释放吲哚美辛的固定式铜宫内节育器减少子宫出血机制的研究

The Mechanism of Decreased Uterine Bleeding for Indomethacin-releasing FCu-IUD

观察放置３种不同类型宫内节育器（ＩＵＤ）妇女置器前、后子宫内膜超微结构及官腔冲洗液前列腺素（ＰＧｓ）含量、组织型纤溶酶原激活剂（ｔ－ＰＡ）和纤溶酶原激活剂抑制剂（ＰＡＩ）活性以及凝血因子Ⅷ相关抗原（ｖＷＦ）含量的动态变化。结果：①ＦＩＣｕ－ＩＵＤ对子宫内膜损伤较ＦＣｕ－ＩＵＤ及ＴＣｕ１２２０Ｃ明显减轻。②置入ＦＣｕ－ＩＵＤ和ＴＣｕ２２０Ｃ后１、３、６个月，６－ｋｅｔｏ－ＰＧＦ_（１ａ）／ＴＸＢ_２比值显著高于置器前（Ｐ＜０．０１或Ｐ＜０．０５），ＰＧＥ_２／ＰＧＦ_２比值升高不明显；置器后ｔ－ＰＡ活性升高显著（Ｐ＜０．０１），ＰＡＩ活性则无明显变化；ｖＷＦ含量置器前、后无统计学差异。③放置ＦＩＣｕ－ＩＵＤ前后，以上各项生化指标的差异均无统计学意义，但与同期 ＦＣｕ－ＩＵＤ和 ＴＣｕ２２０Ｃ相比，６－ｋｅｔｏ－ＰＧＦ_（１ａ）／ＴＸＢ_２比值及 ｔ－ＰＡ活性下降有显著性意义。提示：ＦＩＣｕ－ＩＵＤ释放的吲哚美辛通过减轻Ｃｕ－ＩＵＤ引起的内膜损伤和异物反应，降低Ｃｕ－ＩＵＤ所致的ＰＧＩ２、ｔ－ＰＡ升高和提高ＴＸＡ_２水平，是其减少子宫出血的部分机制。

In order to explore the mechanism of decreased uterine bleeding of women with FICu-IUD, 48 women were divided into three groups and inserted FICu-IUD, FCu-IUD or TCu220C respectively. The ultrastructure of endometrium of the women was observed and the contents of PG_s (6-keto-PGF_(1a), TXB_2, PGE_2, PGF_2),the activities of t-PA and PAI, and the content of vWF in the uterine flushing of the women were determined before and after Inserting IUDs. The results were shown as follows: The endometrial impairment caused by FICu-IUD was mild as compared with that by FCu-IUD and TCu220C. After FCuIUD and TCu220C insertion for 1, 3, 6 months, the 6-keto--PGF_(1a)/TXB_2 ratio was increased very significantly (P<0. 01 or P<0. 05), the PGE_2/PGF_(2a) ratio has not changed distinctly, the activity of t-PA ascended remarkably (P<0. 01), but the activity of PAI and the content of vWF didn't change significantly. Before and after insertion of FICu-IUD, the various indexes in the uterine fluid of the women had no obvious changes. Comparing with those of the insertion of FCu-IUD and TCu220C at the same period, 6- Keto-PGF_(1a)/TXB_2 ratio and the activity of t-PA was increased with the difference being significant. It was concluded that indomethacin released by FICu-IUD in the uterine cavity could lighten the endometrial damage and foreign body reaction caused by Cu-IUD, decrease the rising of the PGI_2 level and the t-PA activity and increase the TXA_2 level, which is considered to be the partial mechanism of decreased uterine bleeding by FICu-IUD.