国产皮下埋植避孕剂对细胞免疫功能的影响

A study on the effects of home made subdermal levonorgestrel implant on cellular immunity

为了解皮下埋植避孕剂对细胞免疫功能的影响 ,对 159例应用国产左旋 18甲基炔诺酮皮下埋植避孕剂妇女血清中细胞因子白细胞介素 (IL ) - 2、IL- 6、α肿瘤坏死因子(TNFα)、γ干扰素 (IFNγ)的水平 ;外周血单核细胞 (PBMC)体外培养自发分泌和在植物血凝素 (PHA)刺激下分泌细胞因子水平 ;T细胞总数及亚群 ,CD4 /CD8比值进行测定。方法 :细胞因子的测定采用酶联免疫吸附测定法 ,T细胞数量及亚群的测定采用改良的碱性磷酸酶抗磷酸酶桥联酶标染色 (APAAP)法。结果 :药物应用 <1.5年者 ,IL- 2和 TNFα水平有所升高 ,以用药时间 0 .5～年的水平最高 ,明显高于正常对照组 (P<0 .0 1) ;IL- 6的水平在早期有所降低 ,但无统计学意义 ;IFNγ未见明显变化。PBMC自发分泌 IL- 2和TNFα水平在用药时间为 0 .5～年最高 ,IL - 6的分泌水平最低 ,以上变化在 >1.5～ 4 .5年者基本恢复正常 ,并保持稳定 ,>4 .5～ 6 .5年者无明显波动。血清 IL- 2、IL- 6和 TNFα的水平变化与 PBMC自发分泌水平相关 ;PBMC在体外经 PHA刺激后 ,分泌 4种细胞因子的水平与对照组无显著性差别。 CD3+、CD4 +、CD8+T细胞数及 CD4 /CD8比值未见明显变化。结论 :左旋 18甲基炔诺酮皮下埋植避孕剂在药物的应用早期对机体的细胞免疫功能有所影响 。

To understand the effects of home made subdermal levonorgestrel implant on cellular immunity and provide the immune safety of the implant. Subjects: 159 women using home made subdermal levonorgestrel implants and 31 healthy women as controls were studied. Methods: The cytokines were tested by ELISA. Numbers of CD3+T cells, CD4+T cells, CD8+T cells were measured by alkaline phosphatase anti alkaline phosphatase(APAAP) methods. Results: During early stage(<1.5 years),the levels of IL 2 and TNF α in sera were higher than that of the controls ( P<0.01 ) The levels of IL 2 and TNF α secreted by peripheral blood mononuclear cells (PBMC) were also higher, but that of IL 6 was lower ( P< 0.01 ) All the changes had recovered to normal level and remained stable during the middle and later stages (1.5～4 5 years),afterwards on change had been found (4.5～6 5 years). The ability of secreting four cytokines of PBMC after the stimulation of PHA showed no difference from that of the controls. The change of levels of IL 2,IL 6 and TNF α in sera was associated with PBMC secretion. Numbers of CD3+T cells, CD4+ T cells and CD8+T cells, and the ratio of CD4/CD8 had no changes. Conclusion: Home made subdermal levonorgestrel implant showed some influence on the cellular immunity in the early stage, but had no harmful effect. So this implant can be used for long term. It may be necessary to check the immunological indices during the early stage for users.