Patel H C, Goh B T, Viswalingam N D, Treharne J D
Diagnostic Clinic, Moorfields Eye Hospital, London, UK.
Genitourin Med. 1995 Apr;71(2):94-7. doi: 10.1136/sti.71.2.94.
To study: (a) the chlamydial antibody response (to the D-K serovars) using the micro-immunofluorescence (micro-IF) test in the following groups: (I) chlamydial genital infection only, (II) chlamydial ocular infection only, (III) combined chlamydial ocular and genital infection (oculo-genital infection), (IV) chlamydial ocular infection with chlamydia-negative non-gonococcal urethritis, (V) adenovirus conjunctivitis (control group 1), (VI) male partners of group I-IV with no chlamydial oculogenital infection or non-gonococcal urethritis (control group 2) (b) the cross reactivity of antibodies in patients' sera between the three chlamydial species and within the serovars of C trachomatis in those with culture-positive chlamydial oculo-genital infection.
oculogenital (diagnostic) clinic at Moorfields Eye Hospital, London, UK.
209 consecutive patients attending the clinic with Chlamydia trachomatis oculogenital infection and 86 patients with adenovirus conjunctivitis (control group 1) and 55 male partners with no evidence of chlamydial oculogenital infection or non-gonococcal urethritis (control group 2).
Of all the patients with proven chlamydial oculogenital infection, 10.5% (22/209) and 94% (197/209) had IgM and IgG antibodies respectively. The geometric mean IgG antibody titres (GMT) were 1:98, 1:123, 1:245 and 1:101 in groups I to IV respectively. The IgG GMT values seen in control groups 1 and 2 were 1:45 and 1:36 respectively. Only 2/86(2%) patients in group V (control group 1) had IgG chlamydial antibodies of 1:32 and 1:64, whilst only 1/55(1.8%) and 4/55(7.3%) of patients in group VI(control group 2) had chlamydial IgG antibody titres of > or = 1:256 and > or = 1:128 respectively. A four-fold rise or fall in IgG antibody titre occurred in 56%(107/192) of patient groups I-IV over 2-6 weeks. Low titre cross-reactive antibody responses against different chlamydial species and serovars were commonly seen; 71%(148/209) of all patients showed cross-reactivity with Chlamydia pneumoniae or psittaci species or both, whilst 92% (193/209) of patients showed some level of cross reactivity to other pooled serovars of C trachomatis (A-C and L 1-3).
Serological diagnosis of chlamydial infection as evidenced by a positive IgM antibody response, high IgG titre (> or = 1:256) or > or = 4-fold rise or fall in IgG antibody titre was seen in 78%(163/209) of patients with culture-positive chlamydial oculogenital infection. Chlamydial IgG antibody titres of > or = 1:256 had a sensitivity of 42.6%, specificity of 98.2%, positive predictive value of 98.8% and a negative predictive value of 31% for chlamydial infection at any site, when considering groups I-IV and control group 2. In this study of 216 patients with conjunctivitis, a positive IgG antibody response (titre > or = 1:16) had a sensitivity of 98.5%, specificity of 97.7%, positive predictive value of 98.5% and a negative predictive value of 97.7%, for chlamydial conjunctivitis. Patients with dual chlamydial infection of conjunctiva and genital tract had a higher IgG GMT titre than those with ocular or genital infection alone: infection at a second site may produce an anamnestic response. Although the micro-IF test is a useful adjunct for the diagnosis of chlamydial infection, cross-reactivity between different chlamydial species and serovars is common. Chlamydial seroepidemiological studies should be interpreted with caution, as studies may attribute a serological response to a particular species or serovar in a setting where two or more are prevalent.
研究：(a) 使用微量免疫荧光（micro-IF）试验检测以下几组人群对衣原体（D-K血清型）的抗体反应：(I) 仅衣原体性生殖器感染；(II) 仅衣原体性眼部感染；(III) 衣原体性眼部和生殖器合并感染（眼-生殖器感染）；(IV) 衣原体性眼部感染合并衣原体阴性的非淋菌性尿道炎；(V) 腺病毒结膜炎（对照组1）；(VI) I-IV组无衣原体性眼-生殖器感染或非淋菌性尿道炎的男性伴侣（对照组2）。(b) 在衣原体培养阳性的眼-生殖器感染患者中，研究患者血清中三种衣原体物种之间以及沙眼衣原体血清型内抗体的交叉反应性。
英国伦敦摩尔菲尔德眼科医院的眼-生殖器（诊断）门诊。
209例连续就诊于该门诊的沙眼衣原体眼-生殖器感染患者、86例腺病毒结膜炎患者（对照组1）以及55例无衣原体性眼-生殖器感染或非淋菌性尿道炎证据的男性伴侣（对照组2）。
在所有经证实的衣原体性眼-生殖器感染患者中，分别有10.5%（22/209）和94%（197/209）的患者有IgM和IgG抗体。I至IV组的IgG抗体几何平均滴度（GMT）分别为1:98、1:123、1:245和1:101。对照组1和2的IgG GMT值分别为1:45和1:36。V组（对照组1）中仅2/86（2%）的患者有滴度为1:32和1:64的衣原体IgG抗体，而VI组（对照组2）中仅1/55（1.8%）和4/55（7.3%）的患者衣原体IgG抗体滴度分别≥1:256和≥1:128。I-IV组56%（107/192）的患者在2至6周内IgG抗体滴度有4倍的升高或降低。常见针对不同衣原体物种和血清型的低滴度交叉反应性抗体反应；所有患者中有71%（148/209）与肺炎衣原体或鹦鹉热衣原体物种或两者均有交叉反应，而92%（193/209）的患者对沙眼衣原体的其他合并血清型（A-C和L1-3）有一定程度的交叉反应。
在衣原体培养阳性的眼-生殖器感染患者中，78%（163/209）的患者出现了IgM抗体反应阳性、高IgG滴度（≥1:256）或IgG抗体滴度≥4倍升高或降低所证实的衣原体感染血清学诊断。当考虑I-IV组和对照组2时，IgG抗体滴度≥1:256对任何部位衣原体感染的敏感性为42.6%，特异性为98.2%，阳性预测值为98.8%，阴性预测值为31%。在这项对216例结膜炎患者的研究中，IgG抗体反应阳性（滴度≥1:16）对衣原体性结膜炎的敏感性为98.5%，特异性为97.7%，阳性预测值为98.5%，阴性预测值为97.7%。结膜和生殖道双重衣原体感染的患者比仅眼部或生殖器感染的患者有更高的IgG GMT滴度：第二个部位的感染可能产生回忆反应。虽然微量免疫荧光试验是诊断衣原体感染的有用辅助手段，但不同衣原体物种和血清型之间的交叉反应很常见。衣原体血清流行病学研究的解释应谨慎，因为在两种或更多种衣原体流行的情况下，研究可能将血清学反应归因于特定的物种或血清型。
