常用IUD脱落或下移不良事件风险因素巢式病例对照研究

Risk factors of the expulsion or the downward shift of the commonly used intrauterine device:a nested case-control study

目的:探讨常用宫内节育器(IUD)发生脱落或下移不良事件的风险因素。方法:采用巢式病例对照研究方法,以2015-2020年参加IUD首诊排查登记且放置数量位为前10位的IUD类型的使用对象为基础建立队列,回顾或前瞻性的收集相应检查结果,其中发生IUD脱落或下移不良事件的对象994例,按照1∶3的方法匹配对照,采用条件logistic回归模型筛选出发生脱落或下移不良事件的可疑风险因素。结果:IUD类型、剖宫产史、副作用以及哺乳均为影响因素。脱落或下移的风险GCu200(OR=2.01,95%CI 1.36~2.96)、GCu220(OR=1.60,95%CI 1.08~2.37)、OCu200(OR=2.00,95%CI 1.25~3.22)、TCu220C(OR=1.56,95%CI 1.10~2.23)、固定式(OR=2.00,95%CI 1.36~2.95)、活性165(OR=2.43,95%CI 1.62~3.64)、活性γ(OR=1.77,95%CI 1.21~2.59)和元宫200(OR=1.45,95%CI 1.02~2.06)高于活性γ(记忆合金);GCu220(OR=1.67,95%CI 1.07~2.60)和固定式(OR=1.66,95%CI 1.06~2.61)高于HCu280;GCu220(OR=0.66,95%CI 0.45~0.97)、HCu280(OR=0.50,95%CI 0.31~0.79)、TCu220C(OR=0.64,95%CI 0.45~0.92)和元宫200(OR=0.60,95%CI 0.42~0.85)低于活性165;有剖宫产史(OR=1.29,95%CI 1.09~1.52)、置器后发生副作用(OR=3.55,95%CI 2.80~4.49)及哺乳使用者(OR=4.62,95%CI 1.09~19.63)发生脱落或下移的风险增高。结论:应针对风险因素选择适合的IUD种类、型号并重视后期随访,以提高育龄妇女生殖健康水平。

Objective:To analyze the risk factors of the expulsion or the downward shift of the commonly used intrauterine devices(IUD).Methods:A nested case-control study was established for the women who had been inserted the top 10 number of IUD types based on their IUD first-diagnosed registration from 2015 to 2020,and these women were included in the cohorts of this study.The results of the corresponding examinations were collected retrospectively or prospectively.There were 994 women with the expulsion or the downward shift of IUD in the case group,and the women matched in the control group according to 1:3.The conditioned logistic regression analysis model was used to screen out the suspicious risk factors of the expulsion or the downward shift of IUD.Results:The type of IUD,the history of cesarean section,the side effect and the lactation of the women were all the influencing factors of the expulsion or the downward shift of their IUD.The risk of the expulsion or the downward shift of GCu200(odds ratio(OR)=2.01,95%CI 1.36-2.96),GCu220(OR=1.60,95%CI 1.08-2.37),OCu200(OR=2.00,95%CI 1.25-3.22),TCu220C(OR=1.56,95%CI 1.10-2.23),fixed IUD(OR=2.00,95%CI1.36-2.95),active 165(OR=2.43,95%CI 1.62-3.64),Gamma Cu IUD(OR=1.77,95%CI1.21-2.59)and YCu 200(OR=1.45,95%CI 1.02-2.06)was significantly higher than that of active Gamma Cu IUD(memory alloy).The risk of the expulsion or the downward shift of GCu220(OR=1.67,95%CI 1.07-2.60)or fixed IUD(OR=1.66,95%CI 1.06-2.61)was significantly higher than that of HCu280.The risk of the expulsion or the downward shift of GCu220(OR=0.66,95%CI 0.45-0.97),HCu280(OR=0.50,95%CI 0.31-0.79),TCu220C(OR=0.64,95%CI 0.45-0.92)and the Yuan Cu 200IUD(OR=0.60,95%CI 0.42-0.85)was significantly lower than that of active 165 IUD.The history of cesarean section(OR=1.29,95%CI 1.09-1.52),the side effect after IUD inserted(OR=3.55,95%CI 2.80-4.49)and the lactation(OR=4.62,95%CI 1.09-19.63)increased the risk of the expulsion or the downward shift of IUD.Conclusion:It is suggested that the appropriate type and the model of IUD should be selected for the women according to the risk factors of the expulsion or downward shift of their IUD,so as to improve the reproductive health level of the women of childbearing age.