连续服用低剂量复方炔诺酮与复方18-甲基炔诺酮对妇女脂质代谢的远期影响

目的 评价连续服用国产低剂量复方炔诺酮（复方炔诺酮）和低剂量复方１８－甲基炔诺酮（复方１８－甲）,对妇女脂质代谢的远期影响。方法 对连续服用复方炔诺酮（复方炔诺酮组,１６７例）和复方１８－甲（复方１８－甲组,１５０例）５～２５年及同期放置宫内节育器（ＩＵＤ）的健康妇女（对照组,１３１例）进行血清甘油三酯（ＴＧ）、总胆固醇（ＴＣ）、高密度脂蛋白（ＨＤＬ－Ｃ）、低密度脂蛋白（ＬＤＬ－Ｃ）、载脂蛋白Ａｌ（ＡｐｏＡｌ）、载脂蛋白Ｂ（ＡｐｏＢ）、脂蛋白ａ「Ｌｐ（ａ）」的测定。３组妇女的年龄、避孕药服用时间、体重指数、经济状况等,差异均无显著性。结果 与对照组比较,服用复方炔诺酮和复方１８－甲５～２５年妇女血清各项脂质水平均有不同程度的变化,两类口服避孕药使ＴＧ、ＨＤＬ－Ｃ显著升高;使ＡｐｏＡ１极显著升高。按不同避孕时间分

Long-term effects of low-dose combined norethisterone and combined 18-metayl-norethisterone on lipid metabolism in healthy women

OBJECTIVE: To assess the long-term effects of combined oral contraceptive pills use on the mean of serum TG, TC, HDL-C, LDL-C, ApoA1, ApoB and Lp(a). METHODS: The study was carried out in 446 women grouped as combined norethisterone containing ethinylestradiol (EE) 35 micrograms and norethisterone 625 micrograms; combined 18-metayl-norethisterone (norgestrel) containing EE 30 micrograms and 18-metayl-norethisterone 300 micrograms for using 5-25 years, and control subjects wearing IUD for the corresponding period. The three groups were similar in age, body mass index (BMI), continued period of contraceptives use and income. RESULTS: The data showed that changes of varying degree of lipid and lipoprotein parameters were obvious in women of long-term taking low-dose combined norethisterone and norgestrel, compared with the control. The mean of TG, HDL-C, ApoA1 were significantly increased simultaneously (P < 0.05, P < 0.01), indicated multiple effects of two low-dose Chinese COCs on lipid lipoprotein parameters. In addition, A significant increase (P < 0.05) in Lp(a), an independent risk factor for cardiovascular disease, was found in norgestrel group. Further more, the results of stratified analysis to duration of contraceptives use showed that the mean of TC, LDL-C, in the combined norethisterone use less than 15 years, after the adjusting for age, were significantly lower (P < 0.05, P < 0.01) and the ratio of LDL-C/HDL-C was improved (P < 0.05), compared with the Norgestrel; at the same time, the mean of ApoA1 was markedly higher (P < 0.05) in combined norethisterone; the ratio of ApoA1/ApoB (1.87 +/- 0.58) in the combined norethisterone group was superior to the ratio value (1.68 +/- 0.55) in norgestrel group. CONCLUSIONS: These beneficial effects on lipid metabolism have been considered indicators of potential cardiovascular protective effect of the combined norethisterone for taking pill less than 15 years, but these protective effects would be reduced with adverse change in lipid and lipoprotein parameters for taking combined norethisterone more than 15 years. In contrast, the mean of TC, LDL-C, two known risk factors for cardiovascular system, in the norgestrel use less than 15 years, after the adjusting for age, were significantly increased (P < 0.05, P < 0.01), and adverse changes in the TC/HDL-C ratio (P < 0.05) and ASI value, compared with the combined norethisterone; Lp(a) level was markedly higher in the norgestrel group than that in the control group (P < 0.05). These adverse effects on lipid metabolism have been considered indicators of potential cardiovascular harmful effect of low-dose norgestrel.