长效口服避孕药复方炔雌醚对糖代谢的远期影响

63名服用复方炔雌醚(CQ)长达5～13年的妇女及65名年龄相仿的未服药妇女进行口服糖耐量试验(OGTT)和各时相的胰岛素浓度、胰岛素释放指数(IGI)、空腹生长激素(HGH)、泌乳素(PRL)以及皮质醇测定。63名中55名的糖耐量均正常,仅8名有轻度减退,其中1名达糖尿病诊断指标。二年后8名中5名进行复查,4名糖耐量均有改善和正常,1名无改变。红细胞胰岛素受体数正常或偏多。原来可考虑为糖尿病者,其糖耐量也有改善,不再足以诊断为糖尿病,但受体数仍明显减少。CQ引起的糖耐量减退系药物一时性影响。但长期服用后1°IGI较对照低,提示胰小岛疲劳。CQ对糖耐量影响的机理是综合性的,可能为皮质醇增多,胰岛素敏感性降低和受体数减少。

EFFECT OF COMPOUND QUINESTROL ON CARBOHYDRATE METABOLISM

Effect on carbohydrate metabolism was observed in 63 women taking Quinestrol (CQ) for 5-13 years and compared with 65 controls. In 55 cases out of the 63, the result of oral glucose tolerance test (OGTT) was normal. The remaining 8 all had normal fasting glucose, however, glucose tolerance was impaired by 1-2 phases (points). One of the 8 cases had 3 points abnormal reaching the interim diagnostic criteria of diabetes. The one-hour insulinogenic index (IGI) of the 63 cases was lower than normal control.Two years later, 5 of the 8 cases witb abnormal OGTT were followed. The results in 4 of the 5 improved or normalized to 0-2 points abnormal, the remaining case remained unchanged. 3 cases were selected for receptor determination. The number of receptor was markedly decreased in one with 2 points abnormal and was normaland slightly elevated in cases with 0-1 point abnormal.The plasma cortisol concentration was markedly elevated in the treated group. Growth hormone was also elevated after medication, while that of PRL was within normal range in majority cases.The result obtained is essentially the same to that from 10 years ago. The slight glucose intolerance during medication is a transient effect of the drug, nevertheless, long-term ingestion of CQ may bring about a decreased IGI at 1 hour indicating fatigue of β-cells. It is suggested that the use of CQ be monitored in obese subjects and those with family history of diabetes and history of large infant delivery.The results show that glucose intolerance may act through elevation of cortisol, insulin resistance of the peripheral tissue and decrease of receptor number.