Am J Cardiol：先心病患者宜用仅含孕酮成分的避孕药

　　西班牙一项研究表明，尽管一些患者有禁忌证，但有相当高比例的先天性心脏病（CHD）患者曾应用雌激素孕酮复合避孕药（EPCC），在转至孕前门诊前，CHD患者应用孕酮成分避孕药（PC）比例较低。PC无血栓形成副作用，并且妇产科副作用发生率可接受，值得推广。论文于5月24日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　既往报道显示，CHD患者避孕方法包括EPCC，但其具有血栓栓塞风险，PC则被建议为其替代避孕药。此项研究对237例转诊至孕前门诊的CHD患者进行回顾性分析。

　　结果显示，33%的患者既往曾应用EPCC，3.8%在应用期间出现血栓栓塞事件。当前采用屏障避孕、EPCC和PC避孕的患者分别占58%、18%和1.3%，未采用任何避孕措施者者占21.7%。PC被提供给146例患者作为替代避孕药，其中73%同意启动治疗。中位随访1年时，启动PC治疗者有73%仍维持治疗。25%的患者报告妇产科副作用，无心血管副作用。

Usefulness of Progesterone-Only Components for Contraception in Patients With Congenital Heart Disease
Abstract
The objective of the study is to report the contraceptive methods used by patients with congenital heart disease (CHD) before referral to a specific preconception clinic and evaluate safety and treatment adherence of the alternative contraception method, progesterone-only component (PC), offered. Contraceptive methods in the CHD population reported included estrogen-progesterone combined contraceptives (EPCC), despite the potential risk for thromboembolism. PC has been suggested as an alternative, but, no information on its use has been reported. Retrospective analysis was performed of all patients (n = 237) referred to the preconception clinic of an adult CHD center. Thirty-three percent of patients had used EPCC in the past; 3.8% had had thromboembolic events during its use. Current contraception consisted of barrier methods in 58% of patients, EPCC in 18%, and PC in 1.3%; 21.7% of patients were not using any contraception. PC was offered as an alternative in 146 patients; 73% of patients agreed to start the treatment. At a median follow-up of 1 year, 73% of patients who started PC maintained the treatment. Gynecologic side effects were reported in 25% of patients, with no cardiovascular effects. In conclusion, a significant proportion of patients with CHD were former users of EPCC, although some had formal contraindications, and the rate of PC use before referral to the preconception clinic was low. After being offered as an alternative treatment, the use of PC in its various forms was extensive, with no thrombogenic side effects and an acceptable rate of gynecologic side effects being reported.