Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China.
Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China; National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China.
EBioMedicine. 2023 Aug;94:104696. doi: 10.1016/j.ebiom.2023.104696. Epub 2023 Jul 4.
Chlamydia trachomatis (CT) infection has an increased risk for fertility-related and pregnancy adverse outcomes partly due to mechanisms related to a pro-inflammatory response to CT-, or cHSP60-induced delayed hypersensitivity. This study aimed to assess the evidence on the association between CT serology and adverse outcomes.
PubMed/Medline, Embase and Web of Science databases were searched for observational studies on the association of CT-specific antibodies (e. g. IgG, IgA, IgM, etc.) with infertility, tubal factor infertility (TFIF), ectopic pregnancy (EP), spontaneous abortion (SA), or preterm labor (PL) that were published from database inception to 31 August 2022. Pooled adjusted odds ratios or relative risks with corresponding 95% confidence intervals were calculated using a random effects model. This study was registered with PROSPERO (CRD42022368366).
We identified 128 studies that met the inclusion criteria, comprising 87 case-control, 34 cross-sectional and 7 cohort studies, for a total of 167 records involving 128,625 women participants included into the meta-analyses. Based on the adjusted estimates, it was found that CT-specific IgG was significantly associated with TFIF (pooled adjusted OR = 2.09, 95% CI 1.33-3.27, I = 63.8%) or EP (pooled adjusted OR = 3.00, 95% CI 1.66-5.40, I = 93.0%). Analyses of the unadjusted estimates indicated significant associations between CT-specific IgG and infertility, TFIF, EP or SA (four pooled unadjusted ORs ranging between 1.60 and 5.14, I ranging between 40% and 83%); IgA and infertility, TFIF, EP (three pooled unadjusted ORs ranging between 3.64 and 4.91, I ranging between 0% and 74%); IgM and TFIF (pooled unadjusted OR = 5.70, 95% CI 1.58-20.56, I = 56%); or cHSP60 and TFIF (pooled unadjusted OR = 7.83, 95% CI 5.42-11.31, I = 49%).
A broad range of CT-specific antibodies have been studied in association with fertility-related and pregnancy adverse outcomes. However, our study identified a low- or moderate-quality evidence for an association of CT serology with the outcomes. There are substantial research gaps in relation to the clinical implications of CT serological biomarkers.
The work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021).
沙眼衣原体 (CT) 感染与生育相关和妊娠不良结局的风险增加有关，部分原因是与 CT 或 cHSP60 诱导的迟发性超敏反应相关的促炎反应机制。本研究旨在评估 CT 血清学与不良结局之间关联的证据。
在 PubMed/Medline、Embase 和 Web of Science 数据库中检索了关于 CT 特异性抗体（例如 IgG、IgA、IgM 等）与不孕、输卵管因素不孕 (TFIF)、异位妊娠 (EP)、自然流产 (SA) 或早产 (PL) 之间关联的观察性研究，这些研究的发表时间从数据库建立到 2022 年 8 月 31 日。使用随机效应模型计算了具有相应 95%置信区间的汇总调整后比值比或相对风险。本研究已在 PROSPERO（CRD42022368366）上注册。
我们确定了 128 项符合纳入标准的研究，包括 87 项病例对照研究、34 项横断面研究和 7 项队列研究，共涉及 128625 名女性参与者的 167 项记录被纳入荟萃分析。基于调整后的估计值，发现 CT 特异性 IgG 与 TFIF（汇总调整后 OR = 2.09，95%CI 1.33-3.27，I = 63.8%）或 EP（汇总调整后 OR = 3.00，95%CI 1.66-5.40，I = 93.0%）显著相关。对未调整估计值的分析表明，CT 特异性 IgG 与不孕、TFIF、EP 或 SA（四个未调整汇总 OR 范围为 1.60 至 5.14，I 范围为 40% 至 83%）、IgA 和不孕、TFIF、EP（三个未调整汇总 OR 范围为 3.64 至 4.91，I 范围为 0% 至 74%）、IgM 和 TFIF（未调整汇总 OR = 5.70，95%CI 1.58-20.56，I = 56%）或 cHSP60 和 TFIF（未调整汇总 OR = 7.83，95%CI 5.42-11.31，I = 49%）之间存在显著关联。
已经研究了广泛的 CT 特异性抗体与生育相关和妊娠不良结局的关联。然而，我们的研究发现 CT 血清学与这些结局之间存在低质量或中等质量证据的关联。在 CT 血清学生物标志物的临床意义方面存在很大的研究差距。
这项工作得到了中国医学科学院创新医学倡议（2016-I2M-3-021）的支持。
