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。     

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     

腹腔镜及开腹子宫切除术对免疫功能影响的对比研究

目的　研究腹腔镜子宫切除术 (LH)和开腹子宫切除术 (AH)对免疫功能的影响。方法　2 0 0 1年 7月～ 2 0 0 3年 7月在因子宫肌瘤行LH患者 78例 ,对照组开腹手术的患者 4 2例。术前 2 4h、术后 2 4h及72h分别抽取肘静脉血 ,采用ELISA双抗体夹心法测定血清IL - 6、TNF -α ,用散射比浊法测定血清CRP水平 ;用流式细胞仪测定CD3 (T细胞总数 )、CD4 (T辅助 /诱导细胞 )、CD8 (T抑制 /杀伤细胞 )、CD16 (NK细胞 )数量。结果　手术前两组患者血清IL - 6、TNF -α和CRP的水平差异无显著性 (P >0 0 5 )。术后 2 4h、 72h两组患者的血清IL - 6、TNF -α和CRP水平与术前相比均明显升高 (P <0 0 1) ,LH组血清L - 6、TNF -α和CRP水平的升高明显低于AH组 (P <0 0 1)。LH组患者的外周血T淋巴细胞亚群和NK细胞在手术前后无明显改变 (P >0 0 5 )。AH组患者在术后 2 4hCD3 、CD4 、CD8 均明显下降 (P <0 0 1) ,在 72h有所回升 ,但仍低于术前水平。AH组NK细胞无明显变化 (P >0 0 5 )。结论　腹腔镜手术创伤小 ,对全身免疫功能影响小。     

沙眼衣原体感染输卵管性不孕患者输卵管液中肿瘤坏死因子α和白细胞介素6的测定

目的　探讨沙眼衣原体 (CT)感染所致输卵管性不孕患者输卵管液中肿瘤坏死因子α(TNF α)和白细胞介素 6 (IL 6 )的水平及其意义。方法　用酶联免疫吸附试验法测定 2 2例CT感染输卵管性不孕 (A组 )、2 3例非CT感染输卵管性不孕 (B组 )及 19例已生育输卵管正常妇女 (对照组 )输卵管液中TNF α和IL 6的水平。结果　A组TNF α的水平为 178ng/L ,高于对照组的 12 4ng/L(P<0 .0 1) ;A组中输卵管阻塞者TNF α为 199ng/L ,高于粘连者的 142ng/L(P <0 .0 1)。A组IL 6的水平为 6 81ng/L ,高于B组的 2 6 4ng/L及对照组的 2 2 9ng/L(P均 <0 .0 1) ,B组与对照组之间比较差异无显著性 (P >0 .0 5 )。结论　无症状输卵管CT感染可使输卵管液中TNF α和IL 6升高 ,其中TNF α与输卵管损伤程度有关。TNF α越高 ,损伤越重     

多囊卵巢综合征患者血清肿瘤坏死因子-α的检测及意义

目的 :探讨多囊卵巢综合征 (PCOS)患者血清肿瘤坏死因子 α(TNF α)与胰岛素抵抗的关系。方法 :采用放射免疫法检测 30例PCOS患者及 35例正常对照组血清TNF α、黄体生成激素 (LH) /卵泡刺激素 (FSH)、睾酮 (T)及空腹胰岛素 ,用氧化酶法检测血浆葡萄糖浓度。结果 :PCOS组血清TNF α、LH/FSH、T、胰岛素抵抗指数 (HOMA IR)均显著高于对照组 (P <0 0 5 ) ;血清TNF α与HOMA IR、LH/FSH、T呈显著正相关。结论 :TNF α可能促进PCOS胰岛素抵抗的发生 ,两方面因素相互作用加重了PCOS的病理生理改变。     

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.     

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。     

IROT对宫颈癌Ⅱb患者CD4+/CD8+的影响及血清TNF-α水平的变化与其临床意义

目的　探讨术中大剂量放射治疗 (intraoperationradiationtherapy ,IROT)对宫颈癌Ⅱb患者免疫功能的影响及其临床意义。方法　 2 0 0 3年 6月至 2 0 0 4年 1月西安交通大学第一医院应用流式细胞仪、放射免疫分析法对6 1例宫颈癌Ⅱb患者 (33例行单纯放疗 ,2 8例行IROT)外周血T细胞亚群 (CD4 、CD8 、CD4 CD8 )、血清中肿瘤坏死因子 α(TNF α)的水平进行检测。结果　单纯放疗组、IROT组在放疗前CD4 、CD8 、CD4 CD8 、TNF α差异无显著性 ;放疗后单纯放疗组CD4 、CD4 CD8 、TNF α明显低于IROT组 ,差异有显著性 (P <0 0 5 ) ,CD8 差异无显著性。结论　IROT与单纯放疗相比 ,对患者CD4 CD8 的影响较轻 ,血清中TNF α水平变化较小 ,有利于机体免疫功能的恢复。     

纳米铜/聚合物复合材料宫内节育器对猕猴宫腔液t-PA、PAF、PGE_2水平的影响

目的:探讨纳米铜/聚合物复合材料宫内节育器(IUD)对置器后子宫出血、疼痛的影响。方法:选择具规律月经周期且有生育史的育龄猕猴30只,分为空白对照组、裸铜组、生物材料组、低剂量纳米铜组(10μg/220mm2)、高剂量纳米铜组(20μg/220mm2),每组6只。采用酶联免疫吸附法(ELISA)检测各组置器后子宫宫腔冲洗液中t-PA、PAF、PGE2水平。结果:①与空白组相比,裸铜组宫腔冲洗液中t-PA及PGE2水平显著升高;②与裸铜组相比,纳米铜组t-PA及PGE2水平均显著降低;③除裸铜组PAF显著高于空白组外,其他各组间PAF水平无明显差异。结论:纳米铜IUD可减少对子宫t-PA和PGE2水平的影响,因而可能减轻置入IUD引起的子宫异常出血、疼痛副反应。     

肿瘤坏死因子 α、白介素 6和红细胞生成素与小儿慢性病贫血的相关性分析

目的探讨小儿慢性病贫血(ACD)时外周血肿瘤坏死因子(TNF) α、白介素(IL) 6与红细胞生成素(EPO)的变化及其在发病机制中的作用。 方法2002年4月至2004年12月常州市儿童医院收治ACD患儿19例(ACD组)，采用放射免疫分析方法测定患儿外周血清中TNF α、IL 6、EPO水平；对照组为17例上呼吸道感染恢复期患儿。 结果与对照组比较，ACD组患儿血清中TNF α、IL 6均显著增高(P<0.05)。血清TNF α、IL 6与血清铁蛋白质量浓度呈正相关。 结论免疫及炎症反应所产生的细胞因子TNF α、IL 6可能通过干扰铁代谢和抑制EPO生成、钝化对EPO的反应等途径介导了ACD的发生和发展过程。     

Expression of leukaemia inhibitory factor (LIF) during the window of implantation in copper T380A intrauterine device users.

OBJECTIVE: The mechanism of action of intrauterine devices (IUDs) is not well understood. This investigation was intended to gain further insight into the role of leukaemia inhibitory factor (LIF) in intrauterine contraception. We evaluated the immunohistochemical distribution patterns of LIF in women wearing a copper T380A IUD. METHODS: The immunohistochemical distribution patterns of LIF in women who had been using a copper T380A IUD for different periods of time, two months after removal of the IUD, and in normal fertile women were evaluated. Endometrial biopsies were obtained from four groups of patients according to the duration of T Cu380A IUD use (group I: <5 years, n = 15, and group II: > or = 5 years, n = 15), after IUD removal (group III, n = 15) and normal fertile women (controls, n = 15) during the window of implantation (WOI). Staining intensity of LIF was evaluated using semi-quantitative IRS-scores. RESULTS: The lowest expression of LIF was observed in women using a copper T380A IUD, being statistically significant compared with the control group (p < 0.05). LIF immunostaining remained abnormal two months after IUD removal. CONCLUSIONS: Copper IUDs can inhibit expression of LIF and they may cause inhibition of the implantation stage, which is crucial for pregnancy.     

Expression of leukaemia inhibitory factor (LIF) during the window of implantation in copper T380A intrauterine device users

Objective The mechanism of action of intrauterine devices (IUDs) is not well understood. This investigation was intended to gain further insight into the role of leukaemia inhibitory factor (LIF) in intrauterine contraception. We evaluated the immunohistochemical distribution patterns of LIF in women wearing a copper T380A IUD.

Methods The immunohistochemical distribution patterns of LIF in women who had been using a copper T380A IUD for different periods of time, two months after removal of the IUD, and in normal fertile women were evaluated. Endometrial biopsies were obtained from four groups of patients according to the duration of T Cu380A IUD use (group I: <5 years, n = 15, and group II: ≥5 years, n = 15), after IUD removal (group III, n = 15) and normal fertile women (controls, n = 15) during the window of implantation (WOI). Staining intensity of LIF was evaluated using semi-quantitative IRS-scores.

Results The lowest expression of LIF was observed in women using a copper T380A IUD, being statistically significant compared with the control group (p < 0.05). LIF immunostaining remained abnormal two months after IUD removal.

Conclusions Copper IUDs can inhibit expression of LIF and they may cause inhibition of the implantation stage, which is crucial for pregnancy.     

Successful retrieval of an intrauterine device with "missing strings" using a manual vacuum aspirator in a desired early pregnancy: case report

Intrauterine pregnancy in the presence of an intrauterine device (IUD) is a rare event. If the pregnancy is desired, IUD removal must be negotiated so that the risk of pregnancy disruption is minimized. Cases in which the IUD strings are "missing" present further challenges. We report successful removal of a copper T380A IUD with missing strings using a hand-held manual vacuum aspirator in the setting of a desired pregnancy. Under real-time abdominal ultrasound guidance, the IUD was removed from the lower cervical canal using a 6-mm cannula attached to a manual vacuum aspirator. Fetal cardiac activity was undisturbed throughout the procedure. The patient subsequently delivered a healthy full-term infant via spontaneous vaginal delivery. Manual vacuum aspiration, a simple office-based procedure, may be a useful approach to removal of an IUD with missing strings.     

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     

Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects

There are many potential mechanisms of action for the intrauterine device (IUD), which vary by type of IUD (inert, copper, or hormonal). This paper reviews the evidence for each potential mechanism of action. On the basis of available data for fertilization rates and clinical pregnancy rates, the relative contribution of mechanisms acting before or after fertilization were quantitatively estimated. These estimates indicate that, although prefertilization effects are more prominent for the copper IUD, both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices.     

氧化再生纤维素防粘连膜在重度宫腔粘连治疗中的作用及其对转化生长因子β1表达的影响

目的:探讨转化生长因子β1(TGF-β1)在重度宫腔粘连发生中的作用,氧化再生纤维素防粘连膜(ORC)预防再粘连的作用及其对TGF-β1表达的影响。方法:选择60例重度宫腔粘连的患者,随机分为观察组和对照组(各30例)。观察组术后宫腔内置入宫内节育器(IUD)+ORC,对照组置入IUD。两组人工周期3个月后复查宫腔镜,观察疗效。通过免疫组化法测定子宫内膜组织中TGF-β1表达水平。结果:治疗前,正常组织和粘连组织中TGF-β1表达量分别为3.33±0.73和5.73±1.61,两者比较差异有统计学意义(P0.01)。两组正常内膜及粘连组织中的TGF-β1表达,治疗后均高于治疗前,差异有统计学意义(P0.01)。观察组治疗后粘连组织中TGF-β1表达低于对照组,差异有统计学意义(P0.01)。观察组的治疗总有效率83.33%,对照组为60.00%,差异有统计学意义(P0.05)。再次粘连的病例中,观察组的分度较对照组降低,差异有统计学意义(P0.05)。结论:TGF-β1可能参与重度宫腔粘连的形成,使用ORC能提高治疗有效率,降低再粘连的分度,并能下调TGF-β1。     

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。     

The role of copper-releasing intrauterine device or levonorgestrel-releasing intrauterine system on uterine bleeding and iron status (prospective study of 8 years)

BACKGROUND: The aims of this study were the effects of copper intrauterine device (Cu-IUD) compared to progesterone (PRG-IUS) or levonorgestrel releasing intrauterine system (LNg-IUS) on menstrual bleeding, menorrhagia and dysfunctional uterine bleeding. The authors evaluated the effect of copper surface area on uterine bleeding. METHODS: Between March 1992 and November 1999, 223 women, referred to I Institute of Obstetrics and Gynaecology University of Rome, were recruited in a prospective study with follow up at 3, 6 and 12 months to evaluate the incidence of endometrial pathology. The study includes 38 fertile women with regular menstruations and without intrauterine devices, as control group, and 185 patients with intrauterine devices, divides as follows: - 117 copper-releasing intrauterine devices: 30 with a copper (Cu) surface area =200 mm2, releasing 45 microgram Cu/24h (Nova T (R)); 27 with a copper surface area =250 mm2, releasing 50 microgram Cu/24h (Multiload 250 (R)); 25 with a copper surface area =375 mm2, releasing 65 microgram Cu/24h (Multiload 375 (R)); 20 with a copper surface area =384 mm2, releasing 100 microgram Cu/24h (No Gravid M (R)); 15 with a copper surface area =440 mm2, releasing 120 microgram Cu/24h (No Gravid 0,5 (R)). - 68 progesterone/levonorgestrel-releasing intrauterine devices: 40 progesterone-releasing intrauterine systems (Progestasert(R)); 28 levonorgestrel-releasing intrauterine systems 20 mg/24h (Mirena (R)). A total of 211 subjects had data that were valid for analysis: 12 women out of 223 (5,4%) were excluded from the prospective study lost to follow-up. A venous blood sample for serum ferritin (mg/l), iron (mg/dl), hemoglobin (g/dl), hematocrit (%), blood cell count, MCHC and MCV was taken during follow-up. RESULTS: PRG or LNg-IUSs determined a significant reduction in menstrual blood loss and in irregular bleeding by gradually reducing endometrial fitness and vascularisation. Serum ferritin significantly increased in women inserted with LNg- IUSs already after 6 months (26+/-22 e 28+/-14 microgram/l versus 32.5+/-19 e 34.5+/-25 microgram/l). Hemoglobin significantly increased (p>0.05) 6 months after insertion. On the contrary this did not occur with the insertion of Cu-IUDs. We observed that the increased amount of copper, released by IUD, causes increasing of bleeding. CONCLUSIONS: The LNg-IUS is a new contraceptive method combining the advantages of both hormonal and intrauterine contraception. In addition, it can be considered an alternative method in the treatment of menorrhagia and dysfunctional uterine bleeding. On the contrary, in women inserted with Cu-IUDs, the main reason of menorrhagia probably is due both to the shape of device and to copper surface area.     

人工流产及放置节育器术后子宫腔内微生物的消长

目的探讨人工流产及放置宫内节育器（ＩＵＤ）术后宫内解脲支原体（ＵＵ）、人型支原体（Ｍｈ）、Ｌ型菌（Ｌ型）、厌氧菌（Ａｎａ）和衣原体（ＣＴ）的消长规律。方法设人工流产、单纯放置ＩＵＤ、放置ＩＵＤ后用青霉素（放置ＩＵＤ＋青霉素）和放置ＩＵＤ后用洁霉素（放置ＩＵＤ＋洁霉素）４组,于术前及术后４个月经周期的经后１周内取宫内吸取物行ＵＵ、Ｍｈ、Ｌ型、Ａｎａ和ＣＴ５种微生物分离鉴定,只要能鉴别出１种,即判定为带菌者。结果术前４组带菌率无差异,术后至第１周期带菌率均最高,以后均为下降趋势,仅单纯放置ＩＵＤ组随周期递增呈线性下降（Ｐ＜０．００１）。人工流产组术后至第１周期与术前比较,差异无显著性（Ｐ＝０．１０５）。同一周期放置ＩＵＤ的３组间无差异,但术后各周期带菌率与术前相比,差异均有显著性（Ｐ＜０．０５）。结论ＩＵＤ存在是宫腔手术后持续带菌的主要因素,机体自然防御机制可清除宫内带菌。放ＩＵＤ后短期内小剂量应用青霉素或洁霉素不足以减少宫内带菌