沙眼衣原体免疫球蛋白G3血清阳性是输卵管通畅的不孕女性生殖结局的一个预测指标。
Chlamydia trachomatis immunoglobulin G3 seropositivity is a predictor of reproductive outcomes in infertile women with patent fallopian tubes.
作者信息
Steiner Anne Z, Diamond Michael P, Legro Richard S, Schlaff William D, Barnhart Kurt T, Casson Peter R, Christman Gregory M, Alvero Ruben, Hansen Karl R, Geisler William M, Thomas Tracey, Santoro Nanette, Zhang Heping, Eisenberg Esther
机构信息
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan; Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
出版信息
Fertil Steril. 2015 Dec;104(6):1522-6. doi: 10.1016/j.fertnstert.2015.08.022. Epub 2015 Sep 25.
OBJECTIVE
To determine if Chlamydia trachomatis (C. trachomatis) seropositivity, as detected by the C. trachomatis elementary body (EB)-based enzyme-linked immunosorbent assay [EB ELISA] predicts pregnancy and pregnancy outcome among infertile women with documented tubal patency.
DESIGN
Cohort study.
SETTING
Outpatient clinics.
PATIENT(S): In all, 1,250 infertile women with documented tubal patency enrolled in 1 of 2 randomized controlled trials: Pregnancy in Polycystic Ovary Syndrome II; and the Assessment of Multiple Intrauterine Gestations From Ovarian Stimulation.
INTERVENTION(S): Sera were analyzed for anti-C. trachomatis immunoglobulin G (IgG)1 and IgG3 antibodies, using a research C. trachomatis EB ELISA. The optical density (OD)405 readings of ≥ 0.35 and ≥ 0.1 were considered positive for IgG1 and IgG3, respectively.
MAIN OUTCOME MEASURE(S): Primary outcomes included pregnancy, live birth, and ectopic pregnancy. Log-linear regression was used to determine the relative risk after adjusting for age, race, treatment medication, smoking status, and current alcohol use.
RESULT(S): A total of 243 (19%) women were seropositive for anti-C. trachomatis IgG3. They tended to be nonwhite and smokers. Anti-C. trachomatis IgG3 seropositive women were significantly less likely to conceive (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.52-0.83) or to have a live birth (RR 0.59, 95% CI 0.43-0.80); these associations were weakened after adjusting for number of hysterosalpingography-documented patent tubes (RR 0.73, 95% CI 0.56-0.97) and (RR 0.73, 95% CI 0.50-1.04), respectively. Anti-C. trachomatis IgG3 seropositive women who conceived had a ×2.7 risk (95% CI 1.40-5.34) of ectopic pregnancy.
CONCLUSION(S): Even in the presence of tubal patency, anti-C. trachomatis IgG3 seropositivity is associated with a lower likelihood of pregnancy. Anti-C. trachomatis IgG3 seropositive women have as high as 3 times the risk of ectopic pregnancy.
CLINICAL TRIAL REGISTRATION NUMBER
PPCOSII: NCT00719186 and AMIGOS: NCT01044862.
目的
通过基于沙眼衣原体原体（EB）的酶联免疫吸附测定法[EB ELISA]检测沙眼衣原体（C. trachomatis）血清反应阳性，以确定其是否能预测输卵管通畅的不孕女性的妊娠情况及妊娠结局。
设计
队列研究。
地点
门诊诊所。
患者
共有1250名输卵管通畅的不孕女性参与了2项随机对照试验中的1项：多囊卵巢综合征II中的妊娠；以及卵巢刺激后多胎宫内妊娠的评估。
干预措施
使用研究性沙眼衣原体EB ELISA分析血清中的抗沙眼衣原体免疫球蛋白G（IgG）1和IgG3抗体。IgG1和IgG3的光密度（OD）405读数分别≥0.35和≥0.1被视为阳性。
主要观察指标
主要结局包括妊娠、活产和异位妊娠。采用对数线性回归来确定在调整年龄、种族、治疗药物、吸烟状况和当前饮酒情况后的相对风险。
结果
共有243名（19%）女性抗沙眼衣原体IgG3血清反应阳性。她们往往是非白人且吸烟。抗沙眼衣原体IgG3血清反应阳性的女性受孕的可能性显著降低（风险比[RR]0.65，95%置信区间[CI]0.52 - 0.83）或活产的可能性降低（RR 0.59，95% CI 0.43 - 0.80）；在调整子宫输卵管造影记录的通畅输卵管数量后，这些关联有所减弱（RR分别为0.73，95% CI 0.56 - 0.97）和（RR 0.73，95% CI 0.50 - 1.04）。抗沙眼衣原体IgG3血清反应阳性且受孕的女性发生异位妊娠的风险增加2.7倍（95% CI 1.40 - 5.34）。
结论
即使输卵管通畅，抗沙眼衣原体IgG3血清反应阳性也与较低的妊娠可能性相关。抗沙眼衣原体IgG3血清反应阳性的女性发生异位妊娠的风险高达3倍。
临床试验注册号
PPCOSII：NCT00719186和AMIGOS：NCT01044862。
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