在一项衣原体筛查试验中，对荷兰队列中的妇女进行了衣原体检测，本研究旨在探讨感染与盆腔炎、宫外孕和输卵管性不孕之间的关系。
Relation between infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial.
机构信息
Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
出版信息
Sex Transm Infect. 2019 Jun;95(4):300-306. doi: 10.1136/sextrans-2018-053778. Epub 2019 Jan 3.
OBJECTIVES
A better understanding of infection (chlamydia)-related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) with a follow-up time of up until 8 years in women previously tested for chlamydia in the Chlamydia Screening Implementation study (CSI) and participating in the Netherlands Chlamydia Cohort Study (NECCST).
METHODS
Women who participated in the CSI 2008-2011 (n=13 498) were invited in 2015-2016 for NECCST. Chlamydia positive was defined as a positive CSI-PCR test, positive chlamydia serology and/or self-reported infection (time dependent). Data on PID, ectopic pregnancy and TFI were collected by self-completed questionnaires. Incidence rates and HRs were compared between chlamydia-positive and chlamydia-negative women corrected for confounders.
RESULTS
Of 5704 women included, 29.5% (95% CI 28.3 to 30.7) were chlamydia positive. The incidence rate of PID was 1.8 per 1000 person-years (py) (1.6 to 2.2) overall, 4.4 per 1000 py (3.3 to 5.7) among chlamydia positives compared with 1.4 per 1000 py (1.1 to 1.7) for chlamydia negatives. For TFI, this was 0.4 per 1000 py (0.3 to 0.5) overall, 1.3 per 1000 py (0.8 to 2.1) and 0.2 per 1000 py (0.1 to 0.4) among chlamydia positives and negatives, respectively. And for ectopic pregnancy, this was 0.6 per 1000 py (0.5 to 0.8) overall, 0.8 per 1000 py (0.4 to 1.5) and 0.6 per 1000 py (0.4 to 0.8) for chlamydia negatives. Among chlamydia-positive women, the strongest risk factor for PID was symptomatic versus asymptomatic infection (adjusted HR 2.88, 1.4 to 4.5) and for TFI age <20 versus >24 years at first infection (HR 4.35, 1.1 to 16.8).
CONCLUSION
We found a considerably higher risk for PID and TFI in chlamydia-positive women, but the incidence for ectopic pregnancy was comparable between chlamydia-positive and chlamydia-negative women. Overall, the incidence rates of sequelae remained low.
TRIAL REGISTRATION
NTR-5597.
目的
深入了解衣原体感染相关后遗症，可为制定有效的衣原体防控策略提供框架。本研究的目的是估计衣原体检测呈阳性的女性在衣原体筛查实施研究（CSI）中接受检测并参加荷兰衣原体队列研究（NECCST）的随访时间长达 8 年的情况下，患盆腔炎（PID）、异位妊娠和输卵管因素不孕（TFI）的风险和风险因素。
方法
2008-2011 年参加 CSI 的女性（n=13498）受邀于 2015-2016 年参加 NECCST。衣原体阳性定义为 CSI-PCR 检测阳性、衣原体血清学阳性和/或自我报告感染（时间依赖性）。PID、异位妊娠和 TFI 的发病数据通过自我完成的问卷收集。校正混杂因素后，比较衣原体阳性和阴性女性的发病率和 HR。
结果
在纳入的 5704 名女性中，29.5%（95%CI 28.3-30.7）为衣原体阳性。总的 PID 发病率为 1.8/1000 人年（py）（1.6-2.2），衣原体阳性者为 4.4/1000 py（3.3-5.7），而衣原体阴性者为 1.4/1000 py（1.1-1.7）。对于 TFI，总发病率为 0.4/1000 py（0.3-0.5），衣原体阳性者为 1.3/1000 py（0.8-2.1），衣原体阴性者为 0.2/1000 py（0.1-0.4）。异位妊娠的总发病率为 0.6/1000 py（0.5-0.8），衣原体阳性者为 0.8/1000 py（0.4-1.5），衣原体阴性者为 0.6/1000 py（0.4-0.8）。在衣原体阳性女性中，PID 的最强危险因素是有症状感染与无症状感染（校正 HR 2.88，1.4-4.5），TFI 的最强危险因素是初次感染时年龄<20 岁与>24 岁（HR 4.35，1.1-16.8）。
结论
我们发现衣原体阳性女性 PID 和 TFI 的风险明显较高，但衣原体阳性和阴性女性的异位妊娠发病率相当。总的来说，后遗症的发病率仍然较低。
试验注册
NTR-5597。
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