pill daily. Only seven women complained of side effects; most of the side effects were mild and disappeared gradually within the first treatment cycle. Intermenstrual spotting was present in only one case receiving one pill daily. It is concluded that vaginal administration of low dose combined pills has a good ovulation suppression effect with minimal side effects and with good cycle control.     

健康管理降低功能社区人群心血管病危险因素的研究

目的研究健康管理对功能社区人群心血管病危险因素的影响。方法选取在我院健康管理中心做体检的一个功能社区共208名,随机分为对照组（n=104）和健康管理组（n=104）,于入组当时和研究结束后分别测量血糖、血脂、血压等指标,并进行心血管病危险因素问卷调奄。对照组给以体检及问卷评估结果和建议,管理组应用签约式健康管理模式。随访1年观察心血管病危险因素的变化。应用SPSS13．0软件包进行数据统计分析,计数资料采用x2检验,计量资料采用t检验。结果两组基线数据比较差异无统计学意义。通过1年时间的健康管理,健康管理组研究后的10年缺血性心血管病发病绝对危险、危险因素个数、对个人健康状况的满意率、人均年请病假天数、日均蔬菜摄入量、日均体力活动时间、血压等指标均较研究前改善,差异有统计学意义（P均〈0．05）,对照组变化差异无统计学意义（P均〉0．05）。健康管理组研究后的10年缺血性心血管病发病绝对危险、危险因素个数、年请病假天数[（0．8±0．4）、172,118d（人均1．13d）]显著低于同期对照组[（1．3±0,5）、283,264d,（人均2．54d）],差异有统计学意义（P均〈0．05）。健康管理组研究后的对个人健康状况的满意度、蔬菜日均摄入量、日均体力活动时间[83．7％（87／104）,520．5g,1．2h]显著改善于同期对照组[52．9％（55／104）,348．3g,0．3h],差异有统计学意义（P均〈0．05）。结论应用签约式健康管理模式可以降低功能社区人群缺血性心血管病发病绝对危险。     

Relation of body fatness and its distribution to cardiovascular risk factors in young blacks and whites. The role of insulin

Persons whose body fat is distributed predominantly in the abdomen compared with the hips are at increased risk of several chronic diseases. This study examined the cross-sectional relation of percent body fat, computed from skinfold thickness, and fat distribution, measured by the waist-to-hip girth ratio, to physiologic cardiovascular risk factors in a biracial sample (blacks and whites) of young adults aged 18-30 years. The subjects were persons who were examined at baseline (1984-1986) in the Coronary Artery Risk Development in Young Adults Study in four US metropolitan areas. The two hypotheses tested were that 1) after adjusting for percent body fat, waist-to-hip girth ratio is associated with several physiologic risk factors, and 2) fasting concentrations of serum insulin partly explain such association. Percent body fat was significantly associated with all measured blood lipids, lipoproteins, apolipoproteins, uric acid, and blood pressure. Waist-to-hip girth ratio was significantly, although more weakly, associated in multivariate models with blood concentrations of triglycerides, high density lipoprotein (HDL) cholesterol, HDL2 cholesterol, apolipoproteins A-I and B, low density lipoprotein cholesterol (in women only), uric acid, and systolic blood pressure, but was not associated in either sex with total cholesterol, HDL3 cholesterol, or diastolic blood pressure. Fasting serum insulin concentrations were significantly associated with percent body fat (Pearson r = 0.45-0.53), waist-to-hip girth ratio (Pearson r = 0.18-0.27), and most of the physiologic risk factors. Inclusion of fasting insulin in multivariate models reduced, but rarely eliminated, associations between waist-to-hip girth ratio and the physiologic risk factors. These findings suggest that obese young adults, especially those with abdominal fat preponderance, carry a physiologic profile that places them at higher risk of cardiovascular disease, and that fasting insulin concentrations are only partly explanatory.     

Caffeine, blood pressure, and serum lipids

To study the effects of caffeine on serum lipids and blood pressure, we conducted a double-blind, randomized trial with two parallel groups in 69 young, healthy subjects. After a 3-wk run-in period, subjects were randomly assigned to one of two groups receiving either 4-6 140-mL cups filtered decaffeinated coffee per day and an equal number of pills containing 75 mg caffeine or 4-6 140-mL cups filtered decaffeinated coffee per day and an equal number of placebo pills, for 9 wk. In both groups caffeine intake from other sources was not allowed. The main finding of this study is that abstinence from caffeine for a period of 9 wk has no effect on either serum lipids or blood pressure.