人工流产术后放置曼月乐或吉妮宫内节育器女性子宫内膜微环境变化  

Microenvironment change of the endometrium of women with fixed intrauterine device or levonorgestrel intrauterine sustained-release system inserted after abortion

作　　者：林美菊 潘春丽 赵婉萍 LIN Meiju;PAN Chunli;ZHAO Wanping(Xianju County Xiage Central Health Center,Taizhou,Zhejiang Province,317321;Xianju People's Hospital of Zhejiang Province)

机构地区：[1]浙江省仙居县下各中心卫生院,317321 [2]浙江省仙居县人民医院

出　　处：《中国计划生育学杂志》2022年第9期1958-1962,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨人工流产术后放置左炔诺孕酮宫内缓释系统(曼月乐)与吉妮宫内节育器(IUD)对子宫内膜微环境的影响。方法:随机选择2019年11月-2021年5月仙居县人民医院自愿接受人工流产手术者共92例进行随机对照观察,在顺利完成人工流产术后分别采用曼月乐或吉妮IUD避孕,每组46例,随访术后6个月时避孕效果及不良反应,检测术前3d及术后3个月时子宫内膜冲洗液及宫颈粘液中各因子水平变化。结果:随访术后6个月时两组均未出现妊娠,不良反应总发生率曼月乐组(15.2%)低于吉妮IUD组(32.6%)(P<0.05)。人工流产术前3d两组宫颈粘液中细胞因子IFN-α2、IFN-γ、IL-6、IL-8,趋化因子CCL5、MCP-1α、MIP-1β、MIP-1水平均无差异(P>0.05),术后3个月时曼月乐组IFN-α2、IFN-γ水平高于吉妮IUD组,IL-6、IL-8低于吉妮IUD组,CCL5低于吉妮IUD组,MIP-1β高于吉妮IUD组(均P<0.05),MCP-1、MIP-1α两组无差异(P>0.05)。术后3个月时两组子宫内膜冲洗液样本T细胞密度均增加了,且吉妮IUD组CD3+、CD4+表达水平高于曼月乐组(P<0.05)。两组CD8+表达无差异(P>0.05),子宫内膜组织Foxp3免疫组化染色均显示T细胞高表达。结论:曼月乐与吉妮IUD避孕效果相当,但放置曼月乐后不良反应更低且炎症反应程度更低,更有利于育龄女性长期应用。Objective: To investigate the microenvironment change of the endometrium of women with fixed intrauterine device(IUD) or levonorgestrel intrauterine sustained-release system(IUDs) inserted after abortion. Methods: A total of 92 pregnant women who wanted abortion were randomly selected and were divided into group A(46 women given IUD inserted after abortion) and group B(46 women given IUDs inserted after abortion) from November 2019 to May 2021. The controceptive effect and side effect of the women in the two groups were followed up for 6 months after abortion. The levels of the cytokines and chemokines in endometrial rinse fluid and in cervical mucus of the women in the two groups 3 days before abortion and 3 months after abortion were detected. Results: There was no woman with pregnancy in both groups in 6 months of follow-up. The total incidence of adverse reactions(15.2%) of the women in group B was significantly lower than that(32.6%) of the women in group A(P<0.05). There were no significant differences in the levels of the cytokines, such as IFN-2, IFN-, IL-6, and IL-8, and the chemokines, such as CCL5, McP-1, and MIP-1 in cervical mucus of the women 3 days before abortion between the two groups(P>0.05). In the 3 rd month after abortion, the levels of IFN-2, IFN-, and MIP-1 of the women in group B were significantly higher than those of the women in group A, and the levels of IL-6, IL-8, and CCL5 of the women in group B were significantly lower(all P<0.05), but there were no significant differences in the levels of McP-1 and MIP-1 of the women between the two groups(P>0.05). In the 3 rd month after abortion, the T cell level in endometrial rinse fluid samples of the women in both groups had increased,and the expression levels of CD3+and CD4+of the women in group A were significantly higher than those of the women in group B(P<0.05).There was no significant difference in the CD8+expression level of the women between the two groups(P>0.05).Foxp3 immunohistochemical staining showed that T cells in endometrial

关 键 词：人工流产术后避孕 左炔诺孕酮宫内缓释系统 吉妮宫内节育器 子宫内膜微环境 宫颈粘液 T淋巴细胞亚群 细胞因子 趋化因子 

分 类 号：R169.4[医药卫生—公共卫生与预防医学]