应用宫内节育器的妇女沙眼衣原体感染与子宫内膜中铜含量的关系

目的:探讨女性生殖道沙眼衣原体(CT)感染与宫内节育器(IUD)种类及内膜中铜含量的关系。方法:用聚合酶链反应检测65例置含铜IUD及97例置不锈钢单环的妇女宫颈分泌物CT;对因症取出IUD的20例妇女,取器后刮取子宫内膜,用原子吸收分光光度法测子宫内膜铜含量。结果:放置含铜IUD者CT感染率(3.1%)明显低于置不锈钢单环者(12.3%),P<0.05;放置含铜IUD的妇女子宫内膜铜含量明显高于置不锈钢单环者(P<0.05)。结论:含铜IUD对生殖道CT感染有抑制作用。含铜IUD可能通过释放的铜离子来发挥抗CT作用。     

放置VCu200 IUD不同年限宫颈粘液含铜量

本文用无火焰原子吸收分光光度仪ＨＩＴＡＣＨＩ－１８０测试置ＶＣｕ２００ＩＵＤ妇女宫颈粘液含铜量２６７例。其结果为自第１年平均含铜量２．６６±０．５８μｇ／ｇ粘液湿重至第１５年降为０．９１±０．６μｇ／ｇ粘液湿重，显示宫颈粘液含铜量随放置时间延长而渐减少。金属圆环组２１４例，各不同年限宫颈粘液含铜量平均为０．３５±０．０８～０．５６±０．１４μｇ／ｇ粘液湿重。未带器组２１例宫颈粘液平均含铜量为０．４７±０．１１μｇ／ｇ粘液湿重，ＶＣｕ２００组与金属圆环组各年限相比均有显著差异（Ｐ＜０．０５～０．００１）。与未带器组比各年ｆＫ亦皆有显著差异（Ｐ＜０．０５～０．００１）。文献报道铜离子浓度达１．０μｇ／ｍｌ有杀死或抑制精子活动的作用，浓度为０．７μｇ／ｍｌ能使孕卵胚泡中毒。本文置ＶＣｕ１２００ＩＵＤ者第１０年时铜离子含量为１．１１μｇ／ｇ粘液湿重，第１５年为０．９１±０．１μｇ／ｇ粘液湿重，依此推测ＶＣｕ２００ＩＵＤ至少可放置１０年以上。     

三种新型含铜宫内节育器宫底及宫颈部Cu2+浓度的初步探讨

目的 :研究三种不同含铜表面积的铜宫内节育器 (Cu IUD)对宫腔底部和宫颈部Cu2 浓度的影响。方法 :采集 6 0例置三种新型、高效的Cu IUD妇女不同时段宫腔底部和宫颈部粘液 ,用原子吸收 /火焰分光光度计法测定其Cu2 浓度。结果 :在置器后 6个月内含铜T形宫内节育器 (TCu380A IUD)和吉妮固定式宫内节育器 (GyneFixIN IUD)组不同时段宫腔底部和宫颈部Cu2 浓度差异无显著性 (P >0 0 5 )。在MCu功能性宫内节育器 (Mcu IUD)组 ,宫腔底部Cu2 浓度高于宫颈部 ,平均浓度分别为 2 8 10± 3 6 1μmol/L、6 91± 2 5 1μmol/L ,差异有显著性 (P <0 0 5 )。在置器 3个月后 ,TCu380A IUD和GyneFixIN IUD组宫颈部Cu2 浓度有一定程度下降 ,而MCu功能性IUD组下降不明显。结论 :含铜表面积小、纵径短的Cu IUD随置器时间延长仍能在宫腔底部释放较高的Cu2 ,而宫颈部Cu2 浓度变化相对不大。     

人工流产术后即时放置三种宫内节育器的多中心随机对照研究

目的 了解3种常用宫内节育器(IUD)在人工流产术后即时放置的临床效果和安全性.方法 通过前瞻性随机对照临床研究,对来自全国7个省市的12个协作中心的1800例研究对象于人工流产术后即时放置IUD,放置的IUD类型分为宫形含铜IUD宫铜200、T形含铜IUDTCu380A和活性γ型IUD 3种,每种分别观察600例,并随访12个月.结果 1798例完成了使用12个月的随访,2例失访(失访率为0.11%,2/1800);17例不符合纳入标准的未产妇资料在进行数据统计分析时被剔除.3种IUD使用者均未发生妊娠(或带器妊娠),且均无子宫穿孔、IUD异位等并发症发生.活性γ型IUD的医疗原因终止率为1.02/百妇女年,低于宫铜200、TCu380A(分别为3.60/百妇女年、2.25/百妇女年),3者比较,差异有统计学意义(P=0.015).宫铜200、TCu380A和活性.y型IUD中,与IUD使用相关的终止率分别为7.58/百妇女年、7.30/百妇女年和3.72/百妇女年,3者比较,差异有统计学意义(P=0.008).结论 人工流产术后即时放置宫铜200、TCu380A和活性γ型IUD的避孕效果均良好,均安全可行,尤其是国产活性γ型IUD,值得推广.     

带铜不锈钢环形宫内节育器与不锈钢环形宫内节育器放置二年的临床效果比较

本文对1978年1月至1980年4月同期放置带铜不锈钢环形宫内节育器1154例和不锈钢环形宫内节育器1298例进行定期随访,以比较临床效果。资料均满二年,按生命表统计临床效果,结果为:①粗累计带器妊娠率,带铜节育器为2.85/100妇女,明显低于不带铜金属单环7.90/100妇女(p<0.01)。②脱落率,带铜节育器为19.28/100妇女,高于不带铜的15.78/100妇女(p<0.05)。③因症取出率分别为8.74及7.60/100妇女(p>0.05),二组间无差异。④二年继续存放率分别为67.56/100妇女和67.71/100妇女(p>0.05),二组相似。带铜节育器带器妊娠率明显降低,且不明显增加因症取出率,建议扩大使用。对于带铜宫内节育器的脱落率稍高的缺点有待研究和改进。     

正常月经周期中宫颈粘液含铜水平的变化

在10名排卵正常,月经规则的妇女(年龄23—46岁)中,研究了宫颈粘液含铜量的周期性变化。一般每周取宫颈粘液标本2、3次,平均每个周期取6个样品,10名妇女共取60个样品。宫颈粘液含铜量用经改进的Stoner和Daslet比色法测定,用每100毫克干燥官颈粘液含有铜的微克数表示。     

固定式宫内节育器和TCu380A宫内节育器15年临床对比研究

目的:探讨固定式宫内节育器(固定式IUD)和TCu380A IUD远期应用的效果,观察15年IUD铜结构的保留状况.方法:采用前瞻性临床对比研究方法,共接收受试者200例,固定式IUD组和TCu380A组各100例.于置器后3个月、6个月、12个月及以后每年随访1次,15年时测定受试者血浆中的铜离子含量,并根据年龄设立对照组.整理全部资料,进行统计学分析.结果:两组受试者各年粗累积妊娠率比较,差异无统计学意义(P>0.05).妊娠与置器时年龄有关(P<0.05).固定式IUD第1年的粗累积脱落率显著高于TCu380A组(P<0.01).5年末、15年末两组的粗累积继续使用率比较,差异无统计学意义(P>0.05).15年末,两组各年主诉的发生率比较,差异无统计学意义(P>0.05).两组各年的粗累积因症取出率比较,差异无统计学意义(P>0.05).宫颈细胞学检查未见肿瘤细胞.使用超过15年的受试者血浆铜离子水平两组间比较差异无统计学意义(P>0.05),与正常对照组相比,差异亦无统计学意义(P>0.05).结论:固定式IUD和TCu380A IUD使用15年的避孕效果基本相似,均为高效、长效、安全的宫内节育器.     

人工流产术后即时放置第三代“爱母”牌宫内节育器(MYCuIUD)的临床效果观察

目的:观察第三代"爱母"牌宫内节育器(MYCu IUD)在人工流产术后即时放置的临床效果和安全性。方法:通过前瞻性随机对照研究,对932例研究对象于人工流产术后即时放置MYCu IUD(研究组)、T形含铜IUD(TCu380A)(对照组),每组各466例,放置后1个月、3个月、6个月、12个月定期随访。结果:930例完成了12个月的随访,失访2例;无子宫穿孔、带器妊娠发生;无其他医疗原因或个人原因取器者;置器12个月时研究组与对照组随访率均为99.8%;置器1年净累积续用率研究组(96.14%)高于对照组(88.41%)(P0.05);置器后1个月、3个月、6个月、12个月研究组与对照组累积脱落率相似,差异无统计学意义(P0.05);置器后1个月、3个月、6个月因症取出率研究组均显著低于对照组,每次随访差异均有统计学意义(P0.05);置器后1个月IUD嵌顿发生率研究组明显高于对照组(P0.05);置器后1个月、3个月、6个月与IUD使用相关的终止率研究组均明显低于对照组(P0.05);置器后1个月、3个月、6个月副反应发生率研究组均明显低于对照组(P0.05)。结论:人工流产术后即时放置MYCu IUD、TCu380A的避孕效果均良好,虽然MYCu IUD因症取出率、副反应发生率低于TCu380A,但其嵌顿发生率高于TCu380A。     

MCuⅡ与TCu 380A宫内节育器的临床比较性研究

目的:观察第二代爱母含铜宫内节育器(AiMu MCuⅡIUD)的临床效果。方法:对要求使用IUD避孕的825例育龄妇女,随机放置MCuⅡIUD(408例)与TCu380A IUD(417例),放置后3个月、6个月、12个月、24个月、36个月定期随访,记录IUD使用情况。结果:随访36个月时MCuⅡ与TCu380A组随访率分别为98.78%、98.57%。MCuⅡ组3个月、36个月的副反应主诉率分别为20.34%和8.28%,除了36个月外,4次随访副反应主诉率均低于TCu380A IUD组,差异有统计学意义(P<0.05)。随访12个月、36个月MCuⅡ组带器妊娠率分别为0.98/100妇女、1.96/100妇女,5次随访MCuⅡ组带器妊娠率均高于TCu380A IUD组,但无统计学差异(P>0.05)。MCuⅡ组6个月的因症取出率和36个月的终止率分别为7.60%和22.06%,MCuⅡ组因症取出率及终止率均低于TCu380A IUD组,除了3个月外,其余4次随访比较均有显著性差异(P<0.05)。结论:MCuⅡIUD副反应少、续用率高,避孕效果与TCu380A相当,是当前可供选择的有效IUD。     

三种国产宫内节育器临床多中心比较性研究——(五年随访总结)

全国13省市共23个单位,对不锈钢金属单环、V Cu200及T Cu220c三种宫内节育器(IUD)进行随机临床多中心比较性研究。自1987年7月1日至1984年3月31日共接受对象6236例。五年末随访率为96.0%。60个月时每百妇女累积续用率以金单为最低,55.8%,V Cu及T Cu各为68.8%及72.4%。V Cu和T Cu的妊娠率分别为7.32%和7.24%,显著地低于金单的20.2%。60个月时金单、V Cu和T Cu的脱落率分别为19.0%、9.7%和5.6%,三者间呈显著性差异。因出血和/或疼痛取出率以金单为最低,二种带铜宫内节育器间无差别。三种IUD使用情况城市与农村间比较,城市的累积续用率均高于农村;妊娠、脱落和个人原因停用农村均高于城市。用Cox比例危险模型和似然比检验,发现金单的失败危险与以下因素有关:年龄、过去IUD使用史、劳动姿态、孕次和宫腔深度;前四个因素对VCu失败危险有影响;TCu失败危险除与前三个因有关外,哺乳期放器对其失败危险亦有影响。年龄和孕次均影响三种IUD的妊娠危险;过去IUD使用史分别作用于金单和VCu;宫腔深度分别影响金单和TCu的妊娠。T Cu的脱落仅受哺乳期放器影响;年龄、孕次、过去IUD使用史影响着VCu的脱落;金单脱落除上述三因素外,还受宫腔深度的影响,且前三个因素均呈极显著性差异。     

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.     

含消炎痛VCu200与VCu200临床比较性研究

对１０００例含消炎痛ＶＣｕ２００与１０００例对照组进行比较性研究。在２４个月末，每１００妇女净累积续用率分别为８３．２０与８３．３６，其中妊娠率分别为２．２０与１．４１（Ｐ＞０．０５）。脱落率在１２与１８个月时药环组较对照组高（Ｐ＜０．０５），２４个月时分别为８．８１／１００与６．６２／１００妇女，无显著性差别，但相对来讲药环组还是较对照组高。因症取出率对照组高于药环组（Ｐ＜０．０５）。主要原因是出血，具体表现在经量增多，经期延长与点滴出血。这三种现象两组之间Ｐ值均＜０．０１，药环与对照环避孕效果相似而药环基本解决了用ＩＵＤ的主要副反应出血问题。本文分析脱落率较高的可能原因，并对药环的装置进行了改进，用改进后的药环观察一年，脱落率有所下降。     

In vitro sperm penetration tests and PCTs in fertile women wearing different medicated IUDs (Cu and progesterone)

In order to evaluate the sperm-cervical mucus interactions in women wearing different intrauterine devices (IUDs), a longitudinal study of over 27 months in 7 selected normally fertile couples was made. In vitro sperm penetration tests and PCTs, in the same woman, were carried out in basal conditions and after insertion of IUDs (copper IUD before and progesterone IUD after). The copper IUD induces little modification on the "in vitro" and "in vivo" sperm passage and on the characteristics of the cervical mucus. In contrast, the progesterone IUD is more effective than the copper IUD in inhibiting sperm penetration even with little modofication of the characteristics of the ovulatory cervical mucus. It appears, therefore, that the cervical mucus modifications are less relevant than the toxic effect on the spermatozoa in the mechanism of activity of progesterone IUDs.     

Physical properties and PGE2 and PGF2 alpha content of cervical mucus in women wearing IUD compared to those not wearing IUD]

In order to study the local changes resulting from wearing and IUD, the authors examined the cervicalmucus in 35 cases of women wearing IUDs for 10 months and 32 women of the same age who were not using contraception. Cervical mucus was taken during the ovulatory stage, days 10-14 of the menstrual cycle. The mean weight of midcycle cervical mucus in women wearing IUDs was 275.43 +or- 167.10 mg as compared with that of the controls 226.56 +or- 150.22 mg (P0.2). The clarity, viscosity, spinnbarkeit, and crystallization of the cervical mucus showed no difference in the 2 groups. Radioimmunoassay showed prostaglandin E2 (PGE2) in the cervical mucus of IUD wearing women to be 44.995 +or- 22.06 pg/mg, and that of the control group as 39.115 +or- 27.32 pg/mg (P0.2). PGF2alpha was 66.34 +or- 42.42 pg/mg in the cervical mucus of IUD wearing women, and 73.152 +or- 52.56 pg/mg (P0.5) in the control group. The cervical mucus in the midcycle of IUD wearing women showed little difference from that of the control group both in physical properties and PGE2 and PGF2alpha contents. (author's mofidifed)     

Will progesterone save the IUD?

In 1971 we began studying pelvic inflammatory disease (PID) in IUD users by examining fallopian tube specimens obtained after elective female sterilization. We studied four groups: 175 nonhormonal-IUD users, 22 Progestasert users, 1,500 non-IUD users and 100 non-IUD users who had had IUDs in the past. We found histologically detectable salpingitis in 49% of the nonhormonal-IUD users, none of whom had symptoms of PID. Culture of 100 specimens from these nonhormonal-IUD specimens proved to be sterile. Viewing the inflammation as predisposing the tissues to bacterial infection would help explain the higher frequency of PID among IUD users than among nonusers. All the Progestasert users lacked histologically detectable salpingitis; the difference was statistically significant (p < 10(-6). This finding suggests that women using progesterone-releasing IUDs have a lower risk of developing PID than do users of other kinds of IUDs.     

宫腔镜在宫内节育器临床和科研中的应用

本文介绍了应用国产XG-3型宫腔镜对30例放置IUD后无副反应、62例有副反应者的观察,包括:44例月经异常、18例下腹痛、3例带环妊娠和19例哺乳期放IUD前作直视检查和观察。62例IUD副反应者中54例镜检示有异常(87%),其中IUD异常占70.4%,内膜变化占24%,合并宫内器质性病变占5.6%。此外,60例常规取器困难中,46例镜检宫腔内发现IUD或其断片,均经宫腔镜直视下或定位后取出。表明宫腔镜用于处理和研究某些IUD副反应和并发症确有一定价值。     

The benefit of endometrial biopsy before IUD insertion

131 patients aged 25-35 followed from 1969-84 underwent endometrial biopsies under antibiotic cover preliminary to insertion of IUDs. 125 subsequently had IUDs inserted, including 10 Dalkon Shields, 50 Gravigards, and 66 copper 200, Gyne-T, or Nova T devices. All IUDs were inserted in the 1st 10 cycle days under a 3-day antibiotic cover. The 131 biopsies revealed 18 simple endometrial hyperplasias, 1 glandulo- cystic hyperplasia, and 5 endometrial polyps. The hyperplasias were treated with a progestin on cycle days 15-25 for 3-6 months and a curettage was performed for the polyps. No cases of endometritis were found in nulligestes. The 11 patients with latent endometritis were treated with antibiotics for 10 days and were vaccinated with an antipyogenic. A repeat endometrial biopsy was done to confirm disappearance of the endometritis before the IUD was inserted. The 126 IUD users were followed for 6 years on average. 2 cases of salpingitis and an adnexal reaction were observed. 2 of the 3 were treated with antibiotics and had no complications. The 3rd underwent tubal microsurgery after which she became pregnant. The IUD was removed in all 3 cases at the onset of symptoms. 1 of the 3 patients did not have a preliminary endometrial biopsy before the IUD was inserted. Despite the small sample size, it appears that a preliminary endometrial biopsy can reduce the infection rate among IUD users to that of the general female population.     

Modes of action of IUDs

There are between 14-17 million women in the world, excluding China, who wear an IUD, or about 3-5% of all married women younger than 45. Studies on the mode of action of IUDs have been conducted mostly on laboratory animals; they show that ovulation and fecundation are not inhibited by the presence of an IUD. Contrary to what was generally believed, the latest studies have shown that the principle mode of action of the IUD is not its anti-implantation effect, but it depends on the adjustment inside the uterine cavity between the size of the uterine cavity itself, and the size and shape of the device. Endometrial modifications caused by IUDs include inflammatory phenomena, and inhibition of endometrial maturation. Moreover, copper IUDs act directly on spermatozoa and on endometrial steroid receptors. It is still not clear what role prostaglandins play in the mechanism of action of IUDs. Incidence of ectopic pregnancy is not greater in IUD wearers than in women who do not use contraception. Follicle stimulating hormone and luteinizing hormone levels also are comparable in IUD wearers and in nonwearers. IUD wearers have a shorter luteal phase, which entails an earlier menstrual bleeding due to the antifibrinolytic action of the IUD; progesterone levels are identical in users and in nonusers of IUDs.     

Copper content in cervical mucus of women wearing plain and copper-bearing spring coils

To test the hypothesis that the copper in copper-bearing intrauterine devices (IUDs) and its reaction with cervical mucus constitute the agent in preventing conception, the copper content of 300 samples of cervical mucus, 150 each from women wearing plain Spring Coil IUDs and those wearing Spring Coils containing 500 mg of copper, was determined at 3, 6 and 12 months after IUD insertion. Stoner and Dasler's modified spectrophotometric micromethod (Clin Chem 10:845, 1964) was used to quantify the copper content of the cervical mucus. Analysis showed no significant change in the copper content of the cervical mucus of women wearing plain Spring Coils compared to that of women not wearing IUDs; however, the amount of copper in the cervical mucus of women wearing copper-bearing Spring Coils was 5--6 times greater at midcycle 3, 6 and 12 months after insertion. Thus, we conclude that there is an important biologic basis for assuming that copper-bearing Spring Coils can inhibit sperm penetration through the cervical mucus and that they can initiate contraceptive activity at the cervical level.