年轻女性应用醋酸甲羟孕酮避孕针避孕对骨矿物质密度的影响

Effect of depot medroxyprogesterone acetate contraceptive injection on bone mineral density in young women

目的 醋酸甲羟孕酮注射避孕药因使用简便、高效而广泛应用,但可降低骨矿物质密度,增加骨质疏松症风险,该文观察年龄19-24岁女性应用DMPA 24个月,与年龄类似非激素避孕妇女比较,评估DMPA对腰椎和股骨颈BMD的影响。方法 选择87例年龄19-24岁女性应用DMPA 24个月,83例年龄相仿女性应用非激素避孕作为对照组,应用双能X线吸收法检测腰椎和股骨颈BMD,每12个月检测1次,连续24个月,比较两组腰椎和股骨颈BMD的改变。结果 用药24个月,与基础值相比,腰椎和股骨颈BMD呈下降趋势,分别降低2.67%和2.71%,但无统计学差异（P=0.080和P=0.076）。而非激素避孕对照组腰椎和股骨颈BMD呈上升趋势,分别升高1.24%和1.30%,与基础值相比无统计学差异（P=0.436和P=0.373）。用药第1年,DMPA用药组与对照组相比,平均腰椎和股骨颈BMD值没有明显差异（P=0.153和P=0.140）;但用药第2年,两组BMD值有明显差异（P=0.012和P=0.008）。结论 年轻女性短期应用DMPA（〈12个月）对腰椎和股骨颈BMD没有明显不利影响,但长期应用对BMD有不利影响。

Objective：To evaluate the effect of depot medroxyprogesterone acetate（DMPA） contraceptive injection on bone mineral density（BMD） of lumbar vertebra and collum femoris by comparing 19-24-year-old women using DMPA for 24 months and the women in the same age group using non-hormonal contraceptives.Methods：Eighty-seven women aged 19-24 years old were treated with DMPA contraceptive injection for 24 months,eighty-three women in the same age group were treated with non-hormonal contraceptives.Dual-energy X-ray absorptiometry was used to detect BMD of lumbar vertebra and collum femoris every 12 months for two times; the changes of BMD of lumbar vertebra and collum femoris in the two groups were compared.Results：After 24 months of treatment,compared with the basal values,BMD of lumbar vertebra and collum femoris in DMPA group decreased by 2.67% and 2.71%,respectively,but there was no statistically significant difference（P = 0.080 and P = 0.076）; BMD of lumbar vertebra and collum femoris in control group increased by 1.24%and 1.30%,respectively,but there was no statistically significant difference（P = 0.436 and P = 0.373）.After 12 months,there was no statistically significant difference in BMD of lumbar vertebra and collum femoris between DMPA group and control group（P = 0.153 and P =0.140）; but after 24 months,there were statistically significant differences between DMPA group and control group（P = 0.012 and P =0.008）.Conclusion：Short-term application of DMPA（less than 12 months） has no obvious adverse impact on BMD of lumbar vertebra and collum femoris in young women,but long-term application has adverse effect.