国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2015, Vol. 34 ›› Issue (1): 9-12.

• 专家论坛 • 上一篇    下一篇

新型口服避孕药的临床应用与心血管疾病风险评价

李瑛   

  1. 210036 南京，江苏省计划生育科学技术研究所
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-01-15 发布日期:2015-01-15
  • 通讯作者: 李瑛

Clinical Application of Oral Contraceptives and its Risk of Cardiovascular Diseases

LI Ying   

  1. Jiangsu Institute of Planned Parenthood Research，Nanjing 210036，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-01-15 Online:2015-01-15
  • Contact: LI Ying

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摘要： 口服避孕药（OC）最近的发展趋势包括超低雌激素剂量、新型孕激素和多相型OC的研制与临床应用，延伸的OC给药方案等，这些进展不仅关注OC的安全性、有效性和避孕之外的益处，还重视妇女的生活方式、共存的医疗结局等。LO MINASTRIN-FE理论上可降低长期用药与雌激素有关的不良反应，安全性会有所提高。含屈螺酮（DRSP）的Safyral不仅可以避孕，还可治疗女性经前情绪障碍、痤疮，提高女性叶酸水平。戊酸雌二醇（E2V）和有很高孕激素活性的地诺孕素（DNG）复合而成的四相OC Natazia■，可用于多囊卵巢综合征、胰岛素抵抗和肥胖妇女避孕。84+7天和24+4天的给药方案1年妊娠率均比21+7天明显降低。目前关键是如何应用新的循证证据指导新型OC的安全使用。

关键词: 避孕药, 口服, 孕激素类, 心血管疾病, 循证医学

Abstract: Recent trends in oral contraceptive (OC) were the ultra low-dose estrogen OC regimen, the novel compounds (third-generation progestins, drospirenone, and estradiol valerate), multi-phase OC, and the varied OC regimens including extended and continuous contraceptives. Contraceptive management should take into account women lifestyle and coexisting medical issues, as well as contraceptive efficacy and safety, and noncontraceptive benefits. LO MINASTRIN-FE may reduce those adverse reactions related to estrogen in long-term use, suggesting the improved safety in theory. Safyral contained with DRSP can be used not only for contraception, but also for treatment of premenstrual dysphoric disorder and acne because it can rise the folate level in women. Natazia■ is a new OC with estradiol valerate and dienogest in a unique 4-phasic formulation which could be recommended as an OC for those women with PCOS, insulin resistant or overweight. So far as newer OCs such as 84+7 and 24+4 regimens, their one-year pregnancy rates were significantly lower than this rate of 21+7 regimen. The key challenge now is how to guide the safe use of new OC with new evidence of the evidence-based medicine.

Key words: Contraceptives, oral, Progestins, Cardiovascular diseases, Evidence-based medicine