【摘要】 目的:明确目前我国不同配方的国产低剂量复方口服避孕药(Combined oral contraceptives,COC)与出血型脑卒中的关系,以降低COC严重不良反应的发生,提高妇女的生殖健康水平。方法:前瞻观察1997年7月～2000年6月江苏省太仓和如东两县的25个乡镇使用COC妇女和同期使用宫内节育器妇女。结果:①与从未使用者相比,当前国产含炔诺酮的低剂量COC使用者出血型脑卒中发病率明显升高,但未发现梗塞型脑卒中发病率升高;②含炔诺酮的低剂量COC停用5年内仍然存在较高的出血型脑卒中发病危险性(RR=3.55,1.43～8.85),但停用5年以上者出血型脑卒中发病危险性明显降低(RR=1.27,0.59～2.74);③复方炔诺酮片与出血型脑卒中的关系明确,但不能排除其他配方的国产避孕药对出血型脑卒中的影响;④低剂量COC使用者中高血压仍然是出血型脑卒中最重要的危险性因素。结论:国产低剂量复方炔诺酮与出血型脑卒中有关,其对出血型脑卒中发病危险性的影响可持续到停用以后,但该作用可逆。应加强对其它国产COC严重不良反应的监测和研究,对COC使用者进行血压筛查和医学监护。更多还原

【Abstract】 Objective: To assess association between difference formulations of low - dose combined oral contraceptives ( COC) in China and the risk of hemorrhagic stroke in order to decrease adverse reaction of COC, promote women’s reproductive health. Methods: This is a prospective study of women residing in 25 townships in Rudong and Taicang county, Jiangsu Province. The 35 ,930 women in low - dose COC cohort and the 75,230 women in IUD cohort were followed up from 1 July 1997 to 30 June 2000. Results: This study clearly documented elevated the incidence rates of hemorrhagic stroke, but not of ischaemic stroke, among current users of low - dose COC containing Norethindrone. Compared with subjects who never used steroid contraceptives , the relative risk of incidence of hemorrhagic stroke reached 3. 55 ( 1. 43 ,8. 85 ) among past users after stopped taking COC for less than Syears, the risk of hemorrhagic stroke remarkably decrease after they stopped taking COC for more than 5 years. Evidence arising mostly from women who have used COC containing Norethindrone, specially to clear Chinese No. 1 formulation, but cannot exclude other effects. Hypertension still was the most important risk factor of hemorrhagic stroke among people who use hormonal contraceptives. Conclusion; There is certain association between increased risk of hemorrhagic stroke and use of the low - dose COC containing Norethindrone, appears to persist long after discontinuation, but effect may be reversible. Continued surveillance seems necessary, especially among users of low - dose containing Norethindrone formulations. Introduction or improvement of blood pressure screening and monitoring seems the next logical step in COC users.更多还原