使用醋酸甲孕酮避孕针对骨质代谢和卵巢功能影响的研究

目的:研究长效醋酸甲孕酮避孕针(DMPA)对生育年龄妇女骨质代谢和卵巢功能影响。方法:选择自愿使用DMPA避孕者30例为实验组,采用避孕套避孕者30例为对照组。①测定两组血清碱性磷酸酶(AKP)、尿钙/肌酐(Ca/cr)、尿羟脯氨酸/肌酐(HYP/Cr);②测定非惯用臂桡尺骨骨密度(BMD)和桡尺骨超远端骨矿含量(BMC);③实验组于用药满一年时,对照组于月经周期第5天采用放免法测定血清性激素值;④实验组于首次用药当日及用药满一年,对照组于月经周期第5天B超监测卵泡发育状况;⑤实验组用药满一年时作阴道脱落细胞检查。结果:两组骨代谢生化指标及桡尺骨骨密度无显著性差异(P>0.05);实验组血清性激素值相当于正常育龄妇女卵泡早期水平,实验组有96.7％研究对象的卵巢内无卵泡或有小卵泡,最大卵泡直径≤1.5cm,卵泡发育状况相当于正常妇女卵泡早期水平,阴道脱落细胞检查显示雌激素水平无低落。结论:使用DMPA一年对骨质代谢无影响;DMPA使用者卵巢功能相当于正常育龄妇女卵泡早期水平。

The effect of DMPA on the bone metabolism and Ovarian function.

Objective: To study the effect of depot medroxyprogesteron acetate (DMPA) on the bone metabolism and ovarian funtion. Methods : Sixty volunteers were divided into the experimental group (n = 30) and control group (n = 30, accepted condom for contraception). The blood levels of AKP and sexual hormone, urine levels of Ca/Cr and HYP/Cr were measured, BMD and BMC of ultra-distal forearm were measured, follicular size were monitored by B-ultrasound, exfoliative cytoscopy of vagina was studied at the end of one year in the experimental group. Results:(1)There was no difference of biochemical indices for bone metabolism (P >0. 05) ;(2)There was no difference of bone density of ultra-distal forearm (P>0. 05) ; (3) Blood levels of sexual hormones in the experimental group were similar to that of the early follicular phase of the normal woman;(4)No follicle or only little follicles occurred in the ovary of 96. 7% experimental wo-nen. The maximum follicular size was less than 1. 5cm; (5) Exfoliative cytoscopy of vagina showed the estrogen level without significant decrease in the experimental group. Conclusion: (1)DMPA had no effect on the bone metabolism to the users for 1 year ;(2)The ovarian function of DMPA users were similar to that of the early follicualar phase of the normal women.