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目的 研究长期放置宫内避孕器 (IUD)后子宫局部微环境的变化及其分子机理。方法 对 6 2例使用IUD和 2 7例未使用IUD(对照组 )妇女 ,利用放射免疫法检测宫腔冲洗液中细胞因子和抗体水平 ;用免疫组化技术测定子宫内膜T淋巴细胞亚群 ;用电镜观察子宫内膜的超微结构 ;采用银染PCR 单链构型多态性分析 (SSCP)技术检测子宫内膜 p16、p5 3及K ras基因突变。 结果 与对照组相比 ,惰性及含铜IUD组的宫腔冲洗液中肿瘤坏死因子 (TNF) α浓度无明显变化 (P >0 0 5 ) ,但含铜IUD组的白细胞介素 (IL) 2浓度为 0 39μg/L± 0 18μg/L、分泌型IgA浓度为 2 0 0 0 μg/L± 12 2 4 μg/L ,对照组为 0 96 μg/L± 0 15 μg/L及 3377μg/L± 190 6 μg/L (P <0 0 5 ) ;含铜IUD组与对照组相比子宫内膜CD8+ 、CD4 + 淋巴细胞的分布差异有显著意义 (P <0 0 5 ) ;长期放置两种IUD后子宫内膜的超微结构观察均未见坏死及异型改变 ;P16、p5 3、K ras基因在各组中均无突变。 结论 长期放置惰性IUD和含铜IUD是安全而有效的 ,但含铜IUD对宫腔局部的免疫功能有一定的影响。
Objective To study the changes of uterine microenvironment and its molecular mechanism after long-term placement of intrauterine device (IUD). Methods Sixty-two women with IUD and 27 women without IUD were enrolled in this study. The levels of cytokines and antibodies in uterine flushing fluid were detected by radioimmunoassay. The endometrial T lymphocyte subsets The ultrastructure of endometrium was observed by electron microscope. The mutation of p16, p5 and Kras genes in endometrium was detected by silver staining PCR single strand conformation polymorphism (SSCP) technique. Results Compared with the control group, there was no significant difference in the concentration of tumor necrosis factor (TNF) in uterine irrigating fluid between the IUD group and the control group (P> 0.05), but the levels of interleukin (IL) 2 concentration of 0 39 μg / L ± 0 18 μg / L, secreted IgA concentration of 200 μg / L ± 12 2 4 μg / L and control group 0 96 μg / L ± 0 15 μg / L and 3377 μg / L ± 190 6 μg / L (P <0.05). The distribution of endometrial CD8 + and CD4 + lymphocytes in copper-containing IUD group was significantly different from that in control group (P <0.05) No ultrastructural changes of endometrium were seen after IUD implantation. Neither necrosis nor dysplasia was found in the endometrium of the IUD. There was no mutation in the P16, p5, and Kras genes in all groups. Conclusion Long-term placement of IUD and copper-containing IUD is safe and effective, but copper-containing IUD has a certain impact on the immune function of the uterine cavity.