Egger M, Low N, Smith G D, Lindblom B, Herrmann B
Department of Social Medicine, University of Bristol, Bristol BS8 2PR.
BMJ. 1998 Jun 13;316(7147):1776-80. doi: 10.1136/bmj.316.7147.1776.
To analyse trends in rates of genital chlamydial infection and ectopic pregnancy between 1985 and 1995 in a county in Sweden.
Uppsala county where screening for chlamydial infection, treatment, and contact tracing has been widespread and where ectopic pregnancies are recorded.
Rates of chlamydial infections and ectopic pregnancy between 1985 and 1995 were calculated for women aged 20-39 years. Poisson and linear regression were used to examine the association between the risk of ectopic pregnancy and the current rates of chlamydial infection and rates of chlamydial infection from up to 5 years earlier.
Rates of chlamydial infection per 100 examinations, rates of ectopic pregnancy per 1000 pregnancies, rate ratios and 95% confidence intervals for an increase in chlamydial infections of 5 new cases per 100 examinations.
103 870 cervical samples from women aged 15-39 years were analysed; 5648 (5.4%) were positive for chlamydia. 51 630 pregnancies were analysed; 930 (1.8%) were ectopic. Both rates declined over time. For women aged 20-24 years there was a strong correlation between the rate of ectopic pregnancy and the rate of chlamydial infection in the same year (r=0.93, P<0. 001); among older women correlations were stronger with rates of chlamydial infection occurring 1 or 2 years earlier. In Poisson regression ectopic pregnancy was most strongly associated with the current rate of chlamydial infection among women aged 20-24 (rate ratio 1.85, 95% confidence interval 1.44 to 2.38), with the rate of infection 1 year earlier among 25-29 year olds (rate ratio 1.72, 1. 33 to 2.22) and 30-34 year olds (rate ratio 2.27, 1.53 to 3.37); and with the rate 2 years earlier among 35 to 39 year olds (rate ratio 2. 58, 1.45 to 4.60).
Declining rates of genital chlamydial infections have probably led to a fall in the rate of ectopic pregnancies. The timing of the decline in the rate of ectopic pregnancies varies with age. Among young women falling rates of chlamydial infection have been accompanied by an immediate reduction in the rate of ectopic pregnancy.
分析1985年至1995年瑞典某县生殖器衣原体感染率和异位妊娠率的变化趋势。
乌普萨拉县衣原体感染筛查、治疗及接触者追踪工作广泛开展，且有异位妊娠记录。
计算1985年至1995年20至39岁女性的衣原体感染率和异位妊娠率。采用泊松回归和线性回归分析异位妊娠风险与当前衣原体感染率以及早至5年前的衣原体感染率之间的关联。
每100次检查的衣原体感染率、每1000次妊娠的异位妊娠率、衣原体感染每增加5例/100次检查时的率比及95%置信区间。
分析了15至39岁女性的103870份宫颈样本；5648份（5.4%）衣原体检测呈阳性。分析了51630例妊娠；930例（1.8%）为异位妊娠。两种率均随时间下降。对于20至24岁女性，同年异位妊娠率与衣原体感染率之间存在强相关性（r = 0.93，P < 0.001）；在年龄较大的女性中，与1或2年前的衣原体感染率相关性更强。在泊松回归中，异位妊娠与20至24岁女性当前的衣原体感染率关联最强（率比1.85，95%置信区间1.44至2.38），与25至29岁女性1年前的感染率关联较强（率比1.72，1.33至2.22）以及30至34岁女性（率比2.27，1.53至3.37）；与35至39岁女性2年前的感染率关联较强（率比2.58，1.45至4.60）。
生殖器衣原体感染率下降可能导致异位妊娠率降低。异位妊娠率下降的时间随年龄而异。在年轻女性中，衣原体感染率下降伴随着异位妊娠率立即降低。
