妇产科医生对复方短效口服避孕药的雌激素剂量和服药方案的认知调查研究

A survey study on obstetricians and gynecologists' awareness of estrogen dosage and medication regimen in combined short-acting oral contraceptives

摘要

目的 了解当前我国妇产科医生对不同种类复方短效口服避孕药(COC)服药方案及其雌激素剂量的认识和适应症应用情况,以期为临床个体化用药决策提供参考。方法 2022年8月至12月在全国20个省、自治区、直辖市的155家医院邀请妇产科医生进行问卷调查,了解其对国内目前五种常用COC的雌激素剂量和服药方案的认知及适应症应用情况.采用卡方检验、Bonferroni法、Cramer's V系数、雷达图等方法对数据进行统计分析及归纳总结。结果 向653名妇产科医生发放调查问卷,回收有效问卷650份,回收率99.54%.妇产科医生对国内目前五种常用COC的知晓率差别较大,其中以屈螺酮炔雌醇片(Ⅱ)(20μg/片,87.69%;24/4方案,84.77%)知晓率最高,去氧孕烯炔雌醇片(20μg/片,45.69%;21/7方案,83.54%)最低.对于治疗痤疮、经前焦虑障碍、易怒、抑郁、经前综合征、多毛症和多囊卵巢综合征,28.77%~31.69%的妇产科医生选择24/4方案,37.54%~47.85%的妇产科医生选择雌激素剂量20μg/片的COC;其中对改善易怒症状(χ²=9.403,P=0.009)方面,硕士及以上妇产科医生选择选择24/4方案的比例高于本科及以下学历者,差异有统计学意义.在改善月经周期规律性、治疗月经过多、经期周期控制效果方面,49.38%~50.00%的妇产科医生选择两方案效果相似,44.46%~56.31%的妇产科医生选择两剂量效果相似;其中在改善月经周期规律性(χ²=8.402,P=0.015)和治疗月经过多(χ²=6.451,P=0.040)方面,选择两剂量相似的副主任医师及以上的比例高于主治医师及以下者,差异均有统计学意义.妇产科医生对不同雌激素剂量和服药方案的选择呈弱相关(0.2<Cramer's V<0.3,P<0.05)。结论 国内妇产科医生对不同COC的知晓率参差不齐,普遍存在对COC的作用机制认知不足.鉴于COC应用的广泛性,建议对妇产科医生加强COC药物作用机制的相关培训,了解雌孕激素剂量、种类与服药方案的关系,准确掌握适应症,以期更好地提供个体化推荐用药.

Abstract

Objective To understand the current awareness and application of different types of combined short-acting oral contraceptive (COC) regimens and their estrogen dosages among obstetricians and gynecologists in China, and to provide a reference for clinical individualized medication decisions. Methods From August to December 2022, obstetricians and gynecologists from 155 hospitals in 20 provinces, autonomous regions, and municipalities were invited to participate in a questionnaire survey. The survey aimed to assess their understanding of the estrogen dosages, medication regimens, and indications of the five most commonly used COC in China. Statistical analysis and summarization were conducted using methods including chi-square test, the Bonferroni method, Cramer's V coefficient, radar chart, etc. Results Survey questionnaires were distributed to 653 obstetricians and gynecologists, and 650 valid responses were collected, resulting in a recovery rate of 99.54%. There was significant variation in awareness among obstetricians and gynecologists regarding the five most commonly used COC in China. Drospirenone and ethinyl estradiol tablets (Ⅱ) (20μg/tablet, 87.69%; 24/4 regimen, 84.77%) had the highest awareness, while desogestrel and ethinyl estradiol tablets (20μg/tablet, 45.69%; 21/7 regimen, 83.54%) had the lowest awareness. For the treatment of acne, premenstrual dysphoric disorder, irritability, depression, premenstrual syndromes, hirsutism and polycystic ovary syndrome, 28.77% to 31.69% of obstetricians and gynecologists preferred the 24/4 regimen, while 37.54% to 47.85% selected COC with an estrogen dose of 20μg/tablet. Notably, for improving irritability symptoms (χ²=9.403, P=0.009), the proportion of obstetricians and gynecologists with a master's degree or higher who selected the 24/4 regimen was significantly higher than those with a bachelor's degree or lower, showing a statistically significant difference. Regarding the improvement of menstrual cycle regularity, treatment of menorrhagia and the effectiveness of cycle control, 49.38% to 50.00% of obstetricians and gynecologists considered the effectiveness of the two regimens to be similar, and 44.46% to 56.31% considered the effectiveness of the two dosages to be similar. Notably, for improving menstrual cycle regularity (χ²=8.402, P=0.015) and treating menorrhagia (χ²=6.451, P=0.040), the proportion of associate chief physicians and above who selected the two doses as similar was significantly higher than that of attending physicians and below, with statistically significant differences. There was a weak correlation between obstetricians and gynecologists' choices of different estrogen doses and medication regimens (0.2<Cramer's V<0.3, P<0.05). Conclusion The awareness of different COC among obstetricians and gynecologists in China is uneven, with a generally insufficient understanding of the mechanisms of action of COC. Given the widespread use of COC, it is recommended to enhance training for obstetricians and gynecologists on the mechanisms of action of COC drugs. This includes understanding the relationship between estrogen-progestin dosages, types, and medication regimens, and accurately mastering the indications. This will better enable them to provide individualized medication recommendations.

关键词

复方短效口服避孕药 / 雌激素 / 孕激素 / 服药方案 / 妇产科医生

Key words

combined short-acting oral contraceptive / estrogen / progestin / regimen / obstetrician and gynecologist

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基金资助

上海市科学技术委员会2021年度“科技创新行动计划”科普专项面上项目:科学避孕、远离人流——产后/流产后女性生殖健康系列科普教育课程和课件开发(21DZ2305800)