背景:沙眼衣原体感染可在高危人群中造成重大疾病负担。本研究旨在评估沙眼衣原体感染的总体患病率。并确定中国女性性工作者(FSW)和男男性行为者(MSM)中这种感染的长期趋势和地理分布。
方法:PubMed,WebofScience,CNKI,从1990年1月1日至2023年4月30日搜索了万方数据和VIP数据库。包括使用核酸扩增试验(NAAT)检测沙眼衣原体感染的出版物。Q检验和I2统计量用于评估研究之间的异质性。使用随机效应模型来估计沙眼衣原体感染的合并患病率。子组,元回归,并进行敏感性分析以探索异质性的来源。使用Egger测试评估发布偏差。使用Jonckheere-Terpstra趋势检验方法对患病率进行趋势分析。
结果:61项研究符合纳入条件(包括38项FSW和23项MSM)。FSW中沙眼衣原体感染的合并患病率为19.5%(95%CI:16.4,23.0),直肠中为12.7%(95%CI:9.2,17.7),在中国,MSM的尿道占6.4%(95%CI:5.3,7.8),口咽占1.3%(95%CI:0.8,2.1)。亚组分析表明,样本量,学习期间,研究区域,标本采集类型,分子诊断方法,招募网站可以解释FSW研究之间的一些异质性,和出版语言,学习期间,研究区域,分子诊断方法,标本采集解剖部位可以解释MSM研究之间的一些异质性。从1998年至2004年,2005年至2009年,2010年至2015年和2016年至2021年,FSW中沙眼衣原体感染的合并患病率为30.3%,19.9%,21.4%,和11.3%,分别。对于MSM,2003年至2009年、2010年至2015年和2016年至2022年的合并患病率为7.8%,4.7%,和6.5%,分别。然而,在中国,FSWs(z=-1.51,P=0.13)或MSM(z=-0.71,P=0.48)中沙眼衣原体感染的患病率没有总体下降.
结论:在中国这两个高危人群中,沙眼衣原体感染的患病率很高。这项研究的结果为在这两个特定人群中预防和控制沙眼衣原体感染的有效监测和筛查策略的制定提供了证据。
BACKGROUND: Chlamydia trachomatis infection can cause a significant disease burden in high-risk populations. This study aimed to assess the overall prevalence of C. trachomatis infection, and determine the long-term trends and geographic distribution of this infection among female sex workers (FSWs) and men who have sex with men (MSM) in China.
METHODS: The PubMed, Web of Science, CNKI, Wanfang Data and VIP databases were searched from 1 January 1990 through 30 April 2023. Publications in which C. trachomatis infection was detected using nucleic acid amplification tests (NAATs) were included. The Q test and I2 statistics were used to assess the heterogeneity between studies. A random-effect model was used to estimate the pooled prevalence of C. trachomatis infection. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. Publication bias was evaluated using Egger\'s test. Trend analysis of the prevalence was performed using the Jonckheere-Terpstra trend test method.
RESULTS: Sixty-one studies were eligible for inclusion (including 38 for FSWs and 23 for MSM). The pooled prevalence of C. trachomatis infection was 19.5% (95% CI: 16.4, 23.0) among FSWs and 12.7% (95% CI: 9.2, 17.7) in the rectum, 6.4% (95% CI: 5.3, 7.8) in the urethra and 1.3% (95% CI: 0.8, 2.1) in the oropharynx from MSM in China. The subgroup analyses showed that the sample size, study period, study region, specimen collection type, molecular diagnosis method, and recruitment site could explain some heterogeneity among studies of FSWs, and the publication language, study period, study region, molecular diagnosis method, and specimen collection anatomical site could explain some heterogeneity among studies of MSM. From 1998 to 2004, 2005 to 2009, 2010 to 2015, and 2016 to 2021, the pooled prevalence of C. trachomatis infection among FSWs were 30.3%, 19.9%, 21.4%, and 11.3%, respectively. For MSM, the pooled prevalence from 2003 to 2009, 2010 to 2015, and 2016 to 2022 were 7.8%, 4.7%, and 6.5%, respectively. However, no overall decline in the prevalence of C. trachomatis infection was observed among FSWs (z = -1.51, P = 0.13) or MSM (z = -0.71, P = 0.48) in China.
CONCLUSIONS: The prevalence of C. trachomatis infection was high in these two high-risk populations in China. The findings of this study provide evidence for the formulation of effective surveillance and screening strategies for the prevention and control of C. trachomatis infection among these two specific populations.