Mabey D C, Robertson J N, Ward M E
Medical Research Council Laboratories, The Gambia.
Lancet. 1987 Dec 26;2(8574):1491-2. doi: 10.1016/s0140-6736(87)92623-7.
Trachoma control necessitates identification of individuals shedding ocular chlamydiae. Conventional techniques of chlamydial culture are unsuitable for large field surveys in developing countries. In this study an enzyme immunoassay (EIA) developed for the detection of chlamydial antigen in genital-tract infection was used in trachoma. Conjunctival swabs were taken for chlamydial antigen detection from 1225 subjects in a Gambian village with endemic trachoma. Of these, 997 had insignificant or no disease and 172 had mild, 30 moderate, and 26 severe disease. Chlamydial antigen was detected in 5.0%, 20.3%, 46.7%, and 26.9% of subjects in these four categories, respectively. Samples for chlamydial isolation were obtained from 259 subjects. The corresponding rates of detection obtained by chlamydial isolation were 3/90 (3.3%), 16/129 (12.4%), 7/21 (33.3%), and 7/19 (36.8%). If isolation is taken as the "gold standard", the EIA technique had a sensitivity of 70.6% and a specificity of 90%. A substantial proportion of subjects with severe conjunctival scarring, from whom chlamydiae cannot generally be isolated, were antigen positive by EIA, implying that persistent chlamydial antigen plays a part in the pathogenesis of the late sequelae of trachoma.
沙眼防治需要识别眼部衣原体感染的个体。传统的衣原体培养技术不适用于发展中国家的大规模现场调查。在本研究中，一种用于检测生殖道感染中衣原体抗原的酶免疫测定法（EIA）被应用于沙眼检测。从冈比亚一个沙眼流行村庄的1225名受试者中采集结膜拭子以检测衣原体抗原。其中，997人无明显疾病或未患病，172人患有轻度疾病，30人患有中度疾病，26人患有重度疾病。这四类受试者中衣原体抗原的检测率分别为5.0%、20.3%、46.7%和26.9%。从259名受试者中获取了用于衣原体分离的样本。通过衣原体分离获得的相应检测率分别为3/90（3.3%）、16/129（12.4%）、7/21（33.3%）和7/19（36.8%）。如果将分离作为“金标准”，EIA技术的敏感性为70.6%，特异性为90%。相当一部分有严重结膜瘢痕形成且通常无法分离出衣原体的受试者，通过EIA检测抗原呈阳性，这意味着持续存在的衣原体抗原在沙眼晚期后遗症的发病机制中起作用。
