Winkler U H
Center of Obstetrics and Gynecology, University Hospital Essen, Germany.
Eur J Contracept Reprod Health Care. 1998 Jun;3(2):65-74. doi: 10.3109/13625189809051406.
The objective of this paper was to assess the risk of thrombosis in users of oral contraceptives. Furthermore, the sensitivity, specificity and predictive values of potential screening tests for the prediction of thromboembolic complications in users of oral contraceptives were calculated for the approximately six million German pill users. Despite high specificity, the predictive values of a positive family history, or evidence of either antithrombin III, protein C or protein S deficiency or resistance to activated protein C, are low due to the very low absolute risk of thrombosis among pill users. More than half of the 840 annual cases would pass the screening protocol undetected. A two-step screening protocol is suggested using family history as a selection criterion (thus reducing the need for laboratory screening by 85%) for laboratory investigation of activated protein C sensitivity and deficiencies of antithrombin III, protein C or protein S. Genotyping for factor V Leiden mutation is useful in cases with equivocal activated protein C sensitivities or to confirm a homozygous genotype.
本文的目的是评估口服避孕药使用者发生血栓形成的风险。此外，针对约600万德国口服避孕药使用者，计算了用于预测口服避孕药使用者血栓栓塞并发症的潜在筛查试验的敏感性、特异性和预测值。尽管特异性较高，但由于口服避孕药使用者中血栓形成的绝对风险极低，家族史阳性或抗凝血酶III、蛋白C或蛋白S缺乏或对活化蛋白C抵抗的证据的预测值较低。每年840例病例中超过一半会在筛查方案中未被检测到。建议采用两步筛查方案，以家族史作为选择标准（从而将实验室筛查需求减少85%），用于实验室检测活化蛋白C敏感性以及抗凝血酶III、蛋白C或蛋白S缺乏情况。对于活化蛋白C敏感性不明确的病例或确认纯合基因型的情况，进行因子V Leiden突变基因分型是有用的。
