Mårdh Per-Anders
Department of Obstetrics and Gynecology, Lund University, Lund, Sweden.
Curr Opin Infect Dis. 2004 Feb;17(1):49-52. doi: 10.1097/00001432-200402000-00010.
This article will highlight recent research into tubal factor infertility as one of the main causes of involuntary childlessness in women. There will be a focus on chlamydial infections.
The most common cause of tubal factor infertility is occlusion of the fallopian tubes due to an infection by a sexually transmitted agent, by Chlamydia trachomatis or Neisseria gonorrhoeae. The prevalence of diagnosed cases of tubal factor infertility (TFI) can be correlated to the epidemiological situation regarding these agents that was prevailing several years ago. This is partly due to the trend seen in many Western countries that women often postpone to try to get pregnant. Therefore, there is often a time lag between the acute primary pelvic inflammatory disease (PID) and when women first consult because of fertility problems. Sub-clinical salpingitis is today regarded as even more common than symptomatic PID. Persistent tubal infections by C. trachomatis are also a common feature, even despite courses of antibiotic therapy. The current focus on TFI has been on the immunopathology of tubal chlamydial infections, for which differences in host factors, such as genetic polymorphism in cytokine response and human leukocyte antigen type, may play a role in the outcome of pelvic inflammatory disease. Hysterosonography is a more convenient mode for diagnosing tubal occlusion than hysterosalpingography. The use of new species-specific antibody tests for C. trachomatis has decreased previous specificity problems found when used to detect tubal occlusion in work-up of women consulting because of infertility.
Infection by C. trachomatis is a major cause of TFI. Many cases of chlamydial salpingitis have a more or less subclinical course. The tubal infection may become chronic in spite of antibiotic therapy. Immunological processes may continue after microbiological cure, which stresses the importance of screening for C. trachomatis in order to detect and treat carriers to hinder spread to still uninfected women.
本文将重点介绍输卵管因素不孕症的最新研究，这是女性非自愿不育的主要原因之一。将重点关注衣原体感染。
输卵管因素不孕症最常见的原因是性传播病原体（沙眼衣原体或淋病奈瑟菌）感染导致输卵管阻塞。输卵管因素不孕症（TFI）确诊病例的患病率与几年前这些病原体的流行情况相关。部分原因是许多西方国家出现的一种趋势，即女性经常推迟尝试怀孕。因此，急性原发性盆腔炎（PID）与女性因生育问题首次咨询之间往往存在时间间隔。如今，亚临床输卵管炎被认为比有症状的PID更为常见。即使经过抗生素治疗疗程，沙眼衣原体持续的输卵管感染也是一个常见特征。目前对TFI的关注集中在输卵管衣原体感染的免疫病理学上，宿主因素的差异，如细胞因子反应中的基因多态性和人类白细胞抗原类型，可能在盆腔炎的转归中起作用。子宫超声造影是一种比子宫输卵管造影更方便的诊断输卵管阻塞的方法。使用针对沙眼衣原体的新的种特异性抗体检测减少了以往在因不孕症咨询的女性检查中用于检测输卵管阻塞时发现的特异性问题。
沙眼衣原体感染是TFI的主要原因。许多衣原体输卵管炎病例或多或少呈亚临床过程。尽管进行了抗生素治疗，输卵管感染仍可能变为慢性。微生物治愈后免疫过程可能仍会持续，这强调了筛查沙眼衣原体以检测和治疗携带者以防止传播给仍未感染女性的重要性。
