消炎痛Vcu200 IUD减少月经过多的机理

自１９９２年１１月至１９９５年６月，对４６例放置无消炎痛ＶＣｕ２００ＩＵＤ及２４例含消炎痛ＶＣｕ２００ＩＵＤ妇女的子宫内膜中６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及纤溶指标包括ｔ－ＰＡ、ＰＡＩ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ的水平进行测定，同时作光、电镜观察置器后ＩＵＤ对子宫内膜的影响。结果：１．无消炎痛ＶＣｕＩＵＤ３月组置器后６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２比值明显高于置器前（Ｐ＜０．０５），ｔ－ＰＡ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ均非常明显低于置器前水平（Ｐ＜０．ｏ１～０．００１）。２．无消炎痛ＶＣｕＩＵＤ＞６月组置器后只ｔ－ＰＡ、ＰＫ、ＦＤＰ明显低于置器前水平（Ｐ＜０．０１～０．００１），其余指标均无统计学差异。３．放置合消炎痛ＶＣｕＩＵＤ３个月后６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及各项纤溶指标与置器前比均无统计学意义。４．子宫内膜形态学变化与置器前相比，表现为血管内血栓形成减少及末梢小血管腔扩大。根据上述结果，置器后内膜中６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２值升高，与ｔ－ＰＡ水平下降可能是置器后月经过多的主要原因，尤以前者起主导作用。本文并对消炎痛ＩＵＤ减少月经过多的作用机理进行了讨论。

A Study on Mechanism of Descresed Menorrhagia by VCu200 IUD with Indomethacin

The present study was carried out in 46 women using VCu200 IUD without indomethacin and 24 women using VCu200 IUD with indomethacin. The endometrial samples were obtaind before as well as 3 months and >6 months after insertion of IUD from 11, 1992 to 6, 1995. The levels of 6-keto-PGF1a,TXB2 and fibrinolytic indicators, including t-PA, PAI,PK, PLG, D-D and FDP in endometrium were measured respectively. At the same time these samples were observed by using microscope and electron microscope for evaluation of the morphologic changes of endometrium after insertion of IUD.The results were showed as follows: 1. 3 months after inserting VCu IUD without indomethacin, the 6-keto-PGF1a/TXB2 ratio was significantly increased (P<0. 05) and t-PA,PK,PLG,D-D,FDP were most significantly lowerd (P<0. 01～0. 001) compared with preinsertional levels. 2. More than 6 months after inserting VCuIUD without indomethacin only the levels of t-PA, PK,FDP were more remarkably lowered (P<0. 01～0. 001) than the pre insertional levels. The rest parameters were not statistically different (P>0. 05), 3. 3 months after insertion of VCuIUD with indomethacin, the levels of 6-keto-PGF1a,TXB2 and all of the fibrinolytic indicators were much the same as those before the IUD insertion. 4. The morphologic changes of endometrium revealed reducing of thrombus formation in blood vessels and dilating of terminal vessel lumens compared with preinsertional status. According to above results, it is indicated that the increasing of 6-keto-PGF1a/TXB2 ratio and lowering of t-PA level in endometrium may be the main cause of menorrhagia with IUD, especally the ratio of 6-keto PGF1a to TXB2 being more important. The mechanism of action of IUD with indomethacin was discussed.