Coste J, Job-Spira N, Fernandez H, Papiernik E, Spira A
INSERM U. 292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Am J Epidemiol. 1991 May 1;133(9):839-49. doi: 10.1093/oxfordjournals.aje.a115964.
A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception. Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1-13.9) and Chlamydia trachomatis seropositivity (OR = 3.9, 95% CI 2.3-6.7) appeared to be important risk factors for ectopic pregnancy. Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 1.3 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1-2.5), prior tubal surgery (OR = 5.1, 95% CI 1.7-15.4), induced conception cycle (OR = 3.2, 95% CI 1.1-9.3), and prior ectopic pregnancy (OR = 13.3, 95% CI 4.5-39.2). However, some of the latter risk factors, i.e., prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases. Maternal age, parity, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported risk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy.
1988年，在巴黎地区的七家妇产医院开展了一项病例对照研究，以评估多种风险因素，尤其是感染因素在异位妊娠中的作用。研究对比了279例病例和279名对照的社会人口学特征、吸烟情况、性史、生殖史、手术史以及受孕条件。经腹腔镜检查确诊的盆腔炎（比值比（OR）=5.5，95%置信区间（CI）2.1 - 13.9）和沙眼衣原体血清学阳性（OR = 3.9，95% CI 2.3 - 6.7）似乎是异位妊娠的重要风险因素。其他与异位妊娠风险增加相关的风险因素包括受孕时与剂量相关的吸烟（OR值为1.3至2.5）、阑尾切除术（OR = 1.6，95% CI 1.1 - 2.5）、既往输卵管手术（OR = 5.1，95% CI 1.7 - 15.4）、诱导受孕周期（OR = 3.2，95% CI 1.1 - 9.3）以及既往异位妊娠（OR = 13.3，95% CI 4.5 - 39.2）。然而，后几种风险因素中的一些，即既往输卵管手术、既往异位妊娠，或许还有阑尾切除术，可能被认为是盆腔炎和性传播疾病的结果。产妇年龄、产次、既往人工流产和既往自然流产与异位妊娠无关。受孕时使用宫内节育器、孕激素微型片以及复方雌孕激素片，相较于预防异位妊娠，对预防宫内妊娠的效果更好。这些发现证实了先前报道的几种异位妊娠风险因素的重要性：性传播疾病、吸烟以及既往异位妊娠。研究还确定了新的风险因素，即阑尾切除术和诱导受孕周期，并表明复方雌孕激素片预防异位妊娠的效果不如预防宫内妊娠的效果好。
