复方口服避孕药与肿瘤发病的关系

复方口服避孕药与肿瘤发病的关系山东省胸科医院（２５００１３）山东工业大学校医院山东省结核病防治中心张丽赵保荣王爱芹复方口服避孕药（ＯＣ）长期用药能否诱发及促癌生长，一直是临床关心的问题。现结合文献对其浅述如下。与乳腺癌的关系：目前多数研究认为，ＯＣ的...     

口服避孕药应用所致的凝血异常及其防治

复方口服避孕药(Combined Oral Contraceptives.COC)是雌激素和孕激素复合制剂,是育龄妇女的有效避孕手段,在发达国家有超过1亿的女性在使用口服避孕药.     

服用紧急避孕药后人工流产及宫外孕的临床研究

目的评估服用左旋甲基炔诺酮紧急避孕后宫外孕的发生及避孕失败人工流产情况。方法对2005～2009年于我院就诊的678例宫外孕患者及2 836例行流产术患者进行回顾性研究,观察这些患者中服用紧急避孕药后失败率的发生及宫外孕的发生情况。结果 678例宫外孕患者中66例（9.73%）曾在无保护性性交72 h内服用紧急避孕药,2 836例行流产术的患者中服用紧急避孕药的有225例（7.93%）。结论紧急避孕药的使用应受到重视,以减少避孕失败及宫外孕的发生。     

溃疡性结肠炎环境因素致病作用的研究

目的　探讨某些环境因素对溃疡性结肠炎 (UC)的致病作用。方法　回顾性统计近10年UC住院患者病历。设计表格 ,对 9个项目由专人进行电话调查。非UC对照组亦填写此表格。UC患者组共 10 1例 ,初发平均年龄 ( 3 9.3 5± 14 .94)岁 ,男性 5 6例 ,女性 45例。非UC对照组共 97名 ,平均年龄 ( 3 8.74± 14 .46)岁 ,男性 5 2名 ,女性 45名。UC多因素致病性分析采用Logistic回归分析。结果　UC组中无母乳喂养史比例 2 6/10 1( 2 5 .7%) ,不吸烟者 (含戒烟者 )比例 90 /10 1( 89.1%) ,服用避孕药比例 16/10 1( 15 .8%)均显著高于非UC对照组比例 (P <0 .0 1)。采用后退剔除程序方法进行Logistic回归分析 ,最后进入模型的 3个变量为哺乳史 (OR :0 .2 76,95 %CI:0 .185～ 0 .411) ,吸烟史 (OR :4.5 48,95 %CI:1.895～ 10 .915 ) ,服用避孕药史 (OR :4.2 73 ,95 %CI:1.0 2 6～ 17.798)。 5 7例患者多次复发 ,初发及复发诱因均主要为饮食不当、劳累、精神紧张等。 3例女性患者在产后 2个月内发病。结论　无或缺乏母乳喂养、非吸烟或戒烟及服用避孕药为UC的危险因素 ;饮食不当、劳累、精神紧张甚至妊娠可能为UC的危险因素     

血糖难降——都是避孕药惹的祸

何女士患糖尿病快两年了,自从得了糖尿病后,无论西医还是中医,她都看过,药吃了不少,钱花了不少,可这讨厌的糖尿病却像鬼魂一样死死地缠者她, 总也得不到缓解, 血糖总也降不下来。     

Increased susceptibility for intrahepatic cholestasis of pregnancy and contraceptive-induced cholestasis in carriers of the 1331T〉C polymorphism in the bile salt export pump

AIM： To study the association of three common ABCB11 and ABCC2 polymorphisms （ABCB11： 1331T〉C→V444A; ABCC2： 3563T〉A → V1188E and 4544G 〉A → C1515Y） with intrahepatic cholestasis of pregnancy （ICP） and contraceptive-induced cholestasis （CIC）. METHODS： ABCB11 and ABCC2 genotyping data were available from four CIC patients and from 42 and 33 ICP patients, respectively. Allele-frequencies of the studied polymorphisms were compared with those in healthy pregnant controls and Caucasian individuals. Furthermore, serum bile acid levels were correlated with the presence or absence of the 1331 C allele. RESULTS： The ABCB11 1331T〉C polymorphism was significantly more frequent in cholestatic patients than in pregnant controls： C allele 76.2% （CI, 58.0-94.4） vs 51.3% （CI 35.8-66.7）, respectively （P = 0.0007）; and CC allele 57.1% （CI 36.0-78.3） vs 20% （CI 7.6-32.4）, respectively （P = 0.0065）. All four CIC patients were homozygous carriers of the C allele. In contrast, none of the studied ABCC2 polymorphism was overrepresented in ICP or CIC patients. Higher serum bile acid levels were found in carriers of the 1331CC genotype compared to carriers of the TT genotype. CONCLUSION： Our data support a role for the ABCB11 1331T〉C polymorphism as a susceptibility factor for the development of estrogen-induced cholestasis, whereas no such association was found for ABCC2. Serum bile acid and 7-glutamyl transferase levels might help to distinguish ABCB4- and ABCB11-related forms of ICP and CIC.     

口服避孕药致门静脉海绵样变性伴多发性血栓1例

病例：患者女，51岁，因“食管静脉曲张2年，呕血、黑便1d”于2007年7月10日收治入院。入院当日呕血、黑便750ml，无晕厥、黑嚎。查体：血压94／63mm Hg（1mm Hg=0.133kPa），心率80次/min。全身皮肤苍白，贫血貌。腹平坦，未见腹壁静脉曲张，肝脾肋下未及,叩诊无移动性浊音。双下肢不肿，可见多处淤斑，无红肿。神经系统：右侧肢体轻瘫试验（＋），右手精细运动欠佳，右侧偏身浅感觉略减退，右侧Babinski征（＋），右侧腱反射较左侧稍活跃，右侧肌张力尚正常，左侧肢体无特殊。患者2年来发生右下肢静脉血栓2次,左下肺动脉栓塞1次：1年前因脑出血行颅内血肿清创术：有胆囊炎史5年。曾服用复方炔诺酮片避孕10余年，用法为月经当日起第5d开始服药,每晚一片，连服22d。曾服用华法林片和阿司匹林肠溶片治疗血栓半年。     

宫外孕的诊断与治疗

宫外孕由著名的阿拉伯外科医师Ablucasis于公元前963年首先报道，由于统计方法的不同，其结果有很大的差异，无论用什么统计方法，宫外孕的发病率在不断地增加是一个不争的事实。根据国外报道：绝育后发生的妊娠中15％～20％为宫外孕。用紧急避孕药者，宫外孕发病率增加。也有些作者报道，人工流产可以增加宫外孕的危险性。传统的观念认为，宫外孕的病因可分为两类：一类为影响受精卵到达宫腔的因素，另一类为孕卵的内在因素。     

Improvement of barrier function and stimulation of colonic epithelial anion secretion by Menoease Pills

AIM: Menoease Pills(MP)1 a Chinese medicine-based new formula for postmenopausal women, has been shown to modulate the endocrine and immune systems. The present study investigated the effects of MP and one of its active ingredients, ligustrazine, on epithelial barrier and ion transport function in a human colonic cell line, T84.METHODS: Colonic transepithelial electrophysiological characteristics and colonic anion secretion were studied using the short circuit current (Isc) technique. RT-PCR was used to examine the expression of cytoplasmic proteins associated with the tight junctions, ZO-l(zonula occludens-1) and ZO-2 (zonula occludens-2).RESULTS: Pretreatment of T84 cells with MP (15 μg/mL) for 72 h significantly increased basal potential difference,transepithelial resistance and basal ISC. RT-PCR results showed that the expressions of ZO-land ZO-2 were significantly increased after MP treatment, consistent with improved epithelial barrier function. Results of acute stimulation showed that apical addition of MP produced a concentrationdependent (10-5 000 μg/mL, EC50 = 293.9 μg/mL) increase in ISC. MP-induced ISC was inhibited by basolateral treatment with bumetanide (100 μmol/L), an inhibitor of the Na^+-K^+-2Cl^- cotransporter, apical addition of Cl^- channel blockers, diphenylamine-2, 2‘-dicarboxylic acid (1mmol/L) or glibenclamide (1 retool/L), but not 4, 4‘-diisothiocyanostilbene-2, 2‘-disulfonic acid or epithelial Na+ channel blocker,amiloride. The effect of MP on ZOo1 and ZO-2was mimicked by Ligustrazine and the ligustrazine-induced ISC was also blocked by basolateral application of bumetanide and apical addition of diphenylamine-2, 2‘-dicarboxylic acid or glibenclamide, and reduced by a removal of extracellular Cl^-.CONCLUSION: The results of the present study suggest that MP and lligustrazine may improve epithelial barrier function and exert a stimulatory effect on colonic anion secretion, indicating the potential use of MP and its active ingredients for improvement of GI tract host defense and alleviation of constipation often seen in the elderly.     

性别差异对降压治疗的影响

戴振华(江苏省人民医院心脏科,江苏南京210029) 女性由于生理方面的原因,高血压的影响因素较男性更复杂,主要为月经因素和生育因素等。初潮年龄越早,高血压的危险因素越大。肥胖者一般初潮较早,易患高血压病。生育次数多的妇女,比生育次数少的妇女患高血压的危险性高;初产年龄越小,发生高血压的危险性也越大。服用避孕药可引起血压升高,妇女服用复方雌孕激素避孕药2年以上,血压升高比不服药者高2 .6 ～5倍。一般认为,肥胖、有糖尿病、高血脂症、高血压家族史的妇女,服避孕药后易出现高血压。因此,一旦发现有高血压应停服避孕药,改用其他避孕…     

女性“糖友”能否服用避孕药

临床上有些晚发性1型糖尿病年轻女患者,服用降糖药或注射胰岛素期间,如果同时服用避孕药的话,有可能出现药物疗效降低、血糖控制不稳的现象。下面,笔者结合临床实践,就女性糖尿病患者使用避孕药的相关问题作如下解答。     

FDA将调查Bayer避孕药致血栓风险

一些研究显示:拜耳医药保健有限公司生产的避孕药物可能增加血栓形成的风险,美国食品药品管理局(FDA)即将对其展开审查。近期发表在《英国医学杂志》的两项研究表明:服用拜耳医药保健有限公司生产的避孕药物Yaz使女性血栓发生风险增高2至3倍。欧洲监管人员称他们正在修订该药的说明书,添加这一最新信息。     

反复胸痛伴晕厥

患女，31岁。因反复胸痛17h．伴晕厥1次入院。既往无高血压、糖尿病、吸烟、肝炎和自身免疫病史，发病前否认发热、上呼吸道感染和腹泻史，月经正常，无特殊药物(包括避孕药)应用史。入院时血压110，70mmHg(1mmHg=0．133kPa)，心率86次／min，律齐，未闻及病理性杂音，无心包摩擦音。心电图示I、aVL、V2-6导联ST段弓背向上型抬高0．1—02mV，Ⅱ、Ⅲ、aVF导联ST段压低0．05—01mV。