Jensen Kirsten E, Thomsen Louise T, Schmiedel Sven, Frederiksen Kirsten, Norrild Bodil, van den Brule Adriaan, Iftner Thomas, Kjær Susanne K
Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Unit of Statistics, Bioinformatics and Registries, Danish Cancer Society Research Center, Copenhagen, Denmark.
Sex Transm Infect. 2014 Nov;90(7):550-5. doi: 10.1136/sextrans-2013-051431. Epub 2014 Apr 12.
Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in women with prevalent HPV infection and in a subgroup of women with persistent HPV infection.
Participants in this population-based cohort study underwent a structured interview, including history of CT infection, and subsequently cervical exfoliated cells were obtained for HPV DNA and CT DNA testing. Women with high-risk HPV DNA infection and no prevalent cervical disease constituted the overall study population (n=1390). A subgroup of women with persistent HPV infection (n=320) was also identified. All women were passively followed for development of cervical lesions in the national Pathology Data Bank. HRs and 95% CIs for CIN3+ during follow-up (up to 19 years) were estimated in an accelerated failure time model.
Women who reported more than one CT infection had a statistically significantly increased risk of CIN3+ (high-risk HPV-positive, HR=2.51, 95% CI 1.44 to 4.37) (persistent HPV infection, HR=3.65, 95% CI 1.53 to 8.70). We found no association between CT DNA and subsequent risk of CIN3+ among women who were HPV-positive or had a persistent HPV infection at baseline.
Repeated CT infections increased the risk of CIN3+ among women with prevalent as well as persistent high-risk HPV infection.
一些研究表明沙眼衣原体（CT）会促进宫颈癌变；然而，持续性人乳头瘤病毒（HPV）感染可能产生的混杂效应未得到探讨。我们研究了CT感染在HPV感染流行的女性以及持续性HPV感染女性亚组中，对后续发生宫颈上皮内瘤变3级或更严重病变（CIN3+）的潜在作用。
在这项基于人群的队列研究中，参与者接受了结构化访谈，包括CT感染史，随后获取宫颈脱落细胞进行HPV DNA和CT DNA检测。高危HPV DNA感染且无宫颈疾病流行的女性构成总体研究人群（n = 1390）。还确定了持续性HPV感染女性亚组（n = 320）。所有女性在国家病理数据库中被被动随访宫颈病变的发生情况。在加速失效时间模型中估计随访期间（长达19年）CIN3+的风险比（HR）和95%置信区间（CI）。
报告有不止一次CT感染的女性发生CIN3+的风险在统计学上显著增加（高危HPV阳性，HR = 2.51，95% CI 1.44至4.37）（持续性HPV感染，HR = 3.65，95% CI 1.53至8.70）。我们发现，在基线时HPV阳性或有持续性HPV感染的女性中，CT DNA与随后发生CIN3+的风险之间无关联。
反复CT感染会增加HPV感染流行以及持续性高危HPV感染女性发生CIN3+的风险。
