披衣菌感染測試應優先測試於懷疑輸卵管病變病患

懷疑輸卵管病變之病患，披衣菌感染測試應比輸卵管攝影優先測試

http://humrep.oxfordjournals.org/content/23/8/1840.full

Screening strategies for tubal factor subfertility

1. J.E. den Hartog1,5, 
2. C.M.J.G. Lardenoije1, 
3. J.L. Severens2,3, 
4. J.A. Land1,4,
5. J.L.H. Evers1 and 
6. A.G.H. Kessels2

+Author Affiliations

1. ¹Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
2. ²Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
3. ³Care and Public Health Research Institute (CAPHRI), Department of Health Organization, Policy and Economics, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
4. ⁴Present address: Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

1. 5Correspondence address. E-mail: je_denhartog@hotmail.com

• Received August 6, 2007.
• Revision received March 25, 2008.
• Accepted May 26, 2008.

 

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Abstract

BACKGROUND Different screening strategies exist to estimate the risk of tubal factor subfertility, preceding laparoscopy. Three screening strategies, comprising Chlamydia trachomatis IgG antibody testing (CAT), high-sensitivity C-reactive protein (hs-CRP) testing and hysterosalpingography (HSG), were explored using laparoscopy as reference standard and the occurrence of a spontaneous pregnancy as a surrogate marker for the absence of tubal pathology.

METHODS In this observational study, 642 subfertile women, who underwent tubal testing, participated. Data on serological testing, HSG, laparoscopy and interval conception were collected. Multiple imputations were used to compensate for missing data.

RESULTS Strategy A (HSG) has limited value in estimating the risk of tubal pathology. Strategy B (CAT→HSG) shows that CAT significantly discerns patients with a high versus low risk of tubal pathology, whereas HSG following CAT has no additional value. Strategy C (CAT→hs-CRP→HSG) demonstrates that hs-CRP may be valuable in CAT-positive patients only and HSG has no additional value.

CONCLUSIONS CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.