Obstrução tubária em mulheres com imunofluorescência indireta para clamídia
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2011-03-02
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Universidade Federal de Goiás
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Background: Actually the Chlamydia trachomatis is responsible for the major number of cases of sexual transmitted bacterial infections. The likelihood of tubal damage in infertile women is associated to the evidence of chlamydia infection. Objectives: To evaluate the ability of indirect immunofluorescence for Chlamydia trachomatis on tubal occlusion and to establish the cutoff point (best sensitivity and specificity) of antibodies IgG titres (indirect immunofluorescence) to detect tubal occlusion (ROC curve). Methodology: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania, in the period of 2006 to 2009. Patients had 17 to 47 years old. To evaluate the risk of tubal occlusion the patients were divided into two groups: patients exposed to chlamydia (significant IFI ≥ 1:16) e unexposed (no significant IFI < 1:16). It was verified patients who had the disease (tubal occlusion) and not sick (without tubal occlusion) in the hysterosalpingography. For the calculations the Chi-square (χ2) were used, corrected to small samples (Fisher Exact Test) when necessary. The p chosen level was 0.05. The ROC curve was calculated with BioEstat® software, using the standard methodology. This study was submitted and approved by Ethics Committee of Hospital Clinics of the Federal University of Goias.Results: Of the 72 patients with significant titres, 34 (47,2%) showed the occurrence of tubal
occlusion. In relation the 132 patients with no significant titres, only 18 (13,7%) had tubal occlusion (p < 0,001). We also observed a progressive increase in the levels of antibodies and the likelihood of tubal occlusion (p < 0,001). The best cutoff point of the ROC curve with the titre was 1:64. However, we believe that we can continue using a cutoff titre to ≥ 1:16 by interfering little in sensitivity and
specificity and because it is currently used in the Clinical Laboratory of Hospital Clinics. Conclusions: The results indicate that serology for Chlamydia trachomatis (indirect immunofluorescence) is valid for screening of tubal
damage. We also showed that the best cutoff (ROC) indirect
immunofluorescence to detect tubal occlusion is 1:64, but between 1:16 and 1:64 there is a slight change in sensitivity and specificity.
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MAIA, Monica Canedo Silva. Tubal occlusion in women with indirect positive immunofluorescence for chlamydia. 2011. 165 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2011.