Injectable contraception

Two reports indicate that some women may experience a mild adverse effect on milk yield. Variable effects of DMPA (depot medroxyprogesterone acetate) on breast milk composition have been reported. Different studies have reported increased, unchanged, or decreased milk concentrations or total contents of lactose, protein or lipid. Another study has indicated a minor depressive effect on development. Recent evidence suggests that milk concentrations of MPA may be as high as maternal plasma levels and transfer of DMPA may be appreciable. There is some concern that DMPA may have small effects on growth, maturation and subsequent reproductive function of the neonate. Sammour's study reported a 16% decrease in protein count in milk. Another study shows a 48% decrease in protein. Since reduced protein concentrations mean reduced immunoglobulins, the infant's prime protection against early death, it is a disservice to publicize a conclusion stating that progestogens do not adversely affect milk production and composition.     

醋酸甲羟孕酮针剂在哺乳期妇女避孕中的应用

目的:寻求哺乳期妇女运用醋酸甲羟孕酮(DMPA)避孕的最佳投药剂量。方法:将受试对象分为DM-PA组和未使用DMPA的产后哺乳期妇女,排除不符合研究标准者,纳入研究对象共319例,DMPA150mg组83例,100mg组80例,75mg组81例,未使用DMPA组75例,DMPA组每3个月深部肌肉注射1次,共4次。结果:非DMPA组避孕成功率为80.00%,150mg与100mgDMPA组避孕成功率均为100.00%,75mg组成功率为98.77%,3个不同剂量DMPA组避孕成功率均显著高于非DMPA组(P<0.01),但3组间差别无统计学意义(P>0.05)。发生的副反应中,点滴出血75mg组为4.94%,明显低于150mg组的16.87%(P<0.05)和100mg组的10.00%(P<0.05)。结论:75mgDMPA用于哺乳期妇女避孕不影响其有效性,且可减少副反应发生率,可作为我国哺乳期妇女运用DMPA避孕的最佳投药剂量。     

长效避孕针醋酸甲孕酮对骨质代谢影响的研究

目的 :探讨长效避孕针醋酸甲孕酮 (DMPA)对中国妇女骨质代谢的影响。方法 :自愿使用 15 0mgDMPA避孕者 30人组成实验组 ,采用阴茎套避孕者 30人组成对照组。测定两组血清雌二醇 (E2 )、血清碱性磷酸酶 (AKP)、尿钙 /肌酐 (Ca/Cr)、尿羟脯氨酸 /肌酐 (Hyp/Cr)及非惯用臂桡尺骨超远端骨矿含量 (BMC)、骨矿密度 (BMD)。结果 :两组血清雌二醇、血清碱性磷酸酶、尿钙 /肌酐、尿羟脯氨酸 /肌酐差异无显著性 (P >0 .0 5 ) ,两组非惯用臂桡尺骨超远端骨矿含量、骨矿密度差异无显著性 (P >0 .0 5 )。结论 :使用DMPA避孕 1年对妇女骨质代谢无影响。     

FDA okays limited use of injectable contraceptive

An announcement by the Food and Drug Administration approving limited use of Depo Provera (medroxyprogesterone acetate) as an injectable contraceptive agent is reported. The drug is quite effective as a contraceptive agent, but may result in infertility after discontinuation of use, and has adverse effects similar to those associated with oral contraceptives. The accompanying physician labeling advises that the drug be prescribed only to patients who accept the possibility that they may not be able to become pregnant after discontinuing use, and those who cannot accept or tolerate other contraceptive methods. Medroxyprogesterone acetate is already in use in the distribution and monitoring the results of its use have been issued.     

帕利哌酮治疗精神分裂症的血药浓度与临床疗效研究

目的  探讨帕利哌酮治疗精神分裂症的血药浓度与剂量、临床疗效及副反应的关系。方法  采用超高效液相色谱串联质谱法分别于治疗后1、2及4周末检测精神分裂症患者体内帕利哌酮血药浓度；于基线期、治疗后1、2及4周末采用阳性与阴性症状量表（PANSS）评定疗效，治疗时出现的症状量表（TESS）评定副反应；于基线期和治疗后4周末行血常规、尿常规、肝肾功能、心电图及泌乳素检查。结果  治疗后1、2及4周末的服药剂量分别为（7.24±1.50），（8.89±1.29）和（9.63±1.77），与相应时间的血药浓度（18.64±7.93），（25.44±10.71）和（27.65±13.89）呈正相关（P <0.05）；帕利哌酮血药浓度（30.91±17.99）与女性患者的血清泌乳素（117.9±50.66）相关（P <0.05）；未发现帕利哌酮血药浓度与PANSS减分率、TESS量表以及体重增加值相关（P >0.05）；有效组与无效组间、出现锥外系反应组患者与未出现锥外系反应组间血药浓度比较差异皆均无统计学意义（P >0.05）。结论  帕利哌酮的血药浓度可能与服药剂量呈非线性正相关；帕利哌酮的血药浓度与女性患者的血清泌乳素水平呈正相关。

     

截瘫大鼠血液生化及骨密度改变

目的：探讨脊髓损伤继发骨质疏松的理论依据以指导临床治疗。 方法： 雄性Wistar大鼠120只随机分12组（每组10只）,各对照组分别行胸₁₀椎板切除,不损伤硬膜及脊髓后0、1、2、3、7和11周,实验组分别于胸₁₀椎板切除后行Allen's法（60gcm）损伤脊髓(导致截瘫)后0、1、2、3、、7和11周,检测血钙（Ca）、血磷(P)、血清碱性磷酸酶（ALP）及肱骨外科颈部、股骨粗隆部、胫骨平台部松质骨骨密度（BMD）改变情况。 结果：实验组( ALP术后1及3周低于对照组（P<0.05）;7周时明显高于对照组（P<0.01）;实验组血磷（P）术后1、2周高于对照组（P<0.01）,实验组血钙（Ca）术后1～3周时均明显高于对照组（P<0.01）,然后逐渐降至略高于正常。实验组肱骨 BMD术后3、7及11周时均明显低于对照组（P<0.01）,以3周时最低;实验组股骨BMD术后7周时低于对照组（P<0.05）,11周时与对照组比较差异无显著性（P>0.05）;实验组胫骨BMD术后 7及11周时均明显低于对照组(P<0.01)实验组术后7与11周比较差异无显著性（P>0.05）。结论：大鼠脊髓损伤截瘫后血液生化指标改变,损伤平面上下均继发骨质疏松,损伤平面上骨密度恢复较早。     

Injectable contraception

When deciding on the choice of a contraceptive, it is necessary to determine whether the method is to be permanent or reversible. If permanent, then the menstrual irregularities, the weight gain, headaches and subjective side effects of depot medroxyprogesterone acetate (DMPA) would suggest that it is not the most appropriate contraceptive for use up to the onset of menopause. Indeed there would be difficulty, given the frequent incidence of amenorrhea, in determining when this had occurred. If the contraception required is to be reversible, then it would be essential to inform the women that, provided she is of proven fertility, her chance of becoming pregnant after the use of DMPA is severely limited for 12 months after her last injection, and that she will have a conception rate of 75% by 15 months and 95% by 24 months. Very few women planning further pregnancies would tolerate that sort of delay in return of fertility, which makes the reliable spacing of their pregnancies impossible. DMPA seems not be the most appropriate agent for permanent contraception, for nulliparous women, for lactating women, or for women planning to space their pregnancies as accurately as possible. Sensitive discussion and accurate information on the advantages, disadvantages and relative reliability of all the available methods of contraception (hormonal, chemical, mechanical, barrier, and natural methods) should enable the woman, in consultation with her sexual partner and her medical practitioner, to choose the method most appropriate to her current and future needs. On the basis of the most recent information about DMPA, it is doubtful that DMPA will ever be the most appropriate choice.     

认知-行为疗法联合醋酸甲羟孕酮对提高癌症患者生活质量的研究

目的探讨应用认知-行为疗法（CBT）联合醋酸甲羟孕酮（MPA）与传统护理干预对癌症患者生活质量的影响。方法 80例癌症患者按照就诊顺序分组,研究组醋酸甲羟孕酮联合认知-行为疗法40例,对照组组40例,疗程8周,用QOL评定临床疗效。结果入院第2周起,研究组QOL量表分数较对照组均明显升高,与对照组比较差异有统计学意义（P〈0.05）。结论应用CBT联合MPA可明显增加患者食欲、促进睡眠、减轻疲乏感、减少不良反应的发生,大幅度改善癌症患者的生活质量。     

Effects of prolonged use of injectable hormonal contraceptive on serum lipid profile

The current study was carried out to determine serum levels of total cholesterol, triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in human female volunteers taking injectable hormonal contraceptives. For this purpose, 200 (two hundred) subjects with age range of 20-35 years were selected. Out of them, 140 (one hundred and forty) were experimental subjects and 60 (sixty) were control. Women without hormonal contraceptive were selected as the subjects of control group. The experimental subjects were taking injectable hormonal contraceptive, DMPA (depo-medroxyprogesterone acetate) for 3-5 years uninterruptedly. The mean serum total cholesterol and mean serum triacylglycerol levels of the DMPA users were significantly (P0.05). The mean serum LDL-cholesterol level of the subjects of DMPA users was significantly (P<0.05) elevated in comparison to that of the control.     

长效醋酸甲孕酮降低大鼠子宫内膜异位症模型中内膜RANTES的表达

目的：探讨长效醋酸甲孕酮(DMPA)对大鼠实验性子宫内膜异位症模型中正常T细胞表达和分泌的受激活调节因子RANTES表达的影响。方法：参照Jones方法建立大鼠子宫内膜异位症动物模型,将建模成功的大鼠随机分为对照组和DMPA治疗组,采用EI．ISA法检测两组子宫在位内膜、异位内膜和血清中RANTES的水平。结果：DMPA治疗组在位、异位内膜和血清中RANTES水平(中位数)分别为89．2,199．4,6 871．5 ng／L;对照组在位、异位内膜和血清中RANTES水平(中位数)分别为141．8,401．8,7 523．3 ng／L。DMPA治疗组在位内膜RAN—TES的水平与对照组比较,差异有显著性(P％0．05)；其异位内膜RANTES的水平与对照组比较,差异有极显著性(P<0．01)；两组血清中的RANTES水平差异无显著性(P>0．05)。结论：DMPA能有效降低子宫内膜异位症模型中内膜RANTES的表达。DMPA可能通过下调内膜RANTES的表达,抑制盆腔的炎性反应,从而缓解子宫内膜异位症患者的盆腔疼痛。     

THE EFFECT OF MONTHLY INJECTABLE CONTRACEPTIVE MEGESTROL ACETATE COMPOUND ON PITUITARY-OVARIAN FUNCTION

A study of injection megestrol acetate co. on the effect of pituitary-ovarian function was carried out in 4 healthy multiparous women. The serum levels of follicle stimularing hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E_2), progesterone (p) and cortisol (F) were assayed by RIA prior to treatment and at 1st, 6th and l2th treatment cycles. The hormonal profile before injection showed normal pituitary-ovarian function with ovulation-like change. During treatment the midcycle FSH-LH surges did not occur. The basal values of FSH at the beginning of each cycle were higher than those before treatment. 24h after injection E_2 increased and persisted at high level for about 5 days and then dropped down to low level The P levels were low throughout the whole cycle. PRL and F were in normal ranges. After treatment persistent high level of E_2 and "LH rebound action" could be seen. The above suggested that this injectable contraceptive has its effect of ovulation inhibition through suppression of midcycle peak of the gonadotrophic hormones. The follicular activity returned earlier than luteal activity. There were overian follicles developing in the ovaries. The rebound phenomenon of pituitary-ovarian function was present. The result of this study revealed that the effect of this injectable contraceptive on pitutaryovarian function is mild.     

甲状腺全切术后预防性补钙对甲状旁腺功能的影响

目的探讨对甲状腺全切患者术后预防性补钙治疗,对甲状旁腺功能恢复的影响。方法将符合入选标准的232例随机分为A和B组,再根据术后3d内最低1d的甲状旁腺素（PrH）值,将A、B组再分为Al（87例,PTH≥8pg／ml）和A2（30例,WH〈8pg／ml）组;B1（83例,PTH≥8pg／m1）和B,（32例,PTH〈8pg/ml）组。术后A组给予静脉补钙6g／d,B组术后暂时不给予补钙;术后不论是否出现低钙血症,但PTH〈8pg/ml均给予静脉补钙6g／d。所有患者检测术前术后第1、2、3天、1周及1个月血钙及PTH的水平,发生甲状旁腺功能减退的患者增加监测术后2、3周血钙及PTH水平。观察并记录患者术后是否出现低血钙及低钙血症、甲状旁腺功能减退。结果①术后1周A．组PTH及术后第1、2、3天和术后1周血钙水平高于B1组（P〈0．05）。A,组低血钙及低钙血症的发生率明显低于B1组（P〈0．05）。②术后第1、2、3周A2组PTH水平高于B2组（P〈0．05）,并较B2组PTH先恢复到正常范围;术后第1天至第3周,A2组血钙水平高于B2组（P〈0．05）,并较B2组先恢复到正常范围;A2组低血钙及低钙血症的发生率明显低于B2组（P〈0．05）。结论甲状腺全切术后预防性补钙有利于甲状旁腺功能恢复。     

Effect of Depot Medroxyprogesterone Acetate （DMPA） on Bone Mineral Density in Women of Reproductive Age

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate（DMPA ） and nonhormonal control subjects. Methods The study included 68 women aged between 25 and 40 years using depot medroxyprogesterone acetate for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results At 24 months of treatment, as compared with baseline, the mean BMD in lumbar spine and femoral neck was decreased by 5.5% and 5.9%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA were significantly decreased compared with the subjects in nonuser （P〈0.001）. Conclusion These results show BMD declined during using DMPA in women aged 25 -40 years old.     

A Muhicentered Clinical Trial of the Long-acting Injectable Contraceptive Depo Provera in Chinese Women

This study was an open trial where 1994 subjects each received Depo Provera injectable contraceptive every three months for one year and were observed a total of 20,294.3 woman months.At the time of observation,only one accidental pregnancy had occurred giving a use-effectiveness rate of 99.94% and a cumulative continuation rate of 72.8%.There were no significant adverse effects on weight and bolld pressure.The main side effects were spotting,prolonged bleeding,and amenorrhea and these were alsothe main reasons of discontinuation.Complaints related to bleeding problems gradually decreased and complaints of amenorrhea increased with continued use. In lactating women,side effects occurrence rate was lower and continuation rate was higher in comparison with non-lactating women.Users did not report any effect on milk secretion.The results of this study confirm that Depo Provera is a very effective contraceptive method.With appropriate counseling and medical support,high acceptability and continuation rate can be achieved. Depo Provera is especially suitable for lactating women and could become a popular contraceptive method for lactating Chinese women.     

核分裂率与增殖细胞核抗原指数在监测给予雌、孕激素后大鼠子宫内膜变化中

目的：探讨核分裂率（ＭＩ）和增殖细胞核抗原（ＰＣＮＡ）指数在监测不同剂量雌、孕激素作用不同时间后,大鼠子宫内膜的增殖与抑制变化中的作用。方法：选择去势后ＳＤ大鼠作为动物模型,模拟临床雌、孕激素的连续与周期给药方案。分别在给药不同时间后,检测大鼠子宫内膜的ＭＩ后ＰＣＮＡ指数的变化。结果：ＰＣＮＡ指数可敏感反映不同剂量雌激素作用不同时间对大鼠子宫内膜的增殖作用,同时也反映不同剂量孕激素作用不同时间对大鼠子宫内膜增殖的抑制作用。ＭＩ可反映雌激素对子宫内膜的增殖作用,同时也反映不同剂量孕激素作用不同时间对大鼠子宫内膜增殖的抑制作用。ＭＩ可反映雌激素对子宫内膜的增殖作用,但在反映孕激素的抑制作用时不敏感。结论：ＰＣＮＡ指数在反映雌、孕激素对子宫内膜的作用时优于ＭＩ。     

Changes of bone mineral in steroid-induced osteonecrosis in rabbits

ObjectiveTo investigate the significance of bone mineral changes in the pathogenic process of steroid-induced osteonecrosis in rabbits.MethodsSeventy adult female Japanese White rabbits were randomly divided into five groups. Animals in steroid group received an intramuscular injection of methylprednisolone acetate (4 mg/kg) once a week, and killed in four different time after first treatment. Animals in control group received an intramuscular injection with the same volume of normal saline, while 150 kU penicillin was injected twice a week for preventing infection in all groups. The contents of serum calcium (Ca) and phosphorus (P) were determined and the bone mineral densities of the femoral head and neck were measured at the 2nd, 4th, 8th and 10th weeks after first treatment. Meanwhile the general condition such as weight, spirit and hair of rabbits was observed.ResultsCompared with the control group, the weight of rabbits in steroid group lost since the first week, and progressively aggravated; the bone mineral density of the femoral head and neck was lowered since the 2nd and 4th week respectively (P<0.05, P<0.01), and lowered more quickly in femoral neck than in femoral head. In steroid group, the bone mineral density of the femoral neck at the 10th week was significantly lower than that at the 8th week (P<0.05). Compared with the control group, the serum levels of Ca and P in steroid group were lowered since the 2nd week (P<0.05, P<0.01). In steroid group, the serum Ca level at the 10th week was lower than that at the 8th week, and the serum P level was lowered more quickly than Ca level was.ConclusionOsteonecrosis appears in rabbits shortly after corticoids are first administered, and osteonecrosis in rabbits is chronologically associated with the onset of hypocalcaemia, hypophosphatemia and lowered bone mineral density. Steroid-induced osteonecrosis may be relevant to bone mineral loss and density lowering of the femoral head and neck.     

2 型糖尿病小鼠不同时间点的病理生理变化

目的 检测不同时间点2 型糖尿病（T2DM）小鼠模型代谢指标、血清胰岛素、心功能等指标,明确T2DM 小鼠模型发生病理改变的时间。方法 雄性8 周C57BL/6 小鼠采用高脂联合链脲佐菌素（STZ）方法复制T2DM 动物模型,在STZ 注射不同时间点,罗氏血糖仪测量小鼠空腹血糖。用Elisa 试剂盒检测小鼠血清胰岛素,应用小动物超声检测小鼠左心室功能。苏木素- 伊红染色及Masson 染色观察心脏大小形态及心肌纤维化情况。结果 STZ 注射1 周后实验组小鼠空腹血糖升高,2 周后出现糖耐量和胰岛素耐量异常;8 周时,清胰岛素异常及左心室舒张功能障碍,并出现左心室肥厚和纤维化;12 周时出现左心室扩张,纤维化加重。结论 STZ 注射2 周小鼠空腹血糖升高,8 周时血清胰岛素降低,并发生左心室肥厚及舒张功能下降,12 周时左心室收缩功能下降,为研究T2DM 的发病机制及干预治疗提供了实验依据。     

醋酸甲羟孕酮对卵巢癌CoC1／cDDP细胞增殖和耐药逆转的影响

目的:探讨醋酸甲羟孕酮(MPA)对人卵巢卵巢癌耐药细胞株CoC1/cDDP细胞增殖和耐药逆转作用影响及机理。方法:采用四甲基偶氮唑蓝法检测不同浓度MPA对CoC1/cDDP不同作用时间的细胞生长抑制率,以及MPA与顺铂(DDP)合用与单独应用时生长抑制率;采用流式细胞技术行细胞周期时相及凋亡分析。结果:MPA明显抑制CoC1/cDDP细胞的增殖,抑制作用呈时间-剂量依赖性(P<0.01);MPA与DDP合用对CoC1/cDDP细胞的增殖抑制作用较单独应用时明显增强,且合用后G0/G1期、G2/M期细胞增加,而S期细胞减少凋亡率增高(P<0.01)。结论:MPA能明显抑制CoC1/cDDP细胞的生长,并能逆转细胞对顺铂的耐药性。     

胆总管结扎致肝纤维化模型大鼠肝脏内源性AcSDKP及其调控因子水平的变化

目的：探讨胆总管结扎致肝纤维化模型大鼠肝脏组织中内源性N-乙酰基-丝氨酰-天门冬酰-赖氨酰-脯氨酸（AcSDKP）及相关调控因子水平的变化,阐明AcSDKP在肝纤维化过程中的作用。方法：45只普通级大鼠随机分为模型组、阻断组和对照组,每组15只。模型组采用胆总管结扎建立肝纤维化动物模型;阻断组应用血管紧张素转化酶抑制剂（ACEI）后建立肝纤维化动物模型;对照组予以开腹,但不结扎胆总管。分别在1、2和4周后留取血清及肝组织,检测各组大鼠肝功能指标、肝组织纤维化程度以及肝组织中AcSDKP水平,应用Western blotting法检测各组大鼠肝组织中胸腺素β4、赖氨酸寡肽酶（POP）和血管紧张素转换酶（ACE）水平。结果：自第1周开始,模型组大鼠血清中丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、总胆红素（TB）和白蛋白（ALB）水平高于其他2组（P<0.05）,而阻断组与对照组比较差异无统计学意义（P>0.05）。自第2周开始,模型组大鼠血清中ALB及肝组织中AcSDKP水平低于其他2组（P<0.05）,而阻断组与对照组比较差异无统计学意义（P>0.05）。第1周,3组大鼠肝组织中Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（CⅣ）和透明质酸（HA）水平比较差异无统计学意义（P>0.05）;第2周,模型组大鼠肝组织中PCⅢ、CⅣ和HA水平高于其他2组（P<0.05）,阻断组与对照组上述指标比较差异无统计学意义（P>0.05）。第2周开始,模型组大鼠肝组织中胸腺素β4和ACE蛋白表达水平高于其他2组（P<0.05）,而POP蛋白表达水平低于其他2组（P<0.05）;阻断组与对照组上述指标比较差异无统计学意义（P>0.05）。模型组大鼠肝组织中第1周结构基本正常,第2周时呈现小灶状坏死,第4周时呈现片状坏死;阻断组与对照组大鼠肝组织各时间点结构基本正常。结论：胆总管结扎致肝纤维化大鼠肝组织中内源性AcsDKP水平降低可能是通过Tβ4-POP-AcsDKP轴实现的。     

醋酸甲羟孕酮对卵巢癌CoCl/cDDP细胞增殖和耐药逆转的影响

目的探讨醋酸甲羟孕酮(MPA)对人卵巢卵巢癌耐药细胞株CoCl/cDDP细胞增殖和耐药逆转作用影响及机理.方法采用四甲基偶氮唑蓝法检测不同浓度MPA对CoCl/cDDP不同作用时间的细胞生长抑制率,以及MPA与顺铂(DDP)合用与单独应用时生长抑制率;采用流式细胞技术行细胞周期时相及凋亡分析.结果MPA明显抑制CoCl/cDDP细胞的增殖,抑制作用呈时间-剂量依赖性(P＜0.01);MPA与DDP合用对CoCl/cDDP细胞的增殖抑制作用较单独应用时明显增强,且合用后G0/G1期、G2/M期细胞增加,而S期细胞减少凋亡率增高(P＜0.01).结论MPA能明显抑制CoCl/cDDP细胞的生长,并能逆转细胞对顺铂的耐药性.