Taylor-Robinson D
Department of Genitourinary Medicine and Communicable Diseases, Imperial College School of Medicine at St Mary's, Paddington, London, UK.
Hum Reprod. 1997 Nov;12(11 Suppl):113-20.
Infection with Chlamydia trachomatis results in intracytoplasmic inclusions and the generation of infectious elementary bodies (EBs). These can be detected by various procedures. Staining of epithelial cells with vital dyes was first used to detect inclusions, but is insensitive. Thus, Papanicolaou-stained cervical smears cannot be recommended. The advent of the ability to grow chlamydiae in cultured cells over 30 years ago had a major impact on chlamydial research and on detection. However, this procedure is probably <70% sensitive for cervical infection and less for urethral infection in men and is now practised infrequently following the advent of other, mostly less laborious and often equally, or more sensitive detection systems. Thus, staining a smear with a specific fluorescent monoclonal antibody to detect EBs is simple and the direct fluorescent antibody tests became a commercial proposition in the early to mid-1980s. Nevertheless, although highly sensitive and specific in competent hands, technical expertise is crucial and even the most experienced may be unable to read a large number of stained smears on slides quickly. In view of this, it is understandable that enzyme-linked immunosorbent assays (ELISAs) gained popularity from the mid-1980s onwards, for they are not very labour intensive and their reading is neither subjective nor tedious. Unfortunately, these aspects outweighed the fact that the ELISAs lack sensitivity, some being very insensitive. The situation has been rescued, however, by the advent in the early 1990s of methods that amplify chlamydial DNA, making it easily detectable by relatively simple procedures. The polymerase chain reaction is such a method and has high specificity and sensitivity, although commercial development has so far not met the high standard expected of it in terms of sensitivity. The ligase chain reaction does not invoke such criticism, and high values for both sensitivity and specificity may be expected, even on urine samples. This augers well for diagnosing an infected individual patient and for effective screening programmes. Antibody tests have no place in a screening programme and are of debatable value in diagnosis.
沙眼衣原体感染会导致胞质内包涵体的形成以及感染性原体（EBs）的产生。这些可以通过各种方法检测到。最初使用活体染料对上皮细胞进行染色来检测包涵体，但这种方法不敏感。因此，不推荐使用巴氏染色的宫颈涂片。30多年前在培养细胞中培养衣原体能力的出现，对衣原体研究和检测产生了重大影响。然而，该方法对宫颈感染的敏感性可能低于70%，对男性尿道感染的敏感性更低，并且在其他大多不那么费力且通常同样敏感或更敏感的检测系统出现后，现在很少使用。因此，用特异性荧光单克隆抗体对涂片进行染色以检测原体很简单，直接荧光抗体检测在20世纪80年代初至中期成为一种商业产品。然而，尽管在技术熟练的人手中具有高敏感性和特异性，但技术专长至关重要，即使是最有经验的人也可能无法快速读取大量载玻片上的染色涂片。鉴于此，酶联免疫吸附测定（ELISA）从20世纪80年代中期开始受到欢迎就可以理解了，因为它们劳动强度不大，而且读数既不主观也不繁琐。不幸的是，这些方面超过了ELISA缺乏敏感性这一事实，有些ELISA非常不敏感。然而，20世纪90年代初出现的扩增衣原体DNA的方法挽救了这种局面，使得通过相对简单的程序就可以轻松检测到它。聚合酶链反应就是这样一种方法，具有高特异性和敏感性，尽管到目前为止商业开发在敏感性方面尚未达到预期的高标准。连接酶链反应没有受到这样的批评，预计其敏感性和特异性都很高，即使对尿液样本也是如此。这对于诊断个体感染患者和有效的筛查计划来说是个好兆头。抗体检测在筛查计划中没有作用，在诊断中的价值也存在争议。
