解脲支原体、沙眼衣原体感染与输卵管性不孕相关性研究

Study on the correlation of Ureaplasma urealyticum and Chlamydia trachomatis infection with tubal infertility

目的探讨解脲支原体(UU)、沙眼衣原体(CT)感染情况与生殖道微环境改变及不孕的临床关系。方法收集2018年7月至2019年5月于中山大学附属第七医院生殖医学中心门诊诊治的输卵管性不孕症患者85例为不孕组,均经超声检查及子宫输卵管造影(HSG)显示宫腔大小形态正常,一侧或双侧输卵管完全或者不完全阻塞,同时排除其他因素导致的不孕;对照组为同期就诊、既往无妊娠史、HSG未见明显输卵管异常的正常备孕妇女45例,收集阴道分泌物及宫颈分泌物检测阴道清洁度和UU、CT感染情况。结果不孕组阴道清洁度Ⅲ~Ⅳ度患者(18.82%)多于对照组(4.4%)(P<0.05)。不孕组CT(18.82%)、UU(38.82%)、CT+UU(15.29%)及总感染率(72.94%)均高于对照组(4.44%、8.89%、2.22%、15.56%),差异有统计学意义(P均<0.01)。多因素Logistic回归分析,显示输卵管性不孕与CT、UU、CT+UU感染均密切相关(CT:P=0.046,OR=3.291;UU:P=0.025,OR=2.789;CT+UU:P=0.017,OR=7.528)。结论 CT、UU感染与输卵管性不孕有关,有必要对育龄妇女,特别是不孕妇女进行筛查,以厘清这些病原体与生育能力受损和不良妊娠结局之间的关系。

Objective To investigate the relationship of Ureaplasma urealyticum(UU)and Chlamydia trachomatis(CT)infections with reproductive tract microenvironment changes and clinical infertility.Methods From July 2018 to May2019,85 cases of tubal infertility were collected as the infertility group from the Outpatient Department of Reproductive Medicine Center,the Seventh Affiliated Hospital of Sun Yat-sen University.The ultrasonography and hysterosalpingography(HSG)showed normal size and shape of uterine cavity,and complete or incomplete obstruction of one or both fallopian tubes;infertility caused by other factors was excluded. The control group consisted of 45 normal women during the same period who had no previous pregnancy history and HSG showed no obvious abnormal fallopian tube. Vaginal and cervical secretions were collected to detect vaginal cleanliness and UU and CT infection.Results The vaginal cleanliness(Ⅲ-Ⅳ)of infertility group(18.82%)was more than that of control group(4.4%)(P<0.05).CT(18.82%),U(38.82%),CT+UU(15.29%)and total infection rates(72.94%)in infertility group were higher than those in control group(4.44%,8.89%,2.22% and 15.56%). The difference was statistically significant(P<0.01). Multivariate logistic regression analysis showed that tubal infertility was closely related to CT,UU and CT+UU infection(CT:P=0.046,OR=3.291;UU:P=0.025,OR=2.789;CT+UU:P=0.017,OR=7.528).Conclusion CT and UU infections are strongly associated with tubal infertility. It is necessary to screen all women at childbearing age,especially infertile women,in order to clarify the relationship between these pathogens and impaired fertility and adverse pregnancy outcomes.