透明质酸钠凝胶宫腔注射联合去氧孕烯炔雌醇口服预防人流术后宫腔粘连

目的 研究透明质酸钠凝胶宫腔注射联合去氧孕烯炔雌醇口服预防人流术后宫腔粘连.方法 选取2012年6月～ 2013年6月笔者医院已行人流手术患者610例随机分为4组,予益母草冲剂口服同时Ⅰ组（150例）予透明质酸钠凝胶2ml宫腔注射.Ⅱ组（152例）予去氧孕烯炔雌醇片1片/天口服,连服21天.Ⅲ组（153例）予透明质酸钠凝胶2ml宫腔注射联合去氧孕烯炔雌醇片1片/天口服,连服21天.Ⅳ组（155例）未做上述处理.观察4组患者人流术后宫腔积液、周期性腹痛、月经过少或闭经情况.结果 宫腔积液发生率,Ⅰ、Ⅲ组与Ⅱ、Ⅳ组相比较,差异有统计学意义（P＜0.05）.周期性腹痛发生率,Ⅲ组与Ⅱ、Ⅳ组比较,差异有统计学意义（P＜0.05）.月经过少或闭经的发生率,Ⅲ组与Ⅰ、Ⅳ组,Ⅱ组与Ⅳ组相比较,差异有统计学意义（P＜0.05）.结论 透明质酸钠凝胶宫腔注射联合去氧孕烯炔雌醇片口服有利于人流术后宫腔积血的排出,减少宫腔积液形成,促进子宫内膜修复,可有效防止宫腔粘连的发生.     

Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome

Background

A prospective randomized trial was conducted to compare efficacy of a drospirenone-containing combined oral contraceptives (COC) with desogestrel-containing COC in women with polycystic ovary-syndrome (PCOS) not desirous of child-bearing.

Study Design

Sixty women were randomized into study group [ethinylestradiol (EE) 30 mcg+drospirenone 3 mg] and control group (EE 30 mcg+desogestrel 150 mcg), treated for 6 months and followed up at 1 month, 3 months, 6 months, during treatment and 3 and 6 months post-treatment. Acne and hirsutism scoring, bodyweight, body mass index (BMI), blood pressure (BP), ultrasound parameters, lipid profile, glycemic profile and hormonal profile were compared.

Results

Cycles were regular in both groups during treatment. Effect of regular cycles persisted in 44.83% (13/30) vs. 17.24% (5/30) in study vs. control group at 6 months post-treatment with 33.3% decreased hirsutism score in the study group (versus no change in control group) even at 6 months after stopping treatment. With treatment, BMI fell by 0.52 kg/m² in the study group; systolic and diastolic BP fell in the study group while it rose in the control group. Low-density lipoprotein significantly decreased and high-density lipoprotein was elevated in the study group (p<.05). The study group showed a significant fall in fasting/postprandial blood sugar and insulin and total testosterone against a rise in the control group.

Conclusion

In women with PCOS, a drospirenone containing COC has better outcome in terms of persistent regular cycles, antiandrogenic effect, fall in BMI and BP, better lipid profile, favorable glycemic and hormonal profile than desogestrel-containing COC.     

Hormone replacement therapy in perimenopausal women and 2-year change of carotid intima-media thickness

Objectives: To assess the 2-year effects of a combined regimen of oral 17β-estradiol and desogestrel (17βE-D) and a sequential combination of conjugated equine estrogens and norgestrel (CEE-N) on common carotid intima-media thickness and end-diastolic lumen diameter in comparison to placebo in perimenopausal women. Methods: The study was a single center, randomized, group-comparative, double-blind study with respect to the 17βE-D and placebo groups and open with respect to CEE-N. After cycle 6, the blind was broken and the trial was continued as an open trial for another 18 months for the active study arms. The study included 121 perimenopausal women recruited from the general population. Common carotid intima-media thickness and end-diastolic lumen diameter were measured at baseline and cycle 24 with B-mode ultrasonography. Results: At cycle 24 small changes in intima-media thickness and lumen diameter were observed. Relative to placebo, changes in intima-media thickness were −0.009 mm [95% CI −0.045; 0.027] for 17βE-D and −0.016 mm [95% CI −0.055; 0.024] for CEE-N. For end-diastolic lumen diameter the changes were −0.091 mm [95% CI −0.236; 0.055] and −0.125 mm [95% CI −0.820; 0.032] for 17βE-D and CEE-N, respectively. Conclusions: In this study among perimenopausal women a significant effect of 17βE-D and CEE-N on common carotid intima-media thickness and lumen diameter could not be demonstrated. Although the sample size of the present trial is too limited to provide definite conclusions, the direction of the effect is in agreement with evidence from earlier studies on the effects of hormone replacement therapy in postmenopausal women.     

去氧孕烯炔雌醇治疗绝经过渡期功能失调性子宫出血临床观察

目的观察绝经过渡期去氧孕烯炔雌醇对功能失调性子宫出血的临床效果。方法选取笔者所在医院2010年2月～2012年2月166例绝经过渡期功能失调性子宫出血的临床资料,随机分为观察组(85例)和对照组(81例),观察组应用去氧孕烯炔雌醇,对照组应用米非司酮;观察用药后两者的治疗时间和体内促绒毛膜性腺激素、雌激素和黄体生成素的变化情况。结果观察组患者治疗前后促绒毛膜性腺激素FSH平均值之间差异有统计学意义(P<0.05),而黄体生成素LH和雌激素E2浓度无明显改变。比较发现,对照组患者的FSH、LH、E2在治疗前后均无显著变化。结论去氧孕烯炔雌醇对于治疗围绝经期内功能失调性子宫出血疗效肯定,止血迅速,作用无反复,值得临床推广。     

去氧孕烯炔雌醇联合维生素B6治疗原发性痛经疗效观察

目的观察去氧孕烯炔雌醇联合维生素B6治疗原发性痛经的临床效果。方法将62例原发性痛经患者随机分为观察组和对照组各31例。观察组采用去氧孕烯炔雌醇联合维生素B6治疗;对照组仅予维生素B6治疗。治疗后比较2组临床疗效。结果观察组总有效率为93.5%高于对照组的74.2%,差异有统计学意义(P<0.05)。结论去氧孕烯炔雌醇联合维生素B6治疗原发性痛经安全有效。     

Route of administration of contraceptives containing desogestrel/etonorgestrel and insulin sensitivity: a prospective randomized study

Background

The study was conducted to investigate whether hormonal contraceptives administered via the oral and vaginal route exert a similar effect on insulin sensitivity (SI).

Study Design

This is a prospective, randomized study performed in the University Hospital. Subjects were healthy lean young women, needing a hormonal contraceptive, randomly allocated to receive for 6 months (a) an oral contraceptive (OC) containing 30 mcg ethinylestradiol (EE)/150 mcg desogestrel (DSG) (high-estrogen group; n=12), (b) an OC containing 20 mcg EE/150 mcg DSG (low-estrogen group; n=12) and (c) a vaginal ring contraceptive releasing, per day, 15 mcg EE/120 mcg etonorgestrel, the active DSG metabolite (n=12).SI and glucose utilization independent of insulin (Sg) were evaluated by the minimal model method. Modifications of total, high-density lipoprotein (HDL) and low-density lipoprotein cholesterol and triglycerides were also evaluated.

Results

Sg did not vary with any treatment. SI decreased during OCs (5.74±0.49 vs. 3.86±0.44; p=.0005), independently of the high/low-estrogen dose. SI did not decrease during vaginal ring use (4.64±1.03 vs. 5.25±1.36; p=.57; p=.019 vs. oral). Total cholesterol and HDL cholesterol increased (p=.02) during OCs, independently of the dose. Triglycerides increased during both oral (p=.01) and vaginal (p=.032) contraceptive use.

Conclusions

The present data indicate that in contrast to OC use, vaginal contraception with the ring does not deteriorate SI. The vaginal ring may represent an appropriate choice for long-term contraception in women at risk for developing diabetes mellitus or metabolic syndrome.     

Insulin sensitivity and lipid metabolism with oral contraceptives containing chlormadinone acetate or desogestrel: a randomized trial

Background

Second-generation and third-generation oral contraceptives containing 30 mcg or more of ethinylestradiol (EE) decrease insulin sensitivity (SI). In this study, we investigated whether SI is decreased by contraceptives containing lower doses EE or by progestins with antiandrogenic properties.

Study Design

Twenty-eight young healthy women were randomly allocated to receive 20 mcg of EE and 150 mcg of desogestrel (DSG) (n=14) or 30 mcg of EE and 2 mg of chlormadinone acetate (CMA) (n=14) for 6 months. SI and glucose utilization independent of insulin (Sg) were investigated by the minimal model method. Lipid modifications were also analyzed.

Results

SI decreased with EE/DSG (7.09±1.4 vs. 4.30±0.91; p=.04; n=12), but not with EE/CMA (5.79±0.93 vs. 6.79±1.1; p=.48; n=12). SI modifications observed in the two groups were significantly different (−2.79±1.15 vs. 1.0±1.38; p=.05). Sg did not vary with either treatment. The response of C-peptide to glucose increased, but significantly so only with EE/CMA (p=.01). The C-peptide/insulin response increased with both EE/DSG (p=.05) and EE/CMA (p=.04). High-density lipoprotein (HDL) cholesterol (p=.02) and triglycerides (p=.02 and p=.01) increased in both groups, but HDL/low-density lipoprotein cholesterol (p=.02), apoprotein A1 (Apo-A1) (p=.04) and Apo-A1/apoprotein B (p=.048) increased significantly only with EE/CMA.

Conclusions

The present study confirms that DSG, even when associated with low EE dose, decreases SI. By contrast, EE/CMA does not deteriorate SI and induces a favorable lipid profile.     

The effects of two monophasic oral contraceptives containing 30 mcg of ethinyl estradiol and either 2 mg of chlormadinone acetate or 0.15 mg of desogestrel on lipid, hormone and metabolic parameters

Background

This study was conducted to compare the effects of two monophasic oral contraceptives (OCs) containing ethinyl estradiol (EE) 30 mcg+either chlormadinone acetate (CMA) 2 mg (Belara^®) or 0.15 mg desogestrel (Marvelon^®) on lipid, hormone and other relevant metabolic parameters.

Study design

Markers of lipid and carbohydrate metabolism, and reproductive hormone levels, were measured in 45 subjects randomly assigned to 6 months of treatment with one of the two OCs. The cortisol response to adrenocorticotrophic hormone (ACTH) stimulation was also evaluated.

Results

In both treatment groups, triglycerides, high-density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo) AI and Apo AII levels increased; low-density lipoprotein cholesterol (LDL-C) and the LDL-C/HDL-C ratio decreased; and total cholesterol and lipoprotein(a) were unchanged during treatment. Effects on HDL-C, Apo AI, LDL-C and the LDL-C/HDL-C ratio were more evident in the EE 30 mcg+CMA 2 mg group. Follicle-stimulating hormone, luteinizing hormone and androgen levels decreased and sex hormone-binding globulin levels increased in both groups. Both OCs increased basal cortisol levels and cortisol response to ACTH. Oral contraceptive did not have a clinically significant impact on carbohydrate metabolism.

Conclusions

Both low-dose monophasic OCs had comparable effects on lipid, hormone and metabolic parameters during six cycles of treatment in healthy female subjects. There was some evidence of a beneficial effect on atherogenic cardiovascular risk markers, which was slightly more pronounced with EE 30 mcg+CMA 2 mg.     

人工流产后应用短效避孕药的临床观察

目的 观察短效避孕药在人工流产后的应用疗效.方法 随机将2010年3月至2011年9月自愿行人工流产术的健康孕妇136例分为观察组、对照组各68例,观察组术后给予去氧孕烯炔雌醇、抗生素治疗,对照组仅口服抗生素.结果 观察组人工流产术后3 d内停止流血者52例(76.5%),平均月经复潮时间(28.5±2.1)d,月经复潮时间在30 d以内者占94.1%(64/68),与对照组比较,差异有统计学意义(P均<0.001).去氧孕烯炔雌醇治疗期间未见严重药物副作用.结论 人工流产术后口服避孕药能有效避孕、减少人工流产术后出血、较快恢复月经周期,有利于育龄期妇女生殖健康.     

人工流产术后即时服用去氧孕烯炔雌醇的疗效分析

目的探讨人工流产术后即时服用去氧孕烯炔雌醇的疗效。方法资料随机选自2011年12月～2013年12月在大同市第一人民医院诊治由于意外怀孕行人工流产的患者96例,按照随机数字表方法分成两组,每组48例,予以术后抗生素作为对照组,予以抗生素联合去氧孕烯炔雌醇作为研究组,分析两组术后的阴道的出血量、治疗相关指标、不良反应和避孕情况。结果阴道出血量治疗前后比较研究组患者比月经量少者占85．42％,对照组的患者比月经量少者占43．75％,研究组比例大于对照组,差异有统计学意义（P〈0．05）;阴道的出血时间、月经的转归时间,比对照组短;研究组子宫的内膜厚度比对照组患者厚;且研究组无不良反应,比对照组12．50％低,差异有统计学意义（P〈0．05）。结论意外怀孕并同意行人工流产患者,术后即时选择去氧孕烯炔雌醇,止血效果良好,不良反应较少。