VitD_3对血清脂类水平的不良影响:应用戊酸雌二醇、环丙氯地孕酮和/或VitD_3的追踪研究

绝经后妇女血中脂蛋白水平改变:低密度脂蛋白(LDL)浓度升高及高密度脂蛋白(HDL)浓度降低,致使冠心病(CHD)发病率增高。既往研究认为外源性雌激素可以改变绝经后妇女血中脂蛋白水平,对心血管系统起保护作用,此观点已得到承认。已有研究指出,血浆HDL水平增高1mg/dl,CHD危险性     

雌激素对绝经后妇女LDL颗粒大小的影响

为观察雌激素对脂代谢物和低密度脂蛋白(LDL)颗粒大小的影响,1996年2月1日～1996年7月31日对20例绝经后日本妇女(平均年龄54岁,平均体表指数22.50kg/cm~2)应用结合马雌激素治疗。研究对象绝经至少1年,禁烟酒,无甲状腺疾病、肝病或糖尿病等,近期未服影响脂蛋白代谢的药物。口服结合马雌激素0.625mg/d,共3个月。治疗前、后作内膜活检及空腹12h后8～10Am抽血检查。血总胆固醇(TC)和甘油三酯(TG)与高密度脂蛋白胆固醇(HDL-C)用酶标法测定,阿朴脂蛋白(Apo)A-     

雌激素补充治疗对绝经妇女同型半胱氨酸影响的初步观察

目的 :观察雌激素补充治疗 (ERT)对绝经妇女同型半胱氨酸 (HCY)的影响。方法 :绝经 1～ 5年正常妇女118例 ,分为 3组 ,Ⅰ组 38例用激素补充治疗 (HRT) 1～ 2年 (戊炔雌三醇 2mg/月 ,每 3个月用甲羟孕酮 8mg/d连用 10天 ) ,Ⅱ组 4 0例短期用ERT组 (戊炔雌三醇 2mg/月用药 3个月 ) ,Ⅲ组 4 0例不用HRT为对照组。Ⅰ组测HCY、Ⅱ组用药前后测HCY ,Ⅲ组与Ⅱ组同期测 2次HCY。结果 :Ⅱ组接受ERT治疗 3个月 ,治疗前HCY(16 .17± 6 .36 ) μmol/L ,治疗后(11.99± 3.2 4 ) μmol/L ,差异有显著性 (P <0 .0 5 ) ;Ⅰ组HCY(12 .0 4± 2 .99) μmol/L ,Ⅲ组 (15 .0 1± 6 .11) μmol/L ,两组差异有显著性 (P <0 .0 5 )。结论 :长期HRT或短期ERT治疗 ,均可使HCY水平降低     

控制性超促排卵对不孕妇女血脂代谢及血清瘦素的影响

目的:探讨控制性超促排卵(COH)对不孕妇女血脂代谢及血清瘦素的影响。方法:接受体外授精-胚胎移植不孕妇女48例,以自身自然周期为对照,比较自然周期与促排卵周期在不同时间点血清高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胆固醇(TG)、甘油三酯(TC)、瘦素(LEP)、雌二醇(E2)及孕酮(P)水平的变化,分析COH过程中血脂各因子及LEP的变化规律。结果:自然周期和促排卵周期血脂各指标无明显波动(P0.05);HDL变化与雌激素水平呈正相关,LDL、TG、TC变化趋势与雌激素水平呈负相关;在自然周期LH出峰日LEP均值水平出现高峰,且明显高于相应自然周期月经第2天的LEP水平(P0.05);COH周期HCG注射日LEP均值水平亦出现高峰,且明显高于促排卵周期月经第2天的LEP水平(P0.05);血清LEP与血清E2呈正相关(P0.05)。结论:短时间应用COH治疗对不孕女性脂代谢无不良影响。     

雌激素对绝经后妇女低密度脂蛋白微粒大小的影响

雌激素替代疗法(ERT)对绝经后妇女的脂质代谢有一定的影响。为研究雌激素对绝经后妇女低密度脂蛋白(LDL)微粒大小的影响,选择20例日本绝经后妇女,其平均年龄54(范围52～62)岁,平均体质指数22.50(范围17～26.50)kg/cm~2,闭经至少1年,不吸烟,不使用可卡因或酒精,无甲状腺疾病、肝病或糖尿病,也未服用影响脂质代谢的药物。每例均使用天然结合型雌激素,0.625mg/d,共3个月。治疗前、后各作子宫内膜活检并测定血浆总胆固醇(TC),甘油三酯(TG),高密度脂蛋白(HDL)及其载脂蛋白AⅠ、AⅡ和B(APO-AⅠ,APO-AⅡ、APO-B)水     

北京地区7~18岁青少年血脂现状调查

目的通过最新一轮的北京地区儿童青少年血脂调查，建立新的正常参考值。 方法于2004-09，随机选取7~18岁北京市中小学生共971人，均来自北京市区及郊区各县。根据年龄(每3岁为一年龄段)及性别分为8组(7~9岁男、女组；~12岁男、女组；~15岁男、女组；~18岁男、女组)，应用日立7060型全自动生化分析仪检测其空腹血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL C)及低密度脂蛋白胆固醇(LDL C)浓度，分别取TC、LDL C第75百分位及第90百分位点作为临界高限及高胆固醇血症浓度，取TG第90百分位点作为高甘油三酯血症浓度，取HDL C第5百分位点作为低高密度脂蛋白浓度，建立北京地区儿童血脂参考值。 结果971名儿童的血浆脂蛋白含量值呈正偏态分布，7~9岁男女性别组间血脂4项浓度；~12岁性别组间TG含量女高于男，余3项无统计学差异；~15岁性别组间TC及LDL C含量女高于男，余2项无统计学差异；~18岁性别组间TC及HDL C女高于男，余2项无统计学差异。 结论通过对971名北京市中小学生的血脂调查，建立了北京地区不同年龄性别儿童青少年的血脂正常值，确立了临界高胆固醇和高胆固醇血症浓度、高甘油三酯血症浓度和低高密度脂蛋白浓度。     

口服和经皮雌激素替代疗法对手术绝经妇女围绝经症状、血脂和凝血功能的影响

目的:研究口服和经皮雌激素替代疗法(ERT)对手术绝经妇女围绝经症状、血脂和凝血功能的影响。方法:手术绝经妇女随机分为口服组和皮贴组,分别使用雌二醇(E2)口服片(1 mg/d)和雌二醇皮贴片(1.5 mg/周)3个月。用药前、后分别检测血中E2和卵泡刺激素(FSH)水平,评估围绝经症状和生存质量,测定血脂和凝血功能。结果:口服组和皮贴组用药后血清E2水平明显升高,FSH水平明显降低,围绝经症状和生存质量均得到明显改善,组间无统计学差异。口服组用药后三酰甘油(TG)、高密度脂蛋白(HDL)较治疗前显著上升,低密度脂蛋白(LDL)较治疗前显著降低;皮贴组用药后HDL较治疗前有升高趋势,但差异无统计学意义(P>0.05),LDL较治疗前显著降低(P<0.05)。口服组用药后活化部分凝血活酶时间(APTT)较治疗前显著降低,其余各凝血指标与治疗前比较均无统计学差异;皮贴组用药后各凝血指标均较治疗前无显著变化。结论:口服和经皮ERT均能改善手术绝经妇女的围绝经症状,但两者在血脂和凝血方面作用不同。     

更年期女性胆固醇水平调查与影响因素分析

目的研究胆固醇代谢与绝经的关联和可能的影响因素。方法对杭州市拱墅区963例40~60岁女性进行横断面调查,收集其月经史及其他临床资料,填写改良Kupperman更年期症状量表(mKMI),检测血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)水平。收集参与者教育程度、婚姻状态、职业状态、收入、居住地等社会人口资料。研究不同绝经状态女性胆固醇水平及高胆固醇血症、LDL-C升高的发生率,并分析年龄、绝经状态、FSH、E_2、社会人口等因素对血清胆固醇的影响。结果963例参与者平均年龄(51.0±5.6)岁,其中绝经前期302例(31.4%),围绝经期197例(20.5%),绝经后期464例(48.2%),绝经后参与者的平均绝经年龄(49.9±3.8)岁。在所有参与者中,绝经前期mKMI总分(6.36±6.43)显著低于围绝经期(10.30±7.88)和绝经后期(10.35±7.97)(P0.001)。绝经前后平均TC、LDL-C水平呈显著上升趋势,FSH、LH水平呈上升趋势,E_2水平呈下降趋势(P0.001)。所有参与者中高胆固醇血症比例为13.3%,LDL-C升高比例为15.0%,从绝经前期过渡到围绝经期、绝经后期的过程中,高胆固醇血症及LDL-C升高的发生率显著上升(P0.001)。Logistic多元回归分析表明FSH≥40IU/L是发生高胆固醇血症和LDL-C升高的危险因素(OR=2.821,95%CI=1.429~5.569,P=0.003;OR=2.587,95%CI=1.356~4.937,P=0.004),调整FSH水平后,年龄、绝经状态、E_2水平、社会人口因素与发生高胆固醇血症和LDL-C升高均无显著关联(P0.05)。结论相比绝经前期,围绝经期和绝经后女性平均TC、LDL-C上升,胆固醇水平升高的发生率增加,FSH水平升高可能是胆固醇代谢紊乱的内在机制,降低FSH水平可作为绝经激素补充治疗的目标和疗效指标。     

地屈孕酮在绝经期女性激素补充治疗中的应用

目的探讨地屈孕酮在绝经期女性激素补充治疗中对子宫内膜的保护和对心血管系统的作用;方法绝经5年内有绝经症状无激素补充治疗禁忌证的35例健康女性,采用戊酸雌二醇1mg+地屈孕酮5mg的连续联合的方案;结果 35例治疗前后子宫内膜无明显改变(P>0.05),治疗前后血总胆固醇(TC)、甘油三酯(TG)无明显变化(P>0.05),治疗后低密度脂蛋白(LDL-C)降低,高密度脂蛋白(HDL-C)升高,治疗后9个月与治疗前/治疗后3个月比较差异有统计学意义(P<0.05);结论地屈孕酮在绝经期女性"雌激素应用窗口"启动激素补充治疗中能有效的保护子宫内膜,可以改善脂代谢,降低心血管疾病的风险。     

激素替代治疗5年安全性分析

目的　探讨激素替代治疗 (HRT)的安全性。方法　 1994年 1月至 2 0 0 1年 8月应用激素替代治疗已满 5年的 74例绝经期妇女 ,分别用倍美力与利维爱治疗。每半年进行妇科、乳腺的B超检查 ,每年进行血生化系列检查。结果　倍美力组用药前甘油三脂 (TG)与用药后比较明显上升 (P <0 0 1) ,高密度脂蛋白胆固醇 (HDL C)上升 (P <0 0 5 ) ,低密度脂蛋白胆固醇 (LDL C)下降 (P <0 0 5 )。利维爱组用药前后比较 ,TG明显降低 (P<0 0 1) ,LDL C下降 (P <0 0 5 )。两组子宫出血例数以绝经初期及应用HRT 3年内最多 ,用药后子宫内膜厚度无明显增加 (P >0 0 5 ) ,子宫体积渐缩小。乳腺增生程度呈减轻趋势 ,但存在个体差异。结论　定期对接受HRT的妇女进行检查及评价 ,使HRT的应用更为安全有效。     

A prospective study of nylestriol on plasma lipids in postmenopausal women]

A prospective, double-blind clinical study has been carried out in 90 chinese women with postmenopausal period covering 0.5 to 21 years by administering a synthetic long-acting estriol derivative-nylestriol in the regimen of 2 mg every 2 weeks for 1 year (49 treated and 41 placebo). The result were: Total cholesterol (TC) and triglyceride (TG) remained unchangeable (P greater than 0.05), while high-density-lipoprotein cholesterol (HDL-C) increased after 6 months, low-density lipoprotein cholesterol (LDL-C) and TC/HDL-C,LDL-C/HDL-C ratios decreased after 3 months of medication (P less than 0.05); FSH were restrained (P less than 0.05), but LH did not change significantly (P greater than 0.05). One third of the women with intact uterus had spotting withdraw bleeding and another one third had moderate amount after the addition of medroxyprogesterone acetate 6 mg daily for 7 days at the end of the 12 months treatment. Side effects included breakthrough bleeding (10.3%), breast tenderness (11.8%), leukorrhagia (29.4). None showed abnormal liver function (GPT).     

孕三烯酮对子宫内膜异位症患者脂代谢及骨密度的影响

目的　观察孕三烯酮对子宫内膜异位症患者脂代谢、性激素水平及骨密度的影响。方法　选择经腹腔镜或开腹手术确诊为子宫内膜异位症的患者 56例,年龄 20 ~45岁,以 40岁为界限分为Ⅰ组 20~39岁(30例),Ⅱ组 40~45岁(26例)。于术后 1周开始口服孕三烯酮,每周 2次,每次 2 5mg,连服 6个月,分别于服药前、服药 6个月时、停药 6个月时测定血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白 胆固醇(HDL-C)、低度脂蛋白 胆固醇 (LDL C)、载脂蛋白A1 (ApoA1 )、载脂蛋白B(ApoB)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇水平及骨密度。结果　服药 6个月时,血清HDL C、ApoA1,Ⅰ组为(1.13±0.26)mmol/L、( 0.91±0.76)g/L;Ⅱ组为(0.95±0.24)mmol/L、(0.92±0.16)g/L;血清LDL-C、ApoB,Ⅰ组为 ( 2.6±0.8 )mmol/l、( 1.28±0.16 )g/L;Ⅱ组为 ( 3. 7±1.1)mmol/L、(1.47±0.44)g/L;服药 6个月时雌二醇及骨密度也显著下降,而TG、TC、FSH、LH水平无明显变化。停药 6个月时,上述各指标均能恢复至服药前水平,骨密度回升,但未能完全达到服药前水平,但停药后 1年,骨密度基本接近服药前水平。结论　孕三烯酮治疗子宫内膜异位症可降低雌二醇水平和骨密度,对血脂代谢有不利的影响,故不宜长期使用;停药 6个月后各指标基本恢复。     

Are serum chemerin levels different between obese and non-obese polycystic ovary syndrome women?

The objective of this study is to measure serum chemerin levels in women with polycystic ovary syndrome (PCOS) and assess their relationship with clinical, metabolic, and hormonal parameters. One hundred eighteen PCOS women and 114 healthy women were recruited in this study. Their blood pressure, body mass index (BMI), waist circumference and waist-to-hip ratio (WHR), fasting insulin (FIN), fasting plasma glucose (FPG), blood serum sex hormone, and blood lipid were measured. Serum chemerin, leptin, and adiponectin were measured by ELISA. Serum chemerin was significantly higher in the obese PCOS group (47.62?±?11.27?ng/mL) compared with non-obese PCOS (37.10?±?9.55?ng/mL) and the obese (33.71?±?6.17?ng/mL) and non-obese (25.78?±?6.93?ng/mL) control groups (p?p?相似文献   

Effects of lovastatin and gemfibrozil in subjects with high ratios of total cholesterol to high-density lipoprotein cholesterol.

Insulin resistance is associated with hypertriglyceridemia, low serum high-density lipoprotein cholesterol (HDL-C) concentrations and high serum total cholesterol (TC) to HDL-C ratios. Several reports have demonstrated that either lovastatin or gemfibrozil may favorably lower serum lipid concentrations. However, their effects on insulin sensitivity are unknown. The primary aim of this study was to compare the effects of lovastatin and gemfibrozil on insulin sensitivity and serum leptin concentrations in subjects with high TC/HDL-C ratios. We enrolled 25 nondiabetic patients, similar in terms of age and weight with TC/HDL-C ratios greater than 5. Thirteen subjects were treated with lovastatin 20 mg per day, and 12 received gemfibrozil 300 mg twice per day. Plasma lipids, glucose, and leptin were measured, and a 75-g oral glucose tolerance test (OGTT) and a modified insulin suppression test were performed before and after 3 months of treatment. The study showed the mean plasma TC, low-density lipoprotein cholesterol (LDL-C) concentrations, and TC/HDL-C ratio were significantly reduced in the lovastatin-treated group, but no obvious effects on plasma triglyceride (TG) and HDL-C were noted. In the gemfibrozil group, plasma TG and HDL-C were markedly lowered, but no significantly different effects in other plasma lipids were found. Gemfibrozil did not affect steady-state plasma glucose (SSPG) concentrations, whereas lovastatin significantly increased SSPG concentrations. Neither drug affected the serum leptin concentration during the OGTT. We conclude that lovastatin significantly lowers plasma TC and LDL-C ratio, and TC/HDL-C concentrations and adversely affects insulin sensitivity, while gemfibrozil markedly reduces plasma TG concentrations without altering insulin sensitivity in subjects with high TC/HDL-C ratios.     

A Study of Lipoproteins in Normal and Pregnancy Induced Hypertensive Women in Tertiary Care Hospitals of the North West Frontier Province-Pakistan

Objectives. To evaluate the levels of serum lipoproteins in women with pregnancy-induced hypertension and compare it with the corresponding levels in pregnant women having normal blood pressure. Method. This cross-sectional study was conducted in the three tertiary care hospitals of Peshawar, North West Frontier Province, Pakistan. A total of 206 pregnant women at gestational age of >20 weeks were registered in the study after taking informed consent. All relevant information was recorded on a predesigned questionnaire. Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C) and triglyceride (TG) levels were measured in 151 women with pregnancy induced hypertension (PIH) and compared with the corresponding values for a control group of 55 normotensive pregnant women. Result. Cholesterol levels were not statistically different between the patient group and controls. Triglyceride levels were significantly higher in the patient group than in controls. Women who developed hypertension after 20 weeks of gestation had 6.7, 4.2, 40.5, and 39.7% higher concentrations of TC, LDL-C, VLDL-C, and TG, respectively, and 28, 22.4, and 67.6% higher ratios of TC : HDL-C, LDL-C : HDL-C, and TG : HDL-C, respectively, as compared to the control subjects. The mean difference of the concentrations of HDL-C, VLDL-C, and TG, and the ratios TC : HDL-C, LDL-C : HDL-C, TG : HDL-C, and HDL-C : VLDL-C between the patients and control group was statistically significant. Conclusion. The assessment of blood lipids may be helpful in the prevention of complications in PIH patients.     

Levels of lipoprotein and homocysteine in non-obese and obese patients with polycystic ovary syndrome.

AIM: This study was designed to examine the relationship between homocysteine (Hcy), lipoprotein levels and insulin resistance in obese and non-obese patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Eighty-five patients (38 obese, 47 non-obese) with PCOS and 50 healthy subjects (25 obese, 25 non-obese) were included in the study. PCOS was defined according to the Homburg criterion. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), insulin, 17-hydroxyprogesterone, free testosterone, androstenedione, vitamin B12 and folate were measured. Also, serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), apoprotein B (Apo B) and apoprotein A (Apo A) were determined. Plasma Hcy levels were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA). RESULTS: Plasma Hcy levels were significantly higher in women with PCOS than in healthy women. HOMA-R (insulin resistance) was significantly higher in women with PCOS compared with healthy women. Serum fasting TC, LDL-C, TG, Apo B, vitamin B12 and folate levels were similar between PCOS and control groups. Lp(a) levels were higher in PCOS patients than in control subjects, whereas HDL-C and Apo A levels were lower. Compared with obese PCOS subjects, non-obese PCOS subjects had low HOMA-R, TC, LDL-C, TG, Apo B, Lp(a) and androgen levels. Plasma Hcy levels, serum HDL-C and Apo A levels were similar between obese and non-obese women with PCOS. Levels of HDL-C and Apo A were lower in both obese and non-obese PCOS patients than in obese and non-obese control subjects, whereas Lp(a) levels were higher. No correlation was observed between plasma Hcy, body mass index, HOMA-R, serum androgen levels, TC, LDL-C, HDL-C, Apo A, Apo B and Lp(a) levels. CONCLUSION: These results showed that elevated insulin resistance and plasma Hcy levels, and changes in serum lipid profile, which are possible risk factors for cardiovascular disorders, play important roles in the development of cardiovascular disease in both obese and non-obese patients with PCOS.     

Effects of simvastatin only or in combination with continuous combined hormone replacement therapy on lipid levels in hypercholesterolemic women

OBJECTIVE: To evaluate the effects of simvastatin only or combined with continuous transdermal hormone replacement therapy (HRT) on the serum lipid profile in hypercholesterolaemic women. MATERIAL AND METHODS: The study population consisted of 75 women after menopause, ranging in age from 45 to 62. The patients were divided into five groups: group I--women receiving HRT (Systen Sequi, Cilag); group II--HRT + statin (Systen Sequi, Cilag + Zocor, MSD); group III--HRT (Systen Conti, Cilag); group IV--HRT + statin (Systen Conti, Cilag + Zocor, MSD) and group V--statin only (Zocor, MSD). Before and after 3 and 6 months therapy serum total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) was measured. RESULTS: The combination of simvastatin + HRT or simvastatin only decreased significantly TC and LDL-C, and increased HDL-C levels at 3 months (groups II, IV and V). A comparative analysis revealed that HRT effect on TC, LDL-C and HDL-C was significantly observed after 6 months (group I and III). TG levels significantly decreased after 6 months of therapy (simvastatin + HRT) in groups II and IV. CONCLUSIONS: The combination of simvastatin and HRT seems to be more effective than simvastatin only in the treatment of hypercholesterolaemia in women.     

Effects of E2 and E2/norgestimate hormone therapy on elevated baseline lipids

OBJECTIVE: To evaluate lipid effects of estradiol/ norgestimate hormone therapy in postmenopausal women with elevated lipid levels. STUDY DESIGN: Postmenopausal women were randomized to E2, 1 mg/intermittent norgestimate (NGM) 90 microg (n = 31), or opposed E2, 1 mg (n = 36), in a 12-month trial. A subset analysis was conducted on participants with unfavorable baseline lipid levels, either total cholesterol (TC) levels > 200 mg/dL, high-density lipoprotein cholesterol (HDL-C) levels < 40 mg/dL, low-density lipoprotein cholesterol (LDL-C) levels > or = 160 mg/dL or triglyceride levels > or = 150 mg/dL. Mean changes and categorical shifts were assessed on fasting blood samples collected at baseline and at 7 and 12 months. RESULTS: Twelve-month mean changes from baseline in women treated with E2/NGM included a 19.8% increase in HDL-C and decreases of 13.4% in LDL-C, 17.5% in triglycerides and 3.3% in TC. Women with poorer lipid profiles at baseline showed the greatest benefit. Results were similar in women randomized to unopposed E2. CONCLUSION: E2/NGM and unopposed E2 were similarly beneficial in modifying lipid fractions in women with unfavorable baseline levels.     

Five years with continuous combined oestrogen/progestogen therapy. Effects on calcium metabolism, lipoproteins, and bleeding pattern

OBJECTIVE--To study the effect of long-term continuous combined oestrogen/progestogen therapy on calcium metabolism, lipoproteins, and bleeding pattern in early postmenopausal women. DESIGN--A prospective, open, controlled study. After initial examinations, control examinations were performed every three months for the first two years and every year for the following three (two) years, with determinations of bone mass, serum lipoproteins, and bleeding pattern. SETTING--Out-patient research clinic at The Department of Clinical Chemistry, Glostrup Hospital, Denmark. PARTICIPANTS--Eighteen healthy women between 6 months and 3 years after a natural menopause, entered in a trial of continuous long-term hormone replacement therapy and a comparison group of 19 age-matched untreated women. INTERVENTION--The treated group received 2 mg of 17 beta-oestradiol combined with 1 mg of norethisterone acetate orally each day continuously for 5 years with a 3 month therapy-free interval after the first 2 years. The women were investigated before treatment, then every 3 months for the first 2 years and every year for the next 3 years for determinations of bone mass, serum lipoproteins and bleeding patterns. The comparison group was followed-up in parallel for the first 4 years. Forearm bone mass was measured with single photon absorptiometry. Blood and urine samples were taken in the morning after an overnight fast and tobacco abstinence. MAIN OUTCOME MEASURES--The effects of hormone therapy on bone mineral content in the forearm, on serum and urine indices of calcium metabolism, on serum levels of total, high (HDL-C) and low (LDL-C) density lipoprotein cholesterol, and bleeding pattern. RESULTS--Bone mineral content in the forearm was stable during the 5 years of treatment, whereas it declined significantly averaging 10% after 4 years in the comparison group. The biochemical estimates of bone turnover decreased to premenopausal level in the hormone group, whereas they remained at a high level in the comparison group. In the hormone group total cholesterol and LDL-C decreased by 20% whereas HDL-C was virtually unchanged. The treatment was associated with minor irregular bleeding in nine women during the first 6 months of treatment, after which no bleeding was experienced. CONCLUSION--Continuous combined oestrogen/progestogen therapy can keep early postmenopausal women free of bleeding episodes for a period of 5 years, after the first 6 months in which spotting occurs in 25%. The therapy prevented bone loss completely. The changes in serum lipoproteins were concordant with a lipid profile associated with a decreased risk of coronary heart disease.     

Contraception in diabetic women: comparative metabolic study of Norplant, depot medroxyprogesterone acetate, low dose oral contraceptive pill and CuT380A

OBJECTIVE: To evaluate the long-term intake of Norplant, depot medroxyprogesterone acetate (DMPA) and low dose oral contraceptive pill (OCs) on glycemic control, lipoprotein metabolism and coagulation profile in diabetic women. METHODS: Prospective comparative study including 80 uncomplicated controlled diabetic women. Twenty women allocated to each group. Clinical, metabolic and coagulation status were followed up at 3, 6 and 9 months' visits. RESULTS: Fasting blood sugar increased in OCs and DMPA users. Total cholesterol (TC) and LDL-cholesterol (LDL-C) decreased in all groups except DMPA where it increased. Triglyceride (TG) only increased in OCs group. HDL-cholesterol (HDL-C) increased with OCs and decreased with Norplant and DMPA. Compared to IUD users, significantly higher percentage TG and HDL-C and lower LDL-C were observed in OCs users, while DMPA users had significantly higher TC and LDL-C and lower HDL-C. Partial thromboplastin time was prolonged in Norplant users. CONCLUSION: In diabetics, Norplant results in minimal metabolic alterations followed by OCs while DMPA has unfavorable outcome.