van Vliet Huib A A M, Frolich Marijke, Christella M, Thomassen L G D, Doggen Carine J M, Rosendaal Frits R, Rosing Jan, Helmerhorst Frans M
Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Hum Reprod. 2005 Feb;20(2):563-8. doi: 10.1093/humrep/deh612. Epub 2004 Nov 11.
Epidemiological studies have shown that both the estrogen dose and progestogen type of oral contraceptives contribute to the increased risk of thrombosis in oral contraceptive users. Thrombin generation-based activated protein C (APC) sensitivity is a global test for the net prothrombotic effect of oral contraceptives and predicts the thrombotic risk. Our objective was to test the usefulness of sex hormone-binding globulin (SHBG) as a marker for the thrombotic risk of an oral contraceptive.
We measured SHBG and APC resistance in 156 healthy users of various types of oral contraceptives.
Users of oral contraceptives with a moderately increased risk of thrombosis (gestodene and desogestrel pills) had higher SHBG levels than users of low-risk oral contraceptives containing levonorgestrel. Similarly, for higher doses of estrogen in oral contraceptives we found higher SHBG levels. Women using oral contraceptives with the highest thrombotic risk (cyproterone acetate pills) rendered the highest SHBG levels. Users of oral contraceptives containing gestodene, desogestrel or cyproterone acetate were more resistant to APC than users of levonorgestrel pills. SHBG levels were positively associated with the increased APC resistance.
Our findings support the hypothesis that the effect of an oral contraceptive on SHBG levels might be a marker for the thrombotic risk.
流行病学研究表明，口服避孕药的雌激素剂量和孕激素类型均会增加口服避孕药使用者发生血栓形成的风险。基于凝血酶生成的活化蛋白C（APC）敏感性是对口服避孕药净促血栓形成作用的一项整体检测，并可预测血栓形成风险。我们的目的是检验性激素结合球蛋白（SHBG）作为口服避孕药血栓形成风险标志物的实用性。
我们测量了156名使用各种类型口服避孕药的健康使用者的SHBG和APC抵抗情况。
血栓形成风险中度增加的口服避孕药（孕二烯酮和去氧孕烯片）使用者的SHBG水平高于含左炔诺孕酮的低风险口服避孕药使用者。同样，对于口服避孕药中较高剂量的雌激素，我们发现SHBG水平也较高。使用血栓形成风险最高的口服避孕药（醋酸环丙孕酮片）的女性SHBG水平最高。含孕二烯酮、去氧孕烯或醋酸环丙孕酮的口服避孕药使用者比左炔诺孕酮片使用者对APC更具抵抗性。SHBG水平与APC抵抗增加呈正相关。
我们的研究结果支持以下假设，即口服避孕药对SHBG水平的影响可能是血栓形成风险的一个标志物。
