放置宫内节育器后出血与衣原体、支原体感染的关系

目的探讨放置宫内节育器(IUD)后出血与衣原体、支原体感染的关系.方法采用套式聚合酶链反应(PCR)方法,对108例放置IUD后出血病例(IUD出血组)、放置IUD后无不良反应者102例(IUD正常组)、未放置IUD子宫异常出血32例(无IUD出血组)及未放置IUD正常妇女30例(无IUD正常组)之宫颈分泌物和子宫内膜中的沙眼衣原体(CT)、生殖支原体(Mg)进行检测.结果IUD出血组宫颈管分泌物CT及Mg阳性检出率分别为36.1%、25.0%,均明显高于IUD正常组和无1UD正常组(P＜0.05),IUD出血组宫腔内膜CT及Mg阳性检出率分别为28.7%、20%,均明显高于其他各组(P＜0.05).结论放置IUD后子宫异常出血与生殖道CT、Mg感染相关.     

宫内节育器对大鼠子宫去甲肾上腺素及肾上腺素含量的影响

为了研究宫内节育器对大鼠子宫组织中肾上腺素能神经末梢的影响,本文用改良荧光分光光度法测定了置器大鼠子宫组织中的去甲肾上腺素(NE)和肾上腺素(E)含量。结果发现放置不锈钢IUD置器侧和放置铜IUD置器侧子宫NE含量均较对照侧显著下降(P<0.01)。而子宫组织中E含量在各组置器侧与对照侧比较差异均无显著意义(P>0.05)。本研究结果提示,IUD作为异物非但使大鼠子宫肌层和内膜呈现明显的形态学变化,而且对子宫组织中肾上腺素能神经末梢的功能也产生明显影响。     

放置不同材料IUD_s后兔子宫内膜纤溶活性的改变

本文介绍兔一侧子宫内分别放置铜、钢、磁性物质及铜加6-氨基己酸(EACA)制成的宫内节育器(IUD),观察子宫内膜的纤溶变化。发现实验侧纤溶活性均明显高于对照侧,以铜为最明显。比较对照试验,铜IUD侧纤溶活性高于钢及磁(P<0.05),钢与磁之间无差异(P>0.05)。置含EACA铜IUD组分别于置器后7,14,28天后观察纤溶活性。7及14天组实验侧与对照侧纤溶活性无差异。28天后实验侧明显高于对照侧。用含EACA铜与无EACA的铜IUD进行对比,7天组实验侧纤溶活性低于对照侧(0.05相似文献   

放置IUD后宫腔微环境的研究

目的 :研究长期放置IUD子宫局部免疫功能的变化。方法 :以放置 5～ 2 0年惰性和含铜宫内节育器 (IUD)共 6 2例为研究组 ,以正常妇女 2 7例为对照组 ,以肿瘤坏死因子 α(TNF α)、白细胞介素 2 (IL 2 )、分泌型IgA(SIgA)和T淋巴细胞为指标。结果 :宫腔冲洗液TNF α浓度在惰性IUD组、含铜IUD组与对照组之间均未见明显差异。含铜IUD组宫腔冲洗液IL 2浓度显著低于对照组 (P <0 0 5 ) ,SIgA浓度亦显著低于对照组 (P <0 0 5 )。含铜IUD组子宫内膜组织抑制或杀伤T淋巴细胞 (CD+8淋巴细胞 )明显多于惰性IUD组和对照组 ;而辅助性T淋巴细胞 (CD4+ 淋巴细胞 )少于对照组 ,与惰性IUD组差异无显著性。结论 :长期放置IUD对子宫局部免疫功能有不同程度的影响     

放置宫内节育器对子宫内膜血管内皮生长因子及其激酶受体表达及微血管密度变化的影响

目的探讨放置固定式带铜宫内节育器(FCu-IUD)和含吲哚美辛FCu-IUD(FICu-IUD),对子宫内膜组织中血管内皮生长因子(VEGF)及其激酶受体(KDR)表达以及微血管密度(MVD)变化的影响及意义.方法采用免疫组化法及原位杂交法,检测放置FCu-IUD妇女(10例,FCu-IUD组)及放置FICu-IUD妇女(10例,FICu-IUD组)放置IUD前后子宫内膜VEGF、VEGF mRNA及KDR的表达,并计数子宫内膜MVD.结果 FCu-IUD组放置IUD后,VEGF及KDR蛋白为0.568±0.027,0.244±0.022,均高于放置IUD前的0.357±0.032,0.215±0.029,放置IUD前后比较,差异有显著性(P<0.05).FCu-IUD组放置IUD前VEGF mRNA表达为0.359±0.022,低于放置IUD后的0.425±0.019,放置IUD前后比较,差异有显著性(P<0.05).FICu-IUD组放置IUD前后VEGF、KDR蛋白及VEGF mRNA表达比较,差异无显著性(P>0.05). FCu-IUD组放置IUD后MVD为19.8±4.8,明显高于放置IUD前的15.4±2.8,且与VEGF蛋白的表达呈正相关关系(r=0.847,P<0.01).FICu-IUD组放置IUD前后MVD比较,差异无明显性(P>0.05).结论放置FCu-IUD可促进子宫内膜VEGF及KDR的表达,FICu-IUD可抑制子宫内膜VEGF及KDR的生成.VEGF及KDR可能参与了FCu-IUD 及FICu-IUD所引起的子宫内膜微血管结构和功能的改变.     

对带IUD妇女输卵管病理形态学的观察

我们对放置金属单环妇女101例及对照组113例于输卵管结扎时取峡部组织进行了镜检。同时用Opton显微镜灰度仪检测了IUD组30例输卵管粘膜纤毛细胞复盖面积的变化,并与对照组17例对比。结果IUD组输卵管有炎性病理改变者占71.29%,对照组为56.64%(P<0.05)。纤毛细胞复盖面积IUD组为22.63%,对照组为38.18%(P<0.05)。提示IUD组与输卵管炎性病变有关,输卵管纤毛细胞复盖面积亦明显减少。     

含消炎痛IUD对家兔子宫内膜影响的酶组织化学观察

本文采用酶组织化学方法观察了含消炎痛IUD对家兔子宫内膜几种酶的影响,并与全铜、硅胶及铜加消炎痛IUD进行了比较.结果表明:(1)含消炎痛IUD组子宫内膜NSE、SDII和ATPase三种酶活性增强;全铜IUD组则上述三种酶活性明显下降;加消炎痛的含铜IUD组子宫内膜酶活性低于含消炎痛IUD组,但高于硅胶对照组.(2)全铜IUD组子宫内膜损伤较明显.由此可见,含消炎痛IUD对子宫内膜上皮功能及结构的损害均小于含铜IUD.     

CuIUD对妇女子宫内膜环氧化酶表达的影响

目的:　研究置固定式铜宫内节育器(FCuIUD)前后妇女子宫内膜组织中环氧化酶(COX-1、COX-2)的表达。方法:　选择符合受试条件的育龄妇女10 例,于月经净后3-7　d放置FCuIUD,置器前及置器后一个月于相同时期、相同部位刮取子宫内膜。RT-PCR法与Western　blot法分析放置FCu-IUD前后妇女子宫内膜组织COX-1、COX-2　mRNA及蛋白表达水平。免疫组化S-P法测定COX-2在子宫内膜的定位与分布。结果:置FCuIUD一个月后,子宫内膜COX-2　mRNA和蛋白表达水平均显著增加,与置器前比较,差异显著(P<0.05)。COX-1　mRNA及蛋白的表达在置器前后无明显差异。COX-2主要分布于腺上皮细胞的胞浆内。结论:　置FCuIUD后妇女子宫内膜COX-2表达在转录和翻译水平均显著增加;COX-2可能是节育器引起的无菌性炎症中PGs释放增加的主要同工酶。     

吉妮固定式宫内节育器应用效果的研究

目的 :研究吉妮固定式宫内节育器 (GyneFixIUD)的效果。方法 :对 10 7例放置GyneFixIUD和 80例放置含铜 375IUD的妇女进行 1年的临床观察和对照研究。结果 :(1)Gyne组在去除放置技术或子宫过软所致的脱落因素后 ,脱落率显著低于含铜组 (P <0 .0 5) ;(2 )在放置IUD后 3个月和 6个月时 ,副作用有淋漓出血 ,经量过多和白带增多等 ,Gyne组明显低于含铜组 ,差异有显著性 (P <0 .0 1,P <0 .0 5,P <0 .0 1)。结论 :GyneFixIUD的临床使用效果好于含铜 375IUD ,脱落率和副作用低于含铜 375IUD     

放置VCu200宫内节育器后五年内的铜离子释放规律

本文研究了放置含铜V 型宫内节育器(VCu200 IUD)后五年内的宫颈粘液含铜量,从而了解VCu200 IUD 的使用年限。随机选择带VCu200 IUD 者1、3、6、12个月各30例;24、36、48、60个月各20例。同时随机选择带不锈钢IUD 者10例,并选16例不带器妇女作正常位对照。于月经第20～23天用玻璃吸管吸取宫颈粘液0.2～0.4克,用无火焰原子吸收分光光度计测铜离子浓度。结果带VCu200 IUD 者各期平均宫颈粘液的含铜量为2.61、1.98、1.96、1.82、1.22、1.20、1.15、0.98微克/每克粘液湿重,与正常未带器者及带不锈钢器者各期的含铜量均有显著差异(p<0.05),释放量虽随时间延长而逐渐减少(y=-0.2764x+2.2340),至第五年与未带器者相比,仍有显著差异(p<0.05),提示VCu200 IUD 使用五年仍有生物活性。     

记忆合金药铜宫内节育器对兔子宫内膜超微结构的影响

目的:研究记忆合金药铜节育器对兔子宫内膜超微结构的影响。方法:雌性日本大耳白兔随机分为3组,实验组记忆合金药铜节育器和对照组不锈钢药铜节育器各18只,假手术对照组6只,通过手术放置节育器于兔子宫腔内,术后1、3、6个月处死兔,取出子宫,扫描和透射电子显微镜下观察放置节育器处的子宫内膜。结果:放置节育器的兔子宫内膜均可见上皮细胞的形态和结构发生改变。扫描电子显微镜下,上皮细胞的变化随节育器放置时间和受压程度的增加而增加,可逐渐出现细胞表面压平、变形,微绒毛稀疏、消失;较长时间放置,可引起上皮细胞损坏、脱落。透射电子显微镜下2种节育器引起的细胞形态和结构的改变相似,主要是内质网扩张,细胞核肿胀,质膜溶解,严重的可见上皮细胞脱落现象。细胞内超微结构的损伤亦随节育器放置时间和受压程度的增加而加重。但基膜始终损伤较轻微,基膜下的间质未观察到明显异常的形态学变化。结论:记忆合金药铜节育器与不锈钢药铜节育器对兔子宫内膜超微结构的影响相似。     

Expression of alpha4beta1 and alphavbeta3 integrins in the endometrium of women using the T200 copper intrauterine device

OBJECTIVE: To investigate the expression of alpha4 and beta3 integrin subunit levels in the endometrium of healthy women and copper intrauterine device (IUD) T200 users. DESIGN: Case control study. SETTING: An academic teaching hospital and a primary care clinic. PATIENT(S): Thirteen copper IUD users and 13 normal fertile women.Intervention(s): Timed endometrial biopsies during the mid-secretory phase (days 20 to 24). MAIN OUTCOME MEASURE(S): Histologic dating of endometrium and immunohistochemical staining intensity of alpha4 and beta3, using the semiquantitative immunohistochemical score (HSCORE). RESULT(S): All endometrial biopsies consistent with menstrual dates were examined for integrin expression (beta3 and alpha4). No difference in alpha4 integrin expression was found between IUD users and controls in both luminal and glandular epithelium. In fertile controls, alphavbeta3 staining was present in 100% and 38.4% of glandular and luminal epithelium, respectively. In contrast, only 61.5% of the IUD users had any alphavbeta3 staining in the glandular epithelium and only 53.9% in the luminal epithelium. The intensity of immunoreactivity between the two groups (mean HSCORE) did not differ significantly. CONCLUSION(S): Proportionately, significantly fewer women using copper IUD had positive alphavbeta3 immunoreactivity in the glandular epithelium of mid-secretory endometrium.     

Effect of copper-IUD on the human endometrium (author's transl)]

Copper intrauterine contraceptive devices (Cu-IUD) are known to have more increased contraceptive effect and less complications that inert IUD. It has previously been shown that progesterone receptor binding is more affected by copper ions and the presence of copper in rabbit uterus results in less sensitivity to progesterone. It was expected that in a human wearer of Cu-IUD, the Cu induced changes of the endometrium in the secretory phase will be more obvious than in the proliferative phase. In this study the histological endometrial dating was compared with the dating by the basal body temperature. In the proliferative phase, 2 cases in 8 had the delayed and advanced datings respectively. In the secretory phase, 7 cases in 18 had the delayed dating and 1 case in 18 had the advanced dating. These results indicate that the proliferative endometrium (estrogen effect) is not affected but the secretory endometrium (progesterone effect) is affected by Cu-IUD, possibly resulting in the luteal insufficiency. (Author's)     

Copper in the menstrual and physiological cycle cervical mucus of copper IUD users (author's transl)

The article studies the concentration of copper in the cervical mucus of users and nonusers of copper IUDs. Of the 170 samples taken 90 were basal, i.e. taken from nonusers, and 80 were taken from users of No-Gravid, Dalkon Shield, Gravigard, Copper T, and Progestasert. Concentration of copper was much higher in IUD wearers than in nonwearers, even after 2 years from insertion, except in wearers of Dalkon Shield and of Progestasert. Copper concentration in wearers of Gravigard and Copper T were lower than concentrations found in wearers of No-Gravid.     

Expression of α4β1 and αvβ3 integrins in the endometrium of women using the T200 copper intrauterine device

Objective: To investigate the expression of α4 and β3 integrin subunit levels in the endometrium of healthy women and copper intrauterine device (IUD) T200 users.Design: Case control study.Setting: An academic teaching hospital and a primary care clinic.Patient(s): Thirteen copper IUD users and 13 normal fertile women.Intervention(s): Timed endometrial biopsies during the mid-secretory phase (days 20 to 24).Main Outcome Measure(s): Histologic dating of endometrium and immunohistochemical staining intensity of α4 and β3, using the semiquantitative immunohistochemical score (HSCORE).Result(s): All endometrial biopsies consistent with menstrual dates were examined for integrin expression (β3 and α4). No difference in α4 integrin expression was found between IUD users and controls in both luminal and glandular epithelium. In fertile controls, αvβ3 staining was present in 100% and 38.4% of glandular and luminal epithelium, respectively. In contrast, only 61.5% of the IUD users had any αvβ3 staining in the glandular epithelium and only 53.9% in the luminal epithelium. The intensity of immunoreactivity between the two groups (mean HSCORE) did not differ significantly.Conclusion(s): Proportionately, significantly fewer women using copper IUD had positive αvβ3 immunoreactivity in the glandular epithelium of mid-secretory endometrium.     

放置IUD后宫腔微生物及子宫内膜病理学研究

研究ＩＵＤ与盆腔感染及子宫内膜恶变或其他病理改变的关系,探讨 ＩＵＤ长期使用的安全性。方法：将 ８８例分为 Ａ、Ｂ、Ｃ、Ｄ ４组,Ａ组 ２０例使用带尾丝活性 ＩＵＤ;Ｂ组２４例使用惰性 ＩＵＤ;Ｃ组 ２４例为正常对照组;Ｄ组 ２０例为盆腔感染组。所有病例取宫腔冲洗液进行需氧菌、厌养菌、解脲支原体、沙眼衣原体等培养,并取子宫内膜进行病理学检查,结果：Ａ、Ｂ组主要表现为正常增生期、分泌期或月经期子宫内膜,部分是单纯性或腺囊性增生,与Ｃ组、Ｄ组差异无显著性（Ｐ＞０．０５）,４组均未见不典型增生及恶变。Ａ、Ｂ、Ｃ３组子宫内膜均无慢性炎症改变,Ｄ组８例存在慢性子宫内膜炎改变,与Ａ、Ｂ、Ｃ组差异有显著性（Ｐ＜０．０５）。Ａ、Ｂ、Ｃ组淋巴细胞、浆细胞、中性白细胞、纤维细胞计数差异无显著性（Ｐ＞０．０５）,Ｄ组淋巴细胞、浆细胞、中性白细胞计数较以上３组明显增加（Ｐ＜０．０５）,间质细胞及纤维细胞计数与以上３组差异无显著性（Ｐ＞０．０５）。Ａ、Ｂ、Ｃ组宫腔微生物检出率分别为３０．０％,２９．２％,２０．８％,与Ｄ组（７０．０％）差异有显著性（Ｐ＜０．０５）。结论：使用ＩＵＤ５－１４年未增加子宫内膜癌、癌前病变及慢性子宫内膜炎发生率。Ｉ     

Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device?

OBJECTIVE: Histopathological evaluation of the endometrium in cases having an intrauterine device (IUD) removed for abnormal uterine bleeding. METHODS: Fifty-eight consecutive patients with a complaint of uterine bleeding leading to IUD removal were recruited for this study. Endometrial sampling, via Novak curette, was performed during IUD removal for histopathological evaluation of the endometrium. RESULTS: A total of 58 current IUD users, presenting with uterine bleeding, were retrospectively analyzed. Mean age of the women was 37.1 +/- 2.1 years (range 25-43). Mean duration of IUD use was 4.2 +/- 1.3 years (range 1-10). Out of 58 cases, 21 (36.2%) did not harbor any endometrial pathology. In eight cases (13.8%), hyperplastic endometrial changes were apparent, six of which were simple hyperplasia (four of them were focal). Two cases of complex hyperplasia were detected (one was diffuse with atypia and one was focal without atypia). In this series, there was one case with an endometrial polyp. Mean age of cases with hyperplastic endometrium was found to be statistically high compared to those with normal endometrial histology (42.4 +/- 3.2 vs. 37.6 +/- 2.1, p = 0.04). In cases with IUD use of > 5 years, chronic endometritis was more prevalent, compared to those with < 5 years of use (chi(2) 5.08, p = 0.02). CONCLUSIONS: IUD use is a risk factor for chronic endometritis. Nevertheless, in 13.8% of cases in this series, as a reason for abnormal uterine bleeding, other than endometritis, endometrial hyperplasia constituted the second most common endometrial pathology among cases over the age of 40, on current IUD use and having complaints of abnormal uterine bleeding. Hence, this finding should prompt the physician to perform endometrial sampling in users of an IUD over the age of 40, presenting with abnormal uterine bleeding.