Kuhl H
Department of Obstetrics and Gynecology, J.W. Goethe University Frankfurt, Germany.
Maturitas. 1996 May;24(1-2):1-19. doi: 10.1016/0378-5122(96)00994-2.
Epidemiological data suggested an involvement of the progestogen component in the pathomechanism of venous and arterial diseases during intake of oral contraceptives. The influence of progestogens on haemostasis parameters depend on type and dose of the progestogen, the presence of an estrogen, the route of application, and the duration of use. Treatment of women with progestogen-only preparations caused only minor effects on coagulation and fibrinolysis. Similarly, during hormone replacement therapy with natural estrogens, the additional application of progestogens induced no unfavourable changes on haemostasis. In contrast, the use of ovulation inhibitors resulted in an acceleration of coagulation and fibrinolysis. This is primarily induced by the marked action of ethinylestradiol on hepatic and vascular function. Progestogens with androgenic properties may counteract the estrogen-induced changes in the hepatic synthesis of platelet aggregation and readiness for coagulation. Estrogen and progesterone receptors are localized in endothelial and smooth muscle cells of the vessel wall, but there are differences in the response of veins and arteries to sex steroids. Estrogens and progestogens may influence collagen and elastin synthesis, and the release of vasoactive compounds and of factors controlling fibrinolysis from endothelium. In veins, progestogens may increase distensibility and capacitance resulting in a decreased blood flow. In predisposed women, this may lead to venous stasis and thrombosis. In arteries, progestogens may act as vasoconstrictors, and may enhance vasospasms at sites of injured endothelium which finally may lead to ischemic diseases.
流行病学数据表明，在口服避孕药期间，孕激素成分参与了静脉和动脉疾病的发病机制。孕激素对止血参数的影响取决于孕激素的类型和剂量、雌激素的存在、给药途径以及使用时间。仅用孕激素制剂治疗女性对凝血和纤溶仅有轻微影响。同样，在用天然雌激素进行激素替代治疗期间，额外使用孕激素并未引起止血方面的不利变化。相比之下，使用排卵抑制剂会导致凝血和纤溶加速。这主要是由乙炔雌二醇对肝脏和血管功能的显著作用引起的。具有雄激素特性的孕激素可能会抵消雌激素诱导的肝脏合成血小板聚集和凝血准备方面的变化。雌激素和孕激素受体定位于血管壁的内皮细胞和平滑肌细胞中，但静脉和动脉对性类固醇的反应存在差异。雌激素和孕激素可能会影响胶原蛋白和弹性蛋白的合成，以及血管活性化合物和控制内皮细胞纤溶的因子的释放。在静脉中，孕激素可能会增加扩张性和容量，导致血流减少。在易感女性中，这可能会导致静脉淤滞和血栓形成。在动脉中，孕激素可能起血管收缩剂的作用，并可能增强受损内皮部位的血管痉挛，最终可能导致缺血性疾病。
