The Value Of Chlamydia Heat Shock Protein60and Chlamydia Trachomatis-specific IgG Antibody For Screening Tubal Damage Pathology

Objective:To access the value of Chlamydia heat shock protein60and Chlamydia trachomatis IgG in screening tubal factor infertility.Methods:Blood samples were from33women with TFI (study groups) and15control women with normal pelvis (control groups) diagnosed with tubal testing by laparoscopy. All patients had suffered hysterosalpingogram before operation. Chlamydial heat shock protein60(CHSP60) and Chlamydial trachomatis IgG were analyzed by using enzyme-linked immunosorbent assay (ELISA) kits.1. To test the expression of CHSP60or CTIgG in study groups and control groups, and to compare the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and Youden index in both groups when testing CHSP60or/and CTIgG in diagnosing tubal factor infertility.2.To study the correlation between CHSP60or CTIgG with Salpingemphraxis location and tubal adhesion in study groups.3. Regarding the laparoscopic results as diagnostic criteria, we study the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and Youden index when useing HSG to diagnose tubal factor infertility and to analysis the positive coincidence rate when using HSG to diagnose the Salpingemphraxis location and tubal adhesion.4. To study combined with the serological test in diagnosing tubal factor infertility is whether more useful than HSG alone.Results:1. In study groups,18people’s serological CHSP60expressed positive(54.55%),and19people’s serological CTIgG expressed positive(57.58%); In control groups,one people’s serological CHSP60expressed positive (6.67%), and one people’s serological CTIgG expressed positive(6.67%),P<0.05and pairwise compare is statistically significance.In study groups, the sensitivity and specificity of CHSP60or CTIgG are respectively54.55%、93.3%,57.58%、93.3%, the sensitivity of CHSP60and CT-IgG is up to80.72%, the specificity is87.04%, the positive likelihood ratio is6.23, the negative likelihood ratio is0.07and Youden index is0.68, indicating that the test of CHSP60and CT-IgG is better in diagnosing tubal factor infertility.2. In the study group are further divided into proximal and distal obstruction groups, the CHSP60positive rate is7.69%(1/13) and the CTIgG positive rate is15.38%(2/13) among the13proximal tubal obstruction patients, the CHSP60positive rate is85%(17/20) and the CTIgG positive rate is85%(17/20) among the20distal tubal obstruction patients, P<0.05, pairwise compare is statistically significance, indicating that CHSP60and CTIgG is correlated to Salpingemphraxis.Also in the study group are further divided into groups with tubal adhesion patients(study groups) and groups without adhesion(control groups). The CHSP60positive rate among tubal adhesion patients is respectively60%(18/30),0(0/3) in study groups and control groups, the CTIgG positive rate is60%(18/30),33.33%(1/3) in study groups and control groups. The rank sum test,P>0.05, there is no statistically significance.3.Of all96tubals, tubal obstruction is regarded as positive.among the66obstruct tubals diagnosed by HSG,33tubals are verified obstruction by laparoscopy, the positive coincidence rate is48.48%(32/66), among the30patency tubals diagnosed by HSG,24tubals are verified patency by laparoscopy, the negative coincidence rate is80%(24/30), the total coincidence rate is58.33%(56/96). The sensitivity is84.21%, the specificity is41.38%, the positive likelihood ratio is1.44, the negative likelihood ratio is0.38and Youden index is0.2559.In the study group, the coincidence rate is64.29%(9/14) and the sensitivity is52.94%among proximal tubal obstruction patients diagnosed by laparoscopy, and the coincidence rate is13.51%(5/37) and the sensitivity is23.81%among distal tubal obstruction patients diagnosed by laparoscopy, the totle coincidence rate is39.58%(38/96).In the study group, the positive coincidence rate is70%(28/40) among tubal adhesion diagnosed by laparoscopy, the negative coincidence rate is37.5%(21/56),the sensitivity is44.44%(28/63), the specificity is63.64%(21/33), the positive likelihood ratio is1.22, the negative likelihood ratio is0.837and Youden index is0.08.4.when testing CHSP60and CTIgG together with HSG,method of parallel combined testing could increase the diagnostic sensitivity to96.96%and serial combined examination could increase the diagnostic specificity to92.39%.Conclusion:1. Testing CHSP60together with CTIgG can improve the sensitivity of screening chlamydia-related tubal factor infertility, It’s a better noninvasive way to exclude chlamydia-related tubal factor infertility.2. CHSP60and CTIgG are correlation to distal tubal obstruction infertility.3.when testing CHSP60and CTIgG together with HSG, method of parallel combined testing may be increase the diagnostic sensitivity and reduce the rate of missed diagnosis, and may be increase the diagnostic specificity and reduce the rate of misdiagnosis.