血浆内皮素与皮下埋植剂使用者子宫异常出血相关性初步探讨

Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

目的:初步探讨血浆内皮素与皮下埋植剂使用者子宫异常出血的相关性。方法:采用前瞻性自身对照研究方法,对29名妇女在埋植手术前后月经周期不同阶段取4次静脉血;本研究前已使用皮下埋植剂的59名随访妇女组成已埋植组,取1次静脉血。应用放免方法测定血浆内皮素、雌激素、孕激素含量。结果:29例自身对照组妇女雌激素水平不论在月经周期的哪一阶段与埋植前比较均无明显改变,埋植后月经紊乱者较月经正常者雌激素、孕激素水平也无明显差异,血浆内皮素水平月经紊乱者偏高（但尚无统计学差异）,且月经紊乱者较月经正常者埋植前月经周期各阶段血浆内皮素水平也明显增高,尤以早增期、中增期明显,P<0.05。已使用埋植剂组的59名妇女,月经紊乱者血浆内皮素水平较月经正常者血浆内皮素也明显增高,P<0.05。结论:血浆高内皮素水平可能和埋植后子宫异常出血存在一定关系。

ve:To investigate the relationship between estradiol, progesterone and endothelin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant. Materials & methods: A prospec-tive self-control clinical trial was conducted in 29 women in the self-control group. Blood samples were obtained on four occasions across the different phases of menstrual cycle before and after using implant. A blood sample was taken for a single determination in another 59 women in the already-use implant group. Plasma of estradiol, progesterone and endothelin were determined by using radioimmunoassays (RIA) in both groups. Results:The level of estradiol and progesterone had no significant differences in women before and after using implant in self-control group. The level of estradiol, progesterone had no differences between women with normal and abnormal menstrual cycle in both groups. The levels of plasma endothe-lin (ET) in women with abnormal bleeding pattern were higher than women with normal bleeding pattern, but difference was not significant. Women with abnormal bleeding pattern had significantly higher ET level than that in women with normal bleeding pattern before using implants, especially in early-prolifera-tive phase and mid-proliferative phase. the level of plasma endothelin was significantly higher in women with disturbed bleeding pattern than that in normal women in the already-use group. Conclusion: High serum concentrations of ET are likely to be correlated with abnormal uterine bleeding in long-term subder-mal contraceptive implants users.