Mongiovi Jennifer M, Babic Ana, Sasamoto Naoko, Shafrir Amy L, Huang Tianyi, Townsend Mary K, Peres Lauren C, Tworoger Shelley S, Terry Kathryn L
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Obstetrics and Gynecology Department, Brigham and Women's Hospital, Boston, MA, United States.
Am J Epidemiol. 2025 Jan 8;194(1):85-94. doi: 10.1093/aje/kwae135.
Ovarian cancer incidence has declined in recent decades, due in part to oral contraceptive (OC) use and tubal ligation. However, intrauterine device (IUD) use has increasingly replaced OC use. As ovarian cancer is an inflammation-related disease, we examined the association of OC use, IUD use, and tubal ligation with plasma levels of C-reactive protein (CRP), interleukin 6, and soluble tumor necrosis factor α receptor 2 in the Nurses' Health Study (NHS) and NHSII. After adjusting for reproductive, hormonal, and lifestyle factors and mutual adjustment for other methods of contraception, there were no differences in inflammatory markers between ever and never use of each method. However, CRP levels decreased from an average of 30.4% (95% CI, -53.6 to 4.4) with every 5 years since initial IUD use (P-trend = .03), while CRP increased an average of 9.9% (95% CI, 5.7, 14.3) with every 5 years of use of OC (P-trend < .0001) as well as differences by body mass index and menopausal status. Our results suggest IUD use and tubal ligation are not associated with higher circulating inflammatory markers long term, although long duration of OC use may increase generalized inflammation, which may in part explain why its protective effect wanes over time. This article is part of a Special Collection on Gynecological Cancer.
近几十年来，卵巢癌发病率有所下降，部分原因是口服避孕药（OC）的使用和输卵管结扎。然而，宫内节育器（IUD）的使用已越来越多地取代了OC的使用。由于卵巢癌是一种炎症相关疾病，我们在护士健康研究（NHS）和NHSII中研究了OC使用、IUD使用和输卵管结扎与血浆C反应蛋白（CRP）、白细胞介素6和可溶性肿瘤坏死因子α受体2水平之间的关联。在调整了生殖、激素和生活方式因素以及对其他避孕方法进行相互调整后，每种方法的曾经使用和从未使用组之间的炎症标志物没有差异。然而，自首次使用IUD起，每5年CRP水平平均下降30.4%（95%CI，-53.6至4.4）（P趋势=0.03），而使用OC每5年CRP平均升高9.9%（95%CI，5.7，14.3）（P趋势<0.0001），且存在按体重指数和绝经状态的差异。我们的结果表明，长期来看，IUD的使用和输卵管结扎与循环炎症标志物升高无关，尽管长期使用OC可能会增加全身性炎症，这可能部分解释了其保护作用为何会随着时间减弱。本文是妇科癌症专题集的一部分。
