Grimes D A
Family Health International, Research Triangle Park, North Carolina 27709, USA.
Lancet. 2000 Sep 16;356(9234):1013-9. doi: 10.1016/S0140-6736(00)02699-4.
Concern about upper-genital-tract infection related to intrauterine devices (IUDs) limits their wider use. In this systematic review I summarise the evidence concerning IUD-associated infection and infertility. Choice of an inappropriate comparison group, overdiagnosis of salpingitis in IUD users, and inability to control for the confounding effects of sexual behaviour have exaggerated the apparent risk. Women with symptomless gonorrhoea or chlamydial infection having an IUD inserted have a higher risk of salpingitis than do uninfected women having an IUD inserted; however, the risk appears similar to that of infected women not having an IUD inserted. A cohort study of HIV-positive women using a copper IUD suggests that there is no significant increase in the risk of complications or viral shedding. Similarly, fair evidence indicates no important effect of IUD use on tubal infertility. Contemporary IUDs rival tubal sterilisation in efficacy and are much safer than previously thought.
对与宫内节育器（IUD）相关的上生殖道感染的担忧限制了其更广泛的使用。在本系统评价中，我总结了有关IUD相关感染和不孕的证据。选择不恰当的对照组、对IUD使用者输卵管炎的过度诊断以及无法控制性行为的混杂效应夸大了表面风险。插入IUD的无症状淋病或衣原体感染女性比插入IUD的未感染女性患输卵管炎的风险更高；然而，该风险似乎与未插入IUD的感染女性相似。一项对使用铜质IUD的HIV阳性女性的队列研究表明，并发症风险或病毒脱落没有显著增加。同样，充分的证据表明使用IUD对输卵管性不孕没有重要影响。当代IUD在功效上可与输卵管绝育相媲美，并且比之前认为的要安全得多。
