Kjos S L, Gregory K, Henry O A, Collins C
Department of Obstetrics and Gynecology, University of Southern California Medical Center, Los Angeles.
Obstet Gynecol. 1993 Dec;82(6):925-30.
To evaluate the efficacy of a diabetes and lipid screening program in women aged 35 or older who either were currently using a low-estrogen-dose oral contraceptive (OC) (0.03-0.04 ethinyl estradiol) or who desired to initiate low-dose OC therapy after using a non-OC method or following a recent pregnancy.
Healthy women with no history of abnormal glucose tolerance, hypertension, or hyperlipidemia aged 35 years and older were routinely screened for diabetes (fasting and 2-hour values after 75 g glucose) and dyslipidemia (fasting total cholesterol, high-density lipoprotein [HDL] and low-density lipoprotein [LDL] cholesterol, and triglycerides). Three groups of women were studied: women currently using low-dose OCs (OC group), women desiring to change to OC therapy (non-OC group), and women within 3 months post-pregnancy (postpartum group).
The three groups were similar in age, parity, body mass index (BMI), and mean arterial pressure. The mean months of contraceptive use were not different between the OC group (30.2 months; 95% confidence interval [CI] 26.6-33.8) and the non-OC group (38.4 months; 95% CI 32.0-44.8). The mean fasting serum glucose, after adjusting for age and BMI, was significantly lower in the OC group (82.4 +/- 9.4 mg/dL) than in the non-OC and postpartum groups (87.2 +/- 12.5 and 86.8 +/- 13.0 mg/dL, respectively; P = .01). After adjustments, no differences between the groups were found in the 2-hour post-glucose levels, triglycerides, or HDL or LDL cholesterol levels. The non-OC group was found to have a significantly lower total cholesterol level (188.7 +/- 32.4 mg/dL) than the OC and postpartum groups (202.7 +/- 38.1 and 204.4 +/- 41.0 mg/dL; P = .02) after adjusting for age and BMI. This association lost its significance after applying multiple range tests, maintaining an alpha error of 0.05.
The absence of significant adverse metabolic markers in longer-term OC users over the age of 35, in comparison to similar-age control groups, does not support the routine use of lipid and diabetes screening before initiating or during the use of low-dose OCs.
评估糖尿病和血脂筛查项目在35岁及以上女性中的效果，这些女性要么正在使用低雌激素剂量口服避孕药（OC）（炔雌醇0.03 - 0.04），要么在使用非OC方法后或近期妊娠后希望开始低剂量OC治疗。
对年龄在35岁及以上且无糖耐量异常、高血压或高脂血症病史的健康女性进行常规糖尿病（空腹及75克葡萄糖负荷后2小时血糖值）和血脂异常（空腹总胆固醇、高密度脂蛋白[HDL]和低密度脂蛋白[LDL]胆固醇以及甘油三酯）筛查。研究了三组女性：目前正在使用低剂量OC的女性（OC组）、希望改用OC治疗的女性（非OC组）以及产后3个月内的女性（产后组）。
三组在年龄、产次、体重指数（BMI）和平均动脉压方面相似。OC组（30.2个月；95%置信区间[CI] 26.6 - 33.8）和非OC组（38.4个月；95% CI 32.0 - 44.8）的平均避孕使用月数无差异。在调整年龄和BMI后，OC组的平均空腹血糖（82.4 ± 9.4毫克/分升）显著低于非OC组和产后组（分别为87.2 ± 12.5和86.8 ± 13.0毫克/分升；P = 0.01）。调整后，各组在葡萄糖负荷后2小时血糖水平、甘油三酯、HDL或LDL胆固醇水平方面未发现差异。在调整年龄和BMI后，发现非OC组的总胆固醇水平（188.7 ± 32.4毫克/分升）显著低于OC组和产后组（分别为202.7 ± 38.1和204.4 ± 41.0毫克/分升；P = 0.02）。在应用多重范围检验并保持α错误为0.05后，这种关联失去了显著性。
与同龄对照组相比，35岁以上长期使用OC的女性中缺乏显著的不良代谢标志物，这并不支持在开始使用或使用低剂量OC期间常规进行血脂和糖尿病筛查。
