Decreased occurrence of endometriosis in women with Chlamydia trachomatis infection
Decreased occurrence of endometriosis in women with Chlamydia trachomatis infection
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沙眼衣原体感染女性子宫内膜异位症的发生率降低
DOI：
10.1111/aji.13498
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发表时间：
2021
影响因子：
3.6
通讯作者：
Kitawaki Jo
中科院分区：
文献类型：
--
作者：
Khan Khaleque N.;Fujishita Akira;Kitajima Michio;Ishimaru Tadayuki;Ogawa Kanae;Koshiba Akemi;Mori Taisuke;Kitawaki Jo
问题尽管有大量关于子宫流出道梗阻在子宫内膜异位症中的危险作用的报道，但关于沙眼衣原体感染导致输卵管梗阻的妇女发生子宫内膜异位症的信息尚不清楚。我们调查了沙眼衣原体感染与输卵管通畅与否在子宫内膜异位症的发生中的作用。MethodsThis是一项回顾性病例对照队列研究，共有539名妇女在2003年1月至2010年6月期间因多种适应症接受了腹腔镜手术。排除异位妊娠、子宫异常、染色体异常、原发性闭经和围绝经期妇女。子宫内膜异位症经腹腔镜检查确诊，并经组织病理学证实。输卵管通畅性诊断采用HSG或腹腔镜彩色输卵管通液试验。衣原体感染的存在进行了检查，通过RT‐PCR和血清学test.ResultsTwo‐ 7名妇女入组。86名（41.5%）女性有衣原体感染。与无衣原体感染的女性相比，衣原体感染的女性输卵管通畅率和子宫内膜异位症的发生率显著降低（分别为P= 0.005和P = 0.0008）。即使在输卵管通畅的女性中，衣原体感染的子宫内膜异位症腹腔镜检测率也显著低于非感染女性（P= 0.02）。多元Logistic回归模型显示，衣原体感染史可显著降低子宫内膜异位症的发生率，且与年龄、月经状况、产次和输卵管通畅无关（比值比0.44; 95%可信区间0.24 - 0.80;P= 0.007）。衣原体感染的输卵管损伤可能会损害逆行月经，这可能会降低子宫内膜异位症的风险。
ProblemDespite abundant reports on the risk role of uterine outflow tract obstruction in endometriosis, information on the occurrence of endometriosis in women withChlamydia trachomatisinfection causing fallopian tube obstruction is unknown. We investigated the role ofChlamydia trachomatisinfection with or without fallopian tubal patency in the occurrence of endometriosis.MethodsThis is a retrospective case‐controlled cohort study with 539 women who had laparoscopic surgery for several indications during the period between January, 2003 and June, 2010. Women with ectopic pregnancy, uterine anomaly, chromosomal abnormality, primary amenorrhea, and perimenopausal women were excluded. Endometriosis was diagnosed by laparoscopic inspection and confirmed by histopathology. Tubal patency was diagnosed by HSG or laparoscopic chromopertubation test. Presence of chlamydia infection was examined by RT‐PCR and serological test.ResultsTwo‐hundred and seven women were enrolled. Eighty‐six (41.5%) women had chlamydia infection. Tubal patency and occurrence of endometriosis were significantly decreased among women with chlamydia infection comparing to women without it (P= .005 andP= .0008, respectively). Even among women with patent tube, laparoscopic detection of endometriosis was significantly decreased in chlamydia infected comparing to non‐infected women (P= .02). Multiple logistic regression model revealed that previous history of chlamydia infection significantly decreased the occurrence of endometriosis, and was independent of age, menstrual status, parity and tubal patency (odds ratio .44; 95% confidence interval .24–.80;P= .007).ConclusionA decreased occurrence of peritoneal endometriosis was observed in women withChlamydia trachomatisinfection. The possible impairment of retrograde menstrual flow by chlamydia‐infected tubal damage may decrease the risk of endometriosis.