Gaydos C A, Roblin P M, Hammerschlag M R, Hyman C L, Eiden J J, Schachter J, Quinn T C
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Clin Microbiol. 1994 Apr;32(4):903-5. doi: 10.1128/jcm.32.4.903-905.1994.
To assess the utility of PCR-enzyme immunoassay (EIA) for diagnosis of acute infection with Chlamydia pneumoniae, we compared tissue culture, PCR-EIA, direct fluorescent-antibody (DFA) stain, and serology in studies with 56 patients with respiratory symptoms and 80 asymptomatic persons. Thirty-five patients were positive by either culture or PCR-EIA, and 101 were negative by both assays. Thirty specimens from symptomatic patients and one from an asymptomatic patient were culture positive; 23 of these were also PCR-EIA positive. Of the eight culture-positive, PCR-EIA-negative specimens, five were DFA negative and three were DFA positive. Four additional specimens were culture negative and PCR-EIA positive; of these, three were DFA positive and one was DFA negative. When we used culture- and/or DFA-positive results as a reference or "gold standard," the sensitivity and specificity of PCR were 76.5 and 99.0%, respectively. When we used PCR- and/or DFA-positive results as the reference, the sensitivity of culture was 87.5%. On the basis of single acute serum specimens, only 8 of these 35 patients had diagnostic antibody titers. Of the asymptomatic patients, 75% had immunoglobulin G or immunoglobulin M antibody to C. pneumoniae; 15 (18.8%) of these had antibody levels considered to be diagnostic of acute infection. This multicenter study indicates that culture and/or PCR-EIA is more reliable for prompt diagnosis of C. pneumoniae infection than single-point serology alone.
为评估聚合酶链反应-酶免疫测定（PCR-EIA）用于诊断肺炎衣原体急性感染的效用，我们在对56例有呼吸道症状的患者和80例无症状者的研究中，比较了组织培养、PCR-EIA、直接荧光抗体（DFA）染色和血清学检测方法。35例患者通过培养或PCR-EIA检测呈阳性，101例通过两种检测均为阴性。30份有症状患者的标本和1份无症状患者的标本培养呈阳性；其中23份PCR-EIA检测也呈阳性。在8份培养阳性但PCR-EIA阴性的标本中，5份DFA检测为阴性，3份DFA检测为阳性。另有4份标本培养阴性但PCR-EIA阳性；其中3份DFA检测为阳性，1份DFA检测为阴性。当我们将培养和/或DFA阳性结果作为参考或“金标准”时，PCR的敏感性和特异性分别为76.5%和99.0%。当我们将PCR和/或DFA阳性结果作为参考时，培养的敏感性为87.5%。基于单次急性血清标本，这35例患者中只有8例具有诊断性抗体滴度。在无症状患者中，75%有抗肺炎衣原体免疫球蛋白G或免疫球蛋白M抗体；其中15例（18.8%）的抗体水平被认为可诊断急性感染。这项多中心研究表明，对于肺炎衣原体感染的快速诊断，培养和/或PCR-EIA比单独的单点血清学检测更可靠。
