LOCALIZATION OF CHLAMYDIA-TRACHOMATIS INFECTION BY DIRECT IMMUNOFLUORESCENCE AND CULTURE IN PELVIC INFLAMMATORY DISEASE
LOCALIZATION OF CHLAMYDIA-TRACHOMATIS INFECTION BY DIRECT IMMUNOFLUORESCENCE AND CULTURE IN PELVIC INFLAMMATORY DISEASE
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DOI：
10.1016/0002-9378(86)90473-4
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发表时间：
1986-04-01
影响因子：
9.8
通讯作者：
HOLMES, KK
中科院分区：
文献类型：
--
作者：
KIVIAT, NB;WOLNERHANSSEN, P;HOLMES, KK
55名疑似盆腔炎的妇女进行了诊断性腹腔镜检查和子宫内膜和输卵管活检，并从尿道、直肠、宫颈内膜、子宫内膜、输卵管和死囊处获得沙眼原体分离标本和沙眼原体单克隆荧光素偶联抗体染色标本。从21例（38%）患者中分离出沙眼衣原体，其中10例（18%）子宫内膜或输卵管培养阳性。50例培养阳性标本中有43例（86%）荧光素结合抗体染色阳性，来自21例其他部位培养阳性患者的78例培养阴性标本中有14例（18%）荧光素结合抗体染色阳性，来自34例所有部位培养阴性患者的192例标本中有1例（0.5%）荧光素结合抗体染色阳性。因此，直接荧光素偶联抗体对培养阳性标本的敏感性为86%，对培养阴性标本的特异性为99%。12例上生殖道标本仅荧光素偶联抗体阳性。荧光素偶联抗体对50个石蜡包埋的子宫内膜抽吸物进行染色，在所有7个培养阳性标本中，在其他部位培养阳性的患者的6个培养阴性标本中，在4个培养阴性标本中，在34个培养阴性患者的标本中没有发现细胞外或细胞内的初级体和/或细胞质包涵体。因此，荧光素结合抗体染色可用于确认沙眼衣原体在子宫内膜炎和输卵管炎中的作用。对于检测子宫内膜或输卵管标本中的衣原体，它比培养更敏感，并且能够确认有盆腔炎临床证据的妇女的子宫内膜组织中确实存在该有机体（而不仅仅是反映子宫颈的污染）。
Fifty-five women with suspected pelvic inflammatory disease underwent diagnostic laparoscopy and endometrial and tubal biopsy, with specimens for isolation of C. trachomatis and for staining with a species-specific monoclonal fluorescein-conjugated antibody to C. trachomatis were obtained from the urethra, rectum, endocervix, endometrium, tubes, and cul-de-sac. C. trachomatis was isolated from 21 patients (38%), including 10 (18%) who had positive endometrial or tubal cultures. The fluorescein-conjugated antibody stain was positive for 43 (86%) of 50 culture-positive specimens, for 14 (18%) for 78 culture-negative specimens from 21 patients who had positive cultures from other sites, and for one (0.5%) of 192 specimens from 34 patients who had negative cultures at all sites. Thus the sensitivity of direct fluorescein-conjugated antibody for culture-positive specimens was 86% and the specificity for specimens from culture-negative patients was 99%. Twelve upper genital tract specimens were positive by fluorescein-conjugated antibody only. Fluorescein-conjugated antibody staining of 50 paraffin-embedded endometrial aspirates showed extracellular or intracellular elementary bodies and or cytoplasmic inclusions in all of seven culture-positive specimens, in four of six culture-negative specimens from patients who had positive cultures at other sites, and in none of 34 specimens from patients with negative cultures. Thus fluorescein-conjugated antibody staining is useful for confirming the role of C. trachomatis in endometritis and salpingitis. It is more sensitive than culture for detection of chlamydia in endometrial or tubal specimens and is able to confirm that the organism is actually present in endometrial tissue (rather than simply reflecting contamination from the cervix) in women with clinical evidence of pelvic inflammatory disease.