Neuer A, Lam K N, Tiller F W, Kiesel L, Witkin S S
Department of Obstetrics and Gynecology, Cornell University Medical College, New York, NY 10021, USA.
Hum Reprod. 1997 May;12(5):925-9. doi: 10.1093/humrep/12.5.925.
Recent evidence suggests that Chlamydia trachomatis can persist in the female upper genital tract in an unculturable state. Since unsuspected C. trachomatis infection has been associated with adverse in-vitro fertilization (IVF) outcome we sought to detect further evidence of C. trachomatis in the genital tracts of women undergoing IVF. The prevalence and distribution of antibodies to the major structural proteins of C. trachomatis in paired follicular fluid and sera of women undergoing IVF were examined. Sera and follicular fluid samples from 149 women were assayed for immunoglobulin (Ig)G and IgA antibodies to two C. trachomatis antigens, the major outer membrane protein (MOMP) and a recombinant lipopolysaccharide (rLPS) fragment. Additionally, the expression of human 60 kDa heat shock protein (hsp 60) in follicular fluid was determined. All cervical and follicular fluid samples were negative for C. trachomatis by polymerase chain reaction, ligase chain reaction and DNA probe. Sera from 60% of the subjects were positive for antichlamydial rLPS IgG; 36% were positive for anti-MOMP IgG. Similarly, rLPS-directed and MOMP-directed IgA were detected in sera of 34 and 14% of the subjects respectively. IgG antibodies to MOMP and rLPS were detected in 42 and 41% of the follicular fluid examined respectively. Anti-MOMP IgA was identified in 8.7% of the follicular fluid while 27.5% were positive for anti-rLPS IgA. Human hsp 60 expression was documented in 11.6% of the follicular fluid tested. IgA antibodies to both MOMP (P = 0.03) and rLPS (P = 0.02) in follicular fluid were associated with a failure to become pregnant after embryo transfer. IgG antibodies in sera and follicular fluid and IgA antibodies in sera were unrelated to IVF outcome. Similarly only anti-MOMP IgA (P = 0.02) and anti-rLPS IgA (P = 0.04) in follicular fluid were correlated with human hsp 60 expression in follicular fluid. The unique association between IgA antibodies to two chlamydial antigens in follicular fluid and both hsp 60 expression and IVF failure provides further support for the possibility that a persistent upper genital tract chlamydial infection contributes to IVF failure in some women.
近期证据表明，沙眼衣原体能够以不可培养的状态在女性上生殖道持续存在。由于未被察觉的沙眼衣原体感染与体外受精（IVF）不良结局相关，我们试图探寻接受IVF治疗的女性生殖道中存在沙眼衣原体的更多证据。检测了接受IVF治疗女性的配对卵泡液和血清中针对沙眼衣原体主要结构蛋白的抗体的患病率和分布情况。对149名女性的血清和卵泡液样本检测了针对两种沙眼衣原体抗原，即主要外膜蛋白（MOMP）和重组脂多糖（rLPS）片段的免疫球蛋白（Ig）G和IgA抗体。此外，还测定了卵泡液中人类60 kDa热休克蛋白（hsp 60）的表达情况。通过聚合酶链反应、连接酶链反应和DNA探针检测，所有宫颈和卵泡液样本的沙眼衣原体均为阴性。60%受试者的血清抗衣原体rLPS IgG呈阳性；36%的抗MOMP IgG呈阳性。同样，分别在34%和14%受试者的血清中检测到了针对rLPS和MOMP的IgA。在所检测卵泡液中，分别有42%和41%检测到了针对MOMP和rLPS的IgG抗体。8.7%的卵泡液中鉴定出抗MOMP IgA，而27.5%的卵泡液抗rLPS IgA呈阳性。在所检测的卵泡液中，11.6%记录到了人类hsp 60的表达。卵泡液中针对MOMP（P = 0.03）和rLPS（P = 0.02）的IgA抗体与胚胎移植后未受孕相关。血清和卵泡液中的IgG抗体以及血清中的IgA抗体与IVF结局无关。同样，仅卵泡液中的抗MOMP IgA（P = 0.02）和抗rLPS IgA（P = 0.04）与卵泡液中人类hsp 60的表达相关。卵泡液中针对两种衣原体抗原的IgA抗体与hsp 60表达及IVF失败之间的独特关联，进一步支持了持续性上生殖道衣原体感染在某些女性中导致IVF失败的可能性。
