Chernesky M, Luinstra K, Sellors J, Schachter J, Moncada J, Caul O, Paul I, Mikaelian L, Toye B, Paavonen J, Mahony J
Medical Microbiology Services, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Sex Transm Dis. 1998 Jan;25(1):14-9. doi: 10.1097/00007435-199801000-00004.
Upper genital tract chlamydial infections in women are on the increase, and serology might be a convenient tool for diagnosis. Evaluations of this approach are needed in women with or without microbiologic evidence of organisms in the upper genital tract.
To compare the results of antibody assays with cervical culture and upper genital tract histopathology in women with pelvic pain and chlamydial plasmid DNA in endometrial biopsies.
Chlamydia trachomatis plasmid DNA was detected by polymerase chain reaction (PCR) on extracted deparaffinized endometrial biopsy tissue. Five antichlamydial antibody assays were performed measuring total antibodies or immunoglobulin G (IgG), IgM, and IgA classes on sera from 14 women with plasmid DNA as well as 31 without plasmid DNA.
Accepting the presence of plasmid DNA as the gold standard, no single test had total diagnostic accuracy. The best sensitivity and specificity occurred with the following assays: whole inclusion fluorescence (WIF) (100% and 80.6%); microimmunofluorescence IgM (MIF IgM) (78.6% and 93.6%); and heatshock protein-60 enzyme immunoassay (42.9% and 100%). Although recombinant anti-lipopolysaccharide enzyme-linked immunosorbent assays measured anti-chlamydial antibodies in a large proportion of these women, specificity was low. The sensitivity and specificity of cervical culture was 28.6% and 100% and of endometrial histopathology was 71.4% and 48.4%. Analysis of patient serological profiles suggested that and 6 women without plasmid DNA may have been cases that were missed by PCR.
Evaluations of assays to diagnosis Chlamydia trachomatis upper genital tract infections could use the presence of organisms or their markers in the upper genital tract as a standard of comparison. Some of these serological assays, such as WIF or MIF IgM, may be helpful in diagnosis, but more studies are needed.
女性上生殖道衣原体感染呈上升趋势，血清学可能是一种便捷的诊断工具。对于有或无上生殖道微生物证据的女性，都需要对这种方法进行评估。
比较抗体检测结果与宫颈培养及上生殖道组织病理学结果，这些女性有盆腔疼痛且子宫内膜活检中有衣原体质粒DNA。
通过聚合酶链反应（PCR）在提取的脱蜡子宫内膜活检组织上检测沙眼衣原体质粒DNA。对14例有质粒DNA以及31例无质粒DNA的女性血清进行了5种抗衣原体抗体检测，测量总抗体或免疫球蛋白G（IgG）、IgM和IgA类别。
以质粒DNA的存在作为金标准，没有单一检测具有完全的诊断准确性。以下检测具有最佳的敏感性和特异性：全包涵体荧光法（WIF）（100%和80.6%）；微量免疫荧光IgM法（MIF IgM）（78.6%和93.6%）；热休克蛋白60酶免疫法（42.9%和100%）。尽管重组抗脂多糖酶联免疫吸附测定法在这些女性中的很大一部分中检测到了抗衣原体抗体，但其特异性较低。宫颈培养的敏感性和特异性分别为28.6%和100%，子宫内膜组织病理学的敏感性和特异性分别为71.4%和48.4%。对患者血清学特征的分析表明，6例无质粒DNA的女性可能是PCR漏诊的病例。
对诊断沙眼衣原体上生殖道感染的检测进行评估时，可以以上生殖道中病原体或其标志物的存在作为比较标准。其中一些血清学检测，如WIF或MIF IgM，可能有助于诊断，但还需要更多的研究。
