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目的:明确目前我国不同配方的国产低剂量复方口服避孕药(Combined oral contraceptives,COC)与出血型脑卒中的关系,以降低COC严重不良反应的发生,提高妇女的生殖健康水平。方法:前瞻观察1997年7月～2000年6月江苏省太仓和如东两县的25个乡镇使用COC妇女和同期使用宫内节育器妇女。结果:①与从未使用者相比,当前国产含炔诺酮的低剂量COC使用者出血型脑卒中发病率明显升高,但未发现梗塞型脑卒中发病率升高;②含炔诺酮的低剂量COC停用5年内仍然存在较高的出血型脑卒中发病危险性(RR=3.55,1.43～8.85),但停用5年以上者出血型脑卒中发病危险性明显降低(RR=1.27,0.59～2.74);③复方炔诺酮片与出血型脑卒中的关系明确,但不能排除其他配方的国产避孕药对出血型脑卒中的影响;④低剂量COC使用者中高血压仍然是出血型脑卒中最重要的危险性因素。结论:国产低剂量复方炔诺酮与出血型脑卒中有关,其对出血型脑卒中发病危险性的影响可持续到停用以后,但该作用可逆。应加强对其它国产COC严重不良反应的监测和研究,对COC使用者进行血压筛查和医学监护。
OBJECTIVE: To clarify the relationship between the domestic low-dose compound oral contraceptives (COC) and hemorrhagic stroke with different formulations in China so as to reduce the incidence of severe adverse reactions of COC and improve the reproductive health of women. Methods: Prospective observation From July 1997 to June 2000, COC women and IUD women were used in 25 towns and villages in Taicang and Rudong counties in Jiangsu Province. Results: ① Compared with never-used patients, the incidence of hemorrhagic stroke was significantly increased in the low-dose COC users with norethindrone in China, but the incidence of infarction-type stroke was not increased; (RR = 3.55, 1.43-8.85) still remained for 5 years after the discontinuation of low-dose COC, but the risk of developing hemorrhagic stroke was significantly lower after 5 years of disablement (RR = 1.27 , 0.59 ~ 2.74). ③The relationship between compound norgestione tablets and hemorrhagic stroke was clear, but the effect of other prescriptions of domestic contraceptives on hemorrhagic stroke could not be ruled out. ④However, The most important risk factor for stroke. CONCLUSION: Domestic low-dose norethindrone is associated with hemorrhagic stroke, and its effect on the risk of developing hemorrhagic stroke persists until it is discontinued, but this effect is reversible. Should be strengthened on other domestic COC serious adverse reactions monitoring and research, COC users for blood pressure screening and medical monitoring.