Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women's Cohort Study
Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women's Cohort Study
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DOI：
10.1136/sti.2005.017186
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发表时间：
2006-06-01
影响因子：
3.6
通讯作者：
Herrmann, B.
中科院分区：
文献类型：
--
作者：
Low, N.;Egger, M.;Herrmann, B.
目的：估计一般女性人群中与生殖器衣原体感染相关的严重并发症的累积发生率。方法：乌普萨拉妇女队列研究是瑞典一项基于人群的回顾性队列研究，将实验室、医院和人口登记册联系起来。我们估计了医院诊断的盆腔炎、宫外孕和不孕症的累积发生率，并使用多变量回归模型根据筛查状态估计风险比。结果：我们分析了 1985 年 1 月至 1989 年 12 月期间乌普萨拉 43 715 名 15 - 24 岁女性的完整数据。截至 1999 年底的随访包括 709 000 名妇女年和 3 025 起事件。 35 岁时盆腔炎的累积发病率为 3.9%（95% CI 3.7% 至 4.0%）：曾经衣原体检测呈阳性的女性为 5.6%（4.7% 至 6.7%），检测结果为阴性的女性为 4.0%（3.7% 至 4.4%），衣原体检测呈阴性的女性为 2.9%（2.7% 至 3.2%）。从未放映过。相应的数字是：宫外孕总体为2.3%（2.2%至2.5%）、2.7%（2.1%至3.5%）、2.0%（1.8%至2.3%）和1.9%（1.7%至2.1%）；对于不孕症，总体为4.1%（3.9%至4.3%）、6.7%（5.7%至7.9%）、4.7%（4.4%至5.1%）和3.1%（2.8%至3.3%）。教育程度低与所有结果的发展密切相关。结论：根据我们和其他基于人群的研究估计，严重衣原体相关并发症的发生率低于预期。纳入初级保健中诊断的盆腔炎数据和行为危险因素的研究将进一步提高我们对衣原体自然史的了解。我们的结果让患者放心，但意味着衣原体筛查计划的好处可能被高估了。
Objective: To estimate the cumulative incidence of severe complications associated with genital chlamydia infection in the general female population.Methods: The Uppsala Women's Cohort Study was a retrospective population based cohort study in Sweden, linking laboratory, hospital, and population registers. We estimated the cumulative incidence of hospital diagnosed pelvic inflammatory disease, ectopic pregnancy, and infertility, and used multivariable regression models to estimate hazard ratios according to screening status.Results: We analysed complete data from 43 715 women in Uppsala aged 15 - 24 years between January 1985 and December 1989. Follow up until the end of 1999 included 709 000 woman years and 3025 events. The cumulative incidence of pelvic inflammatory disease by age 35 years was 3.9% (95% CI 3.7% to 4.0%) overall: 5.6% (4.7% to 6.7%) in women who ever tested positive for chlamydia, 4.0% ( 3.7% to 4.4%) in those with negative tests, and 2.9% (2.7% to 3.2%) in those who were never screened. The corresponding figures were: for ectopic pregnancy, 2.3% (2.2% to 2.5%) overall, 2.7% (2.1% to 3.5%), 2.0% (1.8% to 2.3%), and 1.9% (1.7% to 2.1%); and for infertility, 4.1% (3.9% to 4.3%) overall, 6.7% (5.7% to 7.9%), 4.7% (4.4% to 5.1%), and 3.1% (2.8% to 3.3%). Low educational attainment was strongly associated with the development of all outcomes.Conclusions: The incidence of severe chlamydia associated complications estimated from ours, and other population based studies, was lower than expected. Studies that incorporate data about pelvic inflammatory disease diagnosed in primary care and behavioural risk factors would further improve our understanding of the natural history of chlamydia. Our results provide reassurance for patients, but mean that the benefits of chlamydia screening programmes might have been overestimated.