Harper M A, Meis P J, Steele L
Department of Obstetrics and Gynecology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
J Soc Gynecol Investig. 1997 Mar-Apr;4(2):86-9.
Decreased insulin sensitivity and deterioration in oral glucose tolerance curves have been reported with oral contraceptive use, particularly with those containing levonorgestrel. However, the subdermal levonorgestrel systems release a lower dosage of steroid and avoid the first pass through the liver that occurs with oral administration. We hypothesized, therefore, that continuous subdermal levonorgestrel has no significant effect on insulin sensitivity and other indices of glucose metabolism.
Nine women desiring a subdermal hormonal contraceptive system were recruited for this longitudinal prospective study. Each subject underwent a 3-hour frequently sampled intravenous glucose tolerance test immediately before insertion and after 6 months of continuous use. Insulin sensitivity and glucose effectiveness were determined using a mathematical minimal modeling approach. Glucose clearance and fasting and peak levels of glucose and insulin were examined as well. The matched-pair data were analyzed using paired t tests.
There was no significant change in insulin sensitivity, glucose effectiveness, glucose clearance, or fasting or peak insulin levels. Fasting glucose levels remained within a normal range.
Subdermal levonorgestrel appears to have no significant effect on tissue insulin sensitivity or glucose metabolism after 6 months of continuous use.
据报道，口服避孕药，尤其是含左炔诺孕酮的避孕药，会导致胰岛素敏感性降低和口服葡萄糖耐量曲线恶化。然而，皮下左炔诺孕酮系统释放的类固醇剂量较低，且避免了口服给药时的首过肝脏效应。因此，我们推测，持续皮下使用左炔诺孕酮对胰岛素敏感性和其他葡萄糖代谢指标无显著影响。
招募9名希望使用皮下激素避孕系统的女性参与这项纵向前瞻性研究。每位受试者在植入前及连续使用6个月后，均接受了一次3小时频繁采血的静脉葡萄糖耐量试验。采用数学最小模型法测定胰岛素敏感性和葡萄糖效能。同时检测葡萄糖清除率以及葡萄糖和胰岛素的空腹和峰值水平。配对数据采用配对t检验进行分析。
胰岛素敏感性、葡萄糖效能、葡萄糖清除率或空腹及峰值胰岛素水平均无显著变化。空腹血糖水平保持在正常范围内。
连续使用6个月后，皮下左炔诺孕酮似乎对组织胰岛素敏感性或葡萄糖代谢无显著影响。
