目的:评估使用低剂量口服避孕药的女性发生脑血栓栓塞的风险。
方法:回顾性病例对照研究。
方法:所有丹麦医学,神经学,神经外科,和妇科。
方法:丹麦所有794名年龄在15-44岁的女性在1985-9年和1588年期间遭受过脑血栓栓塞发作,与随机选择的对照组年龄相匹配。
结果:在发出的692/1584个病例/对照问卷中,返回590/1396(85.3%/88.1%)。在案件中,15拒绝参加69有一个修正或不可靠的诊断,40人以前有血栓栓塞性疾病,13怀孕了,152人患有一种易患脑血栓栓塞的疾病。在323个没有已知诱因的病例中,320例报告使用或不使用口服避孕药。在1396个控件中,八人拒绝参加,智力迟钝,或居住在国外;18人返回了未完成的调查表;17人以前患有血栓栓塞疾病;31人怀孕;130人患有易患脑血栓栓塞的疾病。因此,有1198个非易感对照,其中1197人报告使用或不使用口服避孕药.在320个案例中,脑血栓栓塞发作时,口服避孕药使用者为116(36.3%)。相比之下,在1197个对照中有191个用户(16.0%),给出3.0的粗略赔率比。经过多变量分析,包括对年龄的混淆控制,吸烟,多年的教育,以及在1985-90年间使用不同类型的口服避孕药的趋势,含有50微克雌激素的药丸与脑血栓栓塞发作的比值比为2.9(95%置信区间1.6至5.4)相关,那些含有30-40微克雌激素的人的比值比为1.8(1.1至2.9),那些含有孕激素的只有0.9(0.4至2.4)的比值比。比值比不会随着年龄的增长或口服避孕药的使用时间而变化。吸烟者脑血栓栓塞发作的风险增加了50%(在混杂控制后)与口服避孕状态和年龄无关。
结论:低剂量口服避孕药与脑血栓栓塞发作的风险增加相关。与含有50微克雌激素的制剂相比,含有30-40微克雌激素的组合或连续药丸的风险降低了三分之一。仅使用孕激素的药丸不会增加脑血栓栓塞发作的风险。
回顾性病例对照研究的目的是评估1985-89年和1588年随机选择的年龄匹配的对照组发生脑血栓栓塞的风险。共回收590份(85.3%)和1396份(88.1%)对照问卷。因拒绝参加而排除在外,不可靠的诊断,以前的血栓栓塞性疾病,怀孕,和一种易患脑血栓栓塞的疾病。在323个没有已知诱因的病例中,320个报告使用或不使用OCs。在1396个控件中,有1198名非易感对照,其中1197人报告使用不使用OC。在320个案例中,脑血栓栓塞发作时,OC使用者为116(36.3%)。相比之下,在1197个控件中有191个用户(16.0%),给出3.0的粗略赔率比。多因素分析控制了年龄的混杂因素,吸烟,多年的教育,以及1985-90年间不同类型的OC的使用。含有50mcg雌激素的OCs与脑血栓栓塞发作的比值比为2.9,含有30-40mcg雌激素的比值比为1.8,仅含有孕激素的比值比为0.9。吸烟者脑血栓栓塞发作的风险增加50%与OC状态和年龄无关。低剂量OCs与脑血栓栓塞发作的风险增加相关。联合或序贯药丸,含有30-40微克雌激素,与含50mcg雌激素的制剂相比,风险降低了三分之一。仅使用孕激素的药丸不会增加脑血栓栓塞发作的风险。
OBJECTIVE: To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives.
METHODS: A retrospective
case-control study.
METHODS: All Danish medical, neurological, neurosurgical, and gynaecological departments.
METHODS: All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack during 1985-9 and 1588 age matched randomly selected controls.
RESULTS: Of 692/1584
case/control questionnaires sent out, 590/1396 (85.3%/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had had thromboembolic disease previously, 13 were pregnant, and 152 had a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or non-use of oral contraception. Among the 1396 controls, eight refused to participate, were mentally retarded, or lived abroad; 18 returned an uncompleted questionnaire; 17 had had thromboembolic disease previously; 31 were pregnant; and 130 had a disease predisposing to a cerebral thromboembolic attack. Thus 1198 non-predisposed controls were available, among whom 1197 reported use or non-use of oral contraception. Among the 320 cases, 116 (36.3%) were oral contraceptive users at the time of the cerebral thromboembolic attack. By comparison there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. After multivariate analysis, including confounder control for age, smoking, years of schooling, and trend in use of different types of oral contraceptives during 1985-90, pills containing 50 micrograms oestrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9 (95% confidence interval 1.6 to 5.4), those containing 30-40 micrograms oestrogen an odds ratio of 1.8 (1.1 to 2.9), those containing progestogen only an odds ratio of 0.9 (0.4 to 2.4). The odds ratio did not change with increasing age or with duration of oral contraceptive use. A 50% increased risk of a cerebral thromboembolic attacks among cigarette smokers (after confounder control) was independent of oral contraception status and age.
CONCLUSIONS: Low dose oral contraceptives are associated with an increased risk of cerebral thromboembolic attack. Combined or sequential pills containing 30-40 micrograms oestrogen are associated with a one third reduced risk compared with preparations containing 50 micrograms oestrogen. Progestogen only pills did not increase the risk of a cerebral thromboembolic attack.
The objective a retrospective
case-control study was to assess the risk of cerebral thromboembolic attack during 1985-89 and 1588 age matched randomly selected controls were investigated. 590
case (85.3%) and 1396 control (88.1%) questionnaires were returned. Exclusions occurred for refusal to participate, unreliable diagnosis, previous thromboembolic disease, pregnancy, and a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or nonuse of OCs. From among the 1396 controls, 1198 nonpredisposed controls were available, among whom 1197 reported use of nonuse of OCs. Among the 320 cases, 116 (36.3%) were OC users at the time of the cerebral thromboembolic attack. By comparison, there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. Multivariate analysis controlled confounding factors for age, smoking, years of schooling, and use of different types of OCs during 1985-90. OCs containing 50 mcg estrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9, those containing 30-40 mcg estrogen with an odds ratio of 1.8, those containing progestogen only with an odds ratio of 0.9. A 50% increased risk of a cerebral thromboembolic attack among cigarette smokers was independent of OC status and age. Low dose OCs were associated with an increased risk of cerebral thromboembolic attack. Combined or sequential pills, containing 30-40 mcg estrogen, are associated with a one third reduced risk compared with preparations containing 50 mcg estrogen. Progestogen-only pills did not increase the risk of a cerebral thromboembolic attack.