La Rosa J C
Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
Am J Obstet Gynecol. 1988 Jun;158(6 Pt 2):1621-9. doi: 10.1016/0002-9378(88)90200-1.
A recent study at George Washington University Lipid Research Clinic compared three oral contraceptives containing different progestins and found that increases in total cholesterol, triglycerides, and apoprotein. All were not progestin related. Other effects, however, were apparently dependent on the type of progestin, with the androgenically potent agent dl-norgestrel causing dramatic increases in low-density lipoprotein (LDL)-cholesterol and the ratio of low-density to high-density lipoprotein (HDL) and decreases in HDL, particularly HDL2, and apoprotein Al. Reductions in HDL2 and increases in the LDL/HDL ratio are strongly associated with the development of atherosclerosis. In a study of postmenopausal women receiving hormone replacement therapy, estrogen alone was compared with estrogen plus dl-norgestrel. In contrast to the findings of the previous study, norgestrel lowered LDL and produced less substantial decreases in HDL and HDL2. Thus, although an antiestrogenic effect was evident, it cannot be assumed that the changes associated with progestin-containing oral contraceptives will automatically occur when lower doses of progestin are used in hormone replacement therapy.
乔治华盛顿大学脂质研究诊所最近的一项研究比较了三种含有不同孕激素的口服避孕药，发现总胆固醇、甘油三酯和载脂蛋白均有升高。这些升高并非都与孕激素有关。然而，其他影响显然取决于孕激素的类型，具有雄激素活性的药物炔诺酮会导致低密度脂蛋白（LDL）胆固醇以及低密度脂蛋白与高密度脂蛋白（HDL）的比率大幅升高，同时HDL尤其是HDL2和载脂蛋白A1降低。HDL2降低和LDL/HDL比率升高与动脉粥样硬化的发展密切相关。在一项针对接受激素替代疗法的绝经后女性的研究中，将单独使用雌激素与雌激素加炔诺酮进行了比较。与之前的研究结果相反，炔诺酮降低了LDL，并且对HDL和HDL2的降低幅度较小。因此，尽管抗雌激素作用明显，但不能假定在激素替代疗法中使用较低剂量孕激素时，与含孕激素口服避孕药相关的变化会自动出现。
