宫内节育器表面的细菌生物膜研究

Research about bacteriology on intrauterine device

目的:宫内节育器(IUD)是目前常用的长效避孕措施之一,然而众多研究认为IUD的应用增加了盆腔炎性疾病(PID)的发生率。近年研究发现细菌生物膜(BF)与感染性疾病的发生息息相关,本研究拟探究无盆腔炎疾病妇女的不同类型宫内节育器表面是否存在BF,了解IUD是否为BF形成提供平台,是否增加盆腔炎性疾病的易感性。方法:不同类型IUD标本,根据表面清洁程度分别进行单独电子扫描电镜(SEM)观察,单独需氧、厌氧细菌培养,以及SEM观察+培养了解IUD表面是否存在BF。结果:共纳入IUD标本86例,85例非PID女性的IUD,同期1例盆腔感染性疾病患者的IUD。25例进行单独SEM观察,阳性1例,其余标本未见典型BF结构。单独细菌培养47例,需氧细菌培养阳性1例,见大面积菌苔覆盖,考虑污染可能性大,其余标本未见细菌生长。SEM联合培养14例,细菌培养阳性,电镜无阳性发现。其余培养及SEM观察阴性。结论:不论IUD的类型如何,非PID女性体内的IUD表面无BF存在,不同与其他体内医疗装置,BF的形成不能成为限制IUD应用的理由。

Background：Intrauterine device（IUD）is one of the most popular method of longacting contraception,while concerns still exist as to whether the use of IUD increases the risk of pelvic inflammatory disease（PID）. In recent years many issues have been extensively researched about the relationship between bacterial biofilm（BF）and infectious diseases. We designed this study to investigate whether BF exists on IUD of non PID women;and whether IUD increases the susceptibility to PID. Methods：For the study,we recruited 85 participants without PID and a PID patient who choosed IUD as a means of contraception. According to the cleanliness of IUD surface.IUD was removed and sent for scanning electron microscopy（SEM）or/and biological and fungal examination respectively to detect BF. Results：A total of 86 IUDs were recruited,which include stainless steel ring,TCu IUD,Mirena,Multiload,Mcu IUD andγCu380 IUD. Among 25 IUDs which were observed with SEM alone,BF was discovered on a TCu IUD used for one month-a large number of bacilli /cocci and extracellular matrix coverd on the surface of copper. Other specimens had no significant discoveries. The result of 47 microbial culture alone was negative except for one suspected contaminated IUD. 14 IUDS were investigated via both microbial culture and SEM. A 33 year old stainless steel ring which removed because of the symptoms of pelvic pain,aerobic cultivation was positive.But there was no BF detected by SEM.The remaining 13 IUD had no positive result.Conclusions：There was no BF on surface of IUD removed from non- PID women regardless of IUD type;unlike other medical device,the formation of bacterial biofilm should not become a stumbling.