低剂量复方避孕药对妇女凝血指标的影响

Effects of Low-dose Combined Contraceptive Pills on Coagulation Parameters

目的 研究长期服用国产低剂量复方炔诺酮 (1号片 )及低剂量复方 18 甲基炔诺酮 (复方 18 甲 )对健康妇女凝血系统的影响。方法 对连续服用低剂量 1号片和复方 18 甲 5～15年的观察组及同期使用宫内节育器 (IUD)对照组的健康妇女 1～ 1例 ,进行血浆中APTT、PT FIB(A)、PT FIB(B)、TT和凝血因子Ⅱ、ⅤⅦ、Ⅷ、Ⅹ活性测定。结果 两个服药组妇女血浆部分凝血指标有变化 ,其部分凝血活酶时间 (APTT)略低于对照组 (IUD) ,1号片组和对照组之间的差异达到显著性水平(P <0 0 5 ) ,两组因子X的活性水平均明显高于对照组 (P <0 0 5 ,P <0 0 1) ;1号片组因子Ⅷ的活性水平高于对照组 (P <0 0 5 )且因子Ⅶ的活性水平略有升高而复方 18 甲组因子Ⅶ的活性水平略有下降 (P >0 0 5 ) ,其它指标活性水平 3组间相似(P >0 0 5 )。结论 长期服用低剂量国产COCs对妇女的凝血系统有一负面影响 ,不同的避孕药对凝血的影响也略有不同 ,这可能与避孕药中雌孕激素的剂量、雌孕激素的配伍有关。但这些指标均值波动尚在正常范围内 。

Objective To study the effects of long term usage of low dose norethisterone(Chinese No.1) and 18 metayl norethisterone(Norgestrel) on the blood coagulation system of heathy women.Methods One hundred and forty one women were grouped as combined norethisterone(Chinese No.1),combined 18 metayl norethisterone(Norgestrel) using them for 5-15years,and control subjects wearing IUD for the corresponding period.The activity of coagulation factors Ⅱ?Ⅴ?Ⅶ?Ⅷ?Ⅹ and APTT?PT FIB(A)?PT FIB(B)?TT were measured in the three groups.Results The activated partial thromboplastin time(APTT) in the two groups were accelerated,having a statistically significant increase in the Chinese No.1 group.Factor X activity in two groups was significantly higher than that in control group( P <0 05, P <0 01).Factor Ⅷ activity in the Chinese No.1 group increased significantly compared with control group( P <0 05).Other parameters tested in three groups were similar except that Factor Ⅶ increased in the Chinese No.1 group,but decreased in the Norgestrel group( P >0 05).Conclusion Long term usage of Chinese low dose COCs had a slight negative influence on haemolstati,the small differences in level of coagulation factors of the two COCs may depend on the dosage of estrogen and the type of progestogen used in combination.However,in the present situation,these changes did not exceed the variation seen in healthy women who did not use COCs,and had no clinical relevance.