因症停用宫内节育器妇女子宫内膜细胞状态313例分析

Analysis of endometrial cell state in 313 women by reason of disease to deactivate IUD

目的检测因症停用宫内节育器(intrauterine devices,IUD)妇女的子宫内膜状态,探讨IUD对子宫内膜的影响因素。方法应用子宫内膜细胞采集器在募集对象取出IUD时采取子宫内膜脱落细胞制片,样本集中寄往北京大学附属医院妇产科宫腔细胞学检测中心阅片并诊断。结果因症停用人群内膜与月经周期不同步、良性增生性改变、非典型增生性改变发生率都明显高于无症状人群(P<0.01或P<0.05)。各种IUD类型两两对比,吉妮致美IUD内膜状态与月经周期不同步的发生率明显高于其他IUD(P<0.01),母体乐IUD良性增生改变的发生率明显高于活性γIUD(P<0.05),其余类型对比差异均无统计学意义。IUD放置时间1-5年内膜状态与月经周期不同步的发生率明显高于其他时间(P<0.01),IUD放置时间<1年与1-5年对比,非典型增生性改变的发生率有统计学意义(P<0.05),其余两两对比差异无统计学意义。结论放置IUD后子宫异常出血等副反应人群常伴有子宫内膜良性增生性改变及非典型增生性改变,与异物刺激宫壁有直接关系,以放置后1年发生率较高,与IUD类型无明显关系。IUD可能还影响下丘脑-垂体-卵巢轴及子宫内膜细胞因子的分泌活动,引起子宫内膜与月经周期不同步反应。宫腔放置IUD后子宫内膜细胞形态特点的观察有待进一步积累,在子宫内膜细胞学诊断系统中,有必要补充和完善受IUD影响的子宫内膜细胞学诊断标准。

Objective To detection for disease to deactivate the IUD women with endometrial status,to study the influencing factors of endometrial IUD.Methods When the collection object IUD was extracted,endometrial cell collector was applied to take endometrial exfoliative cells,these samples were concentrated sent to Peking University affiliated hospital of obstetrics and gynecology uterine cytology test center for interpretation and diagnosis.Results The incidence rate of endometrium was not consistent with menstrual cycle and benign hyperplastic change and atypical hyperplastic change,because the side reaction to deactivate the IUD crowd were significantly higher than those the asymptomatic population（P 0.01 or P 0.05）.A variety of IUD type between the two groups were compared,anine to the United States IUD endometrial status and menstrual cycle was not synchronous onset was significantly higher than that of other IUD（P 0.01）,the incidence rate of benign hyperplastic change of mutile IUD was significantly higher than the activity of γ IUD（P 0.05）,the remaining types of contrast were not statistically significant.The incidence rate of endometrium was not consistent with menstrual cycle of IUD time 1-5 years was significantly higher than any other time（P 0.01）,intrauterine device placing time less than 1 year and the time of placement of 1-5 years comparative,the incidence rate of atypical hyperplastic change was statistically significant（P 0.05）,the rest of the each other between the contrast had no statistical significance.Conclusion After IUD placement of abnormal uterine bleeding and other side reaction of the crowd is often accompanied by endometrial benign hyperplastic changes and atypical hyperplastic change,it have a direct relationship with foreign body stimulation of uterine wall,after 1 year have a higher incidence rate,it is no obvious relationship with IUD type.IUD may also affect the hypothalamic pituitary ovarian axis and endometrial secretion of cytokine activity,causing endometrial and menstrual cycle is not synchronous response.Intrauterine placed IUD after endometrial cell morphology is observed in need of further accumulation,in endometrial cytology diagnosis system,it is necessary to supplement and perfect the diagnostic criteria of the influence of IUD on endometrial cytology.