孕激素在闭经和流产中的临床应用课件.pptVIP

地屈孕酮和妊娠 估计大约35,000,000女性服用地屈孕酮 尽管妊娠的数目很难估计，但是预测约9,000,000孕妇服用过地屈孕酮 到目前为止，尚无证据表明孕期不能口服地屈孕酮 * * * 请注意烯丙雌醇是一种雌烷,属于19-去甲基睾酮类 孕激素类药物分为天然孕激素和合成孕激素. 合成孕激素的结构接近于要么与黄体酮要么接近于睾酮. References Schindler AE, Campagnoli C, Druckmann R, Huber J, Pasqualini JR, Schweppe KW, Thijssen JH. Classification and pharmacology of progestins. Maturitas. 2003 Dec 10;46 Suppl 1:S7-S16 Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol. 1994;170:1499-1507. Stanczyk FZ. Pharmacology, pharmacokinetics and pharmacodynamics: pharmacokinetics of progestogens. Int Proc J. 1989;1:11-20. Rebar RW, Zeserson K. Characteristics of the new progestogens in combination oral contraceptives. Contraception. 1991;44:1-10. Philibert D, Bouchoux F, Degryse M, et al. The pharmacological profile of a novel norpregnane progestin (trimegestone). Gynecol Endocrinol. 1999;13:316-326. Muhn P, Krattenmacher R, Beier S, et al. Drospirenone: a novel progestogen with antimineralocorticoid and antiandrogenic activity: pharmacological characterization in animal models. Contraception. 1995;51:99-110. * * * * * 这是达芙通的适应症——下一章节将详诉先兆流产及习惯性流产。 达芙通用于激素替代治疗将不讨论，因为在中国其未注册此类适应症。 * * Pregnancy is a semi-graft – 50% of the fetal antigens are foreign to the mother. In some pregnancies, the mother recognizes these foreign paternal antigens and sets up an immune rejection reaction to them, which causes abortion. In habitual abortion, this reaction is repeated in every subsequent pregnancy. In healthy pregnancy, however, the fetus is not compromised by an allogenic immune response. In these pregnancies, a cross talk between the pre-embryo and the mother-to-be starts early after fertilization, and results in a protective immune response in the mother. * * 在月经周期的后半期，子宫内膜必须在足够孕酮分泌的支持下才能实现向分泌相的转化。 雌激素和孕酮之间的相互作用由下丘脑和垂体的分泌物控制，又受雌激素和孕酮自身负反馈调节。 * After pointing out pathways of pregnancy protection, involving the HLA-G, IDO or uterine natural killer cells, one might ask: what causes the