【摘要】 【目的】研究不同类型沙眼衣原体蛋白在输卵管性不孕中的致病作用，预测具有临床检测价值的沙眼衣原体蛋白抗体。【方法】本研究共纳入输卵管性不孕组（TFI）58例，正常生育组（FC）41例，非输卵管性不孕组（IFC）18例。血清检测CT-IgG ELISA试剂盒检测三组人群血清中CT-IgG的表达情况；利用前期获得表达、纯化的6种沙眼衣原体蛋白，建立这6种沙眼衣原体蛋白抗体的ELISA检测方法，分别检测6种沙眼衣原体蛋白抗体在TFI组、FC组和IFC组血清中的表达情况；对三组研究对象6种沙眼衣原体蛋白抗体的OD值进行统计描述，以CT-IgG的检测结果（阳/阴）为参考标准，绘制6种沙眼衣原体蛋白抗体的受试者工作特征曲线，利用约登指数确定各抗体的截断值。以TFI作为参考类，将FC、IFC分别与参考类建立两个无序多分类logistic回归模型，探究沙眼衣原体蛋白抗体、年龄预测TFI、FC和IFC的价值，并利用后退法筛选变量。【结果】各组研究对象CT376和CT443抗体OD值不全相同，CT-IgG阳性率不全相同。经两两比较发现，TFI组的CT376抗体OD值高于FC组（0.86 vs. 0.60,P=0.026）。TFI组的CT376抗体OD值高于IFC组（0.86 vs. 0.64,P=0.026）。IFC组CT443抗体OD值高于TFI组（0.59vs. 0.34,P=0.036），高于FC组（0.59 vs. 0.30,P=0.02）。经过比较，CT376抗体的阳性率在三组间不全相同（P<0.05）；无序多分类logistic回归分析结果表明：TFI与FC建立的无序多分类logistic回归分析结果显示，CT-IgG [P <0.001,OR=0.084,95%CI(0.025,0.284)]、CT376抗体[P=0.068, OR=0.359,95%CI(0.120,1.078)]。CT-IgG是输卵管性不孕发生的独立危险因素，CT376抗体尚不能成为输卵管性不孕的独立危险因素；TFI与IFC建立的无序多分类logistic回归分析显示，在不孕的患者中，CT-IgG [P<0.05,OR=0.194,95%CI(0.046,0.817)]、CT376抗体[P<0.05,OR=0.176,95%CI(0.038,0.818)]和CT381抗体[P<0.05,OR=0.112,95%CI(0.016,0.796)]是输卵管性不孕发生的独立危险因素。【结论】CT376抗体在输卵管性不孕患者中的表达情况高于正常生育及非输卵管性不孕的人群，提示CT引起的输卵管性不孕或许与CT376有关。检测CT-IgG和CT376血清抗体可能对CT引起的输卵管性不孕有预测价值。更多还原

【Abstract】 【Objective】 To further study the pathogenic role of different types of Chlamydia trachomatis(CT) proteins in tubal factor infertility, evaluate the clinical detection value of Chlamydia trachomatis protein antibody in predicting tubal factor infertility.【Methods】 A total of 58 cases of tubal factor infertility(TFI), 41 cases of fertile controls(FC) and 18cases of infertile controls(IFC) were included. For serum detection, first, CT-IgG ELISA kit was used to detect the expression of CT-IgG in serum of three groups of people; then, 6 kinds of Chlamydia trachomatis proteins were expressed and purified in the early stage to establish the antibody test for these proteins, and ELISA detection method was used to detect the expression of their antibodies in the serum of TFI group, FC group and IFC group, respectively; and finally, the antibody OD value of the 6 kinds of Chlamydia trachomatis proteins in the three groups of subjects were statistically described, and CT-IgG was used as the reference standard to draw the receiver operating characteristic curve(ROC curve) of each CT antibody. The Youden Index determines the cutoff value for each antibody. Taking TFI as the reference class, two disordered multiple classification logistic regression models were established with the FC and IFC groups, respectively; and the reference class was used to explore the value of various antibodies and age in predicting TFI, FC and IFC of Chlamydia trachomatis. The back-off method was used to screen the variables.【Results】 The OD value of CT376 antibody in the TFI group was higher than that in the FC group(0.86 vs. 0.60, P=0.026). The CT376 antibody OD value in the TFI group was higher than that in the IFC group(0.86 vs. 0.64, P=0.026). The CT443 antibody OD value in the IFC group was higher than that in the TFI group(0.59 vs. 0.34, P=0.036) and higher than that in the FC group(0.59 vs. 0.30, P=0.02).The multiple classification logistic regression analysis established between TFI and FC showed that CT-IgG [P<0.001, OR=0.084, 95%CI(0.025, 0.284)], CT376 antibody [P=0.068, OR=0.359, 95%CI(0.120, 1.078)]. CT-IgG is an independent risk factor for tubal infertility, and CT376 antibody cannot be an independent risk factor for tubal infertility. The multiple classification logistic regression analysis established between TFI and IFC showed that among infertile patients, CT-IgG [P<0.05, OR=0.194, 95%CI(0.046, 0.817)], CT376 antibody [P<0.05, OR=0.176, 95%CI(0.038, 0.818)] and CT381 antibody [P<0.05, OR=0.112, 95%CI( 0.016, 0.796)] were independent risk factors for tubal infertility.【Conclusion】 The expression of CT376 antibody in tubal infertility patients is higher than that in fertile and infertile controls, suggesting that CT-induced tubal factor infertility may be related to CT376. CT-IgG, and CT376 antibodies are meaningful in predicting CT-induced tubal factor infertility.更多还原