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目的已经放置含铜宫内节育器(copper intrauterine device,Cu-IUD)的妇女肾移植后续用Cu-IUD(continuinguse of copper-bearing intrauterine devices,CCIUD)是否会增加子宫出血的风险,肾移植后是否需要取出留置Cu-IUD,目前国际上尚无相关报道。文中评估了育龄尿毒症女性肾移植术后CCIUD对月经模式的影响。方法 145例育龄肾移植女性受者按移植时所采用的避孕方法分为2组,CCIUD组77例,避孕套对照组68例。所有受者仔细填写调查表,内容包括术前及术后第1、3、6、12、24月的月经模式(月经正常、月经过多、经期延长、点滴出血、周期改变、闭经)等。结果术后第3、6、12、24月CCIUD组月经过多、点滴出血、周期改变、闭经出现率均与避孕套组相似,差异无统计学意义(P>0.05)。术后第3月、6月2组经期延长出现率相似,但术后第12、24月CCIUD组经期延长出现率(27.6%、28.9%)明显高于避孕套组(10.4%、9.0%,P<0.05)。调整移植时年龄、移植前生育、教育水平、体重指数、移植前月经模式、肾脏基础疾病、免疫抑制剂、排斥反应后,CCI-UD组术后第12、24月经期延长出现率仍明显高于避孕套组(P<0.05),CCIUD组对避孕套组优势比(OR)分别为3.138(95%可信区间1.172-8.400)、14.526(95%可信区间2.910-72.516)。尽管如此,2组相比术后2年内各时期血红蛋白、血肌酐水平相似,差异均无统计学意义(P>0.05)。结论肾移植术后续用IUD除经期延长外,不影响其他月经模式,不影响血红蛋白和血肌酐水平。
Objectives Has women with copper intrauterine device (Cu-IUD) have a continued risk of uterine bleeding after a continuoususe of copper-bearing intrauterine devices (CCIUD) after kidney transplantation? Cu-IUD need to be taken out of indwelling, there is no relevant international report. The article evaluated the effect of CCIUD on menstrual patterns in women with child-bearing uremia after kidney transplantation. Methods 145 cases of female recipients of childbearing age transplantation were divided into two groups according to the contraceptive methods used in the transplantation. There were 77 cases in CCIUD group and 68 cases in condom control group. All recipients carefully fill in the questionnaire, including preoperative and postoperative 1, 3, 6, 12, 24 months of menstrual patterns (normal menstruation, menorrhagia, menstrual prolongation, bleeding, periodic changes, amenorrhea) and so on. Results After 3, 6, 12, and 24 months, the menorrhagia, drip bleeding, periodic changes and the incidence of amenorrhea in CCIUD group were similar to those in the condom group, with no significant difference (P> 0.05). The incidences of menstruation were similar between the two groups at 3 months and 6 months after operation, but the incidence of menstruation was significantly higher in CCIUD group (27.6%, 28.9%) than that in condom group (10.4%, 9.0% P <0.05). In the CCI-UD group, the incidence of menstruation after 12th and 24th month of follow-up was still significantly higher after adjusting for age at transplantation, pre-transplant fertility, education level, body mass index, premenstrual menstrual pattern, underlying kidney disease, immunosuppressive agents and rejection In the condom group (P <0.05), the odds ratios (OR) of the CCIUD group to the condom group were 3.138 (95% confidence interval 1.172-8.400) and 14.526 (95% confidence interval 2.910-72.516), respectively. However, there were no significant differences in hemoglobin and serum creatinine between the two groups in each of the two years after operation (P> 0.05). Conclusion IUD after renal transplantation in addition to menstrual prolongation, does not affect other menstrual patterns, does not affect hemoglobin and serum creatinine levels.