沙眼衣原体急性感染与恢复期携带的鉴别实验研究

Laboratory research on the differential methods between Chlamydia trachomatis infection and carriers

目的 研究沙眼衣原体急性感染期与恢复期的实验鉴别方法,并探讨是否存在治疗后转为正常携带者现象。方法 采用荧光定量PCR法、Clearview查抗原法及高倍镜下白细胞计数法检测4 5份沙眼衣原体急性感染患者样本(A组) ,6 5份治疗后患者样本(B组) ,治疗未愈2 6例经再次治疗后第2次复查患者样本。结果(1)急性感染期,Clearview法检测衣原体阳性率均为10 0 % (45 /4 5 ) ,PCR荧光定量≥10 6拷贝者占86 .6 7% (39/4 5 ) ,白细胞计数10～30个或以上者占88.89% (40 /4 5 )。(2 )经治疗后,荧光定量PCR法和Clearview法检测衣原体均为阴性占6 0 % (39/6 5 ) ,Clearview抗原检测阳性率下降为7.6 9% (5 /6 5 ) ,PCR荧光定量>10 6拷贝者下降为6 .15 % (4/6 5 ) ,治疗前后比较,P <0 .0 1;白细胞计数在10～30个以上者下降为3.0 8% (2 /6 5 ) ,治疗前后比较,P <0 .0 1。(3)未愈者再经治疗后,Clearview抗原检测均10 0 %呈阴性(2 6 /2 6 ) ,PCR荧光定量<10 6拷贝(>10 2 拷贝)阳性率5 7.6 9% (15 /2 6 )。结论 PCR荧光定量是否>10 6拷贝、Clearview和白细胞计数法都是临床检测衣原体感染和随访疗效的良好方法。沙眼衣原体感染者经治疗后延长治疗期仍可长期携带衣原体,实验显示为荧光定量PCR法检测携带者在<10 6拷贝时。

Objective To study the laboratory differential method on difference between Chlamydia trachomatis (Ct) acute infection and convalescent carriers and to evaluate the prognosis after the treatment. Methods Samples were assayed with fluorescent quantitative polymerase chain reaction (FQ-PCR), Clearview antigen detection and microscopic white blood cell (WBC) counting, samples were classified into three groups: the acute infection group A (45 samples), post-treatment group B (65 samples) and repetitive treatment group C (26 samples from patients without curing after treatment). Results (1) In group A, 100% (45/45) of samples were positive for Ct by Clearview method, 86.67% (39/45) of FQ-PCR copy≥10 6, 88.89% (40/45) of WBC counting were between or more than 10-30. (2) In group B, 60% (39/65) of samples were all negative for Ct with both FQ-PCR and Clearview antigen detection, 7.69% of samples were positive for Ct with Clearview method, 6.15 (4/65) of FQ-PCR copy >10 6, 3.08% (2/65) of WBC counting were more than 10-30, there were significant difference between before and after treatment (P< 0.01). (3) In group C, 100% (26/26) were all negative for Ct with Clearview antigen detection, 57.69% (15/26) of FQ-PCR copy <10 6. Conclusion FQ-PCR, Clearview detection and WBC counting are all ideal methods for clinical detection and follow-up for Ct. The Ct infection is refractory for treatment, patients can still become carriers for Ct even after prolonged treatment, Clearview antigen detection is negative if FQ-PCR copy <10 6 in Ct carriers.