莱姆病诊断技术应用探讨

目的:探讨不同莱姆病诊断技术的灵敏度和特异度。方法:应用间接免疫荧光抗体法(IFA)、酶联免疫吸附试验(ELISA)、蛋白印迹法(WB)3种方法检测新疆123例疑似莱姆病患者血清及部分脑脊液抗伯氏疏螺旋体IgM、IgG抗体,其中3例PCR法检测尿液,结合相应的影像学、电生理检查诊断莱姆病。似然比方法计算灵敏度。结果:依据中国疾病控制中心制定的标准确诊莱姆病43例。其神经系统、皮肤损害、关节炎发生率分别为31·7%(39/123),1·62%(2/123),1·62%(2/123)。IFA、ELISA、和WB3种检验方法的阳性率分别为60·47%、48·84%、39·53%。用似然比方法计算灵敏度:IFA为60·47%、ELISA为48·84%、WB为39·53%;联合灵敏度为79·60%;特异度均为100%。3例PCR均阳性。结论:应用IFA、ELISA和WB技术检测血清和脑脊液抗伯氏疏螺旋体抗体有助于临床诊断。     

巢式聚合酶链反应检测脑脊液中单纯疱疹病毒DNA

应用巢式聚合酶链反应(PCR)检测患者脑脊液(CSF)中单纯疱疹病毒1型(HSV-1)DNA。23例经鞘内HSV-1特异性IgG抗体检测阳性的“HSV-1型性脑炎(HSE)”中19例PCR阳性,4例阴性患者病程均超过1个月。22例IgG阴性的“散发性脑炎”中7例PCR阳性,此7例皆于发病1周内检查CSF,其中2例取材于发病当日。1周后复查7例患者,CSF PCR仍为阳性,IgG皆阴性,提示PCR适用于HSE的早期诊断。     

森林脑炎并发莱姆病

森林脑炎并发莱姆病王静，王蒙，邹亚君，潘文华，梁淑华现将本科１９９３～１９９４年收治的５０余例森林脑炎的病人，经间接血清荧光免疫法测为森林脑炎抗体阳性的同时，检测了１２例血清莱姆病抗体，发现８例莱姆病抗体阳性的情况介绍如下。１临床资料１．１一般资料年...     

2000至2004年新疆维吾尔自治区莱姆病的监测

目的:监测莱姆病(LD)在新疆地区的流行情况与特征,为LD的防治提供决策依据。方法:2000至2004年采用间接免疫荧光抗体法(IFA)、蛋白印迹法(WB),对业已证实的新疆自然疫源地区2167人份的血清标本进行抗LD螺旋体抗体(IgM、IgG)检测;采用IFA、WB、ELISA试验对来自21个县、市的门诊与住院患者,随机抽样1443人份血清标本进行抗LD螺旋体抗体(IgM、IgG)检测作对照;共计3610份血清标本。结果:自然疫源地2167人份血清中IFA:IgM阳性数546人、IgG阳性数223人、总阳性数769人,总阳性率为35.49%。其中471人份血清同时作WB法,其IgM、IgG阳性数均为28人,阳性率为13.49%,与对照组总阳性率20.99%比,差异有统计学意义(P<0.01)。结论:新疆自治区LD自然疫源地平均感染率明显高于国内(1.5%和8.06%)水平,各年度的抗体水平呈递增趋势,应该加强对新疆LD的监测与防治。     

莱姆病神经系统损害附2例报告

莱姆病(Lyme Disease,LD)是一种由伯氏疏螺旋体所引起,经硬蜱为主要传播媒介的自然疫源性疾病.可侵犯全身多系统,特别是神经系统的表现多种多样,易被误诊.现将我院神经内科收治的2例神经莱姆病患者的诊治情况报告如下.     

抗LGI1抗体相关边缘性脑炎17例临床分析

目的探讨抗LGI1抗体相关边缘性脑炎患者的临床特点。方法回顾性分析17例抗LGI1抗体相关边缘性脑炎患者的临床表现、病程、影像学、治疗方案及预后。结果本研究17例患者男14例,女3例,年龄中位数61岁。临床表现认知功能障碍14例(82%),面-臂肌张力障碍(FBDS)11例(65%),部分性发作10例(59%),强直-阵挛发作8例(47%),精神行为异常9例(53%)。17例患者均行血清LGI1抗体检测,16例阳性,1例阴性(脑脊液抗体检测阳性)16例患者行脑脊液LGI1抗体检测,14例阳性。17例患者均给予一线治疗,2例患者复发,随访时间1年,部分患者遗留轻度近记忆力障碍,无患者死亡。结论抗LGI1抗体相关边缘性脑炎是一种自身免疫性脑炎,中老年男性患者多见,单向病程为主,可以复发。临床常以FBDS、部分性发作为首发表现,继而出现认知功能障碍,对免疫治疗敏感,预后较好。     

聚合酶链反应诊断单纯疱疹病毒性脑炎的初步研究

应用聚合酶链反应(PCR)检测已为CSF特异性抗体证实的6例急性期单纯疱疹病毒性脑炎(HSE)患者10份CSF中病毒DNA,结果PCR全部阳性。其中2份标本第一步PCR为阴性,第二步套式PCR为阳性。10份其它中枢神经感染的CSF的PCR全部阴性。说明PCR方法简单、迅速、敏感性及特异性高,是病原学诊断的一大突破,适于早期和快速诊断HSE。     

莱姆病神经系统表现

目的报道2例莱姆病神经系统表现并进行相关文献复习。方法对可疑病例进行全面检查，排除其他可能的疾病，并进行莱姆病相关检查。结果发现2例神经系统莱姆病，例1表现为多颅神经炎、脊髓病变、多发性神经根神经炎，例2表现为多发性神经根神经炎及周围神经病变。常规脑脊液检查正常。血清及脑脊液抗伯氏疏螺旋体抗体滴度分别为1：64~1:264及1：128~1:256。结论对原因不明的多颅神经炎、脊髓病变、周围神经病变应进行莱姆病相关化验，以利早期诊断、治疗。     

病毒性脑炎患者CSF HSV-IDNA和HCMV DNA PCR检测临床评估

目的 :评价患者脑脊液 (CSF)单纯疱疹 I型病毒 (HSV- I) DNA和巨细胞病毒 (HCMV) DNA聚合酶链反应(PCR)检测以对单纯疱疹病毒性脑炎 (HSE)和巨细胞病毒性脑炎 (HCME)早期诊断的临床价值。方法 :对 45例病毒性脑炎病人的 CSF进行 HSV- I DNA、HCMV DNA检测 ,并对其检测结果结合临床表现、实验室和影像学检查 ,以及抗病毒药物应用与疗效进行综合分析 ,评价其临床价值。结果 :45例病毒性脑炎患者中 HSV- I DNA阳性 16例 ,占 35 .6 % ;HCMV DNA阳性 9例 ,占 2 0 % ;阴性者 2 0例 ,占 44 .4%。结论 :病毒性脑炎病人的 CSF HSV- I DNA、 HCMVDNA PCR检测是从病毒性脑炎中早期鉴别 HSE和 HCME的有价值的手段之一 ,但其检测结果需密切结合临床资料进行分析评价。     

18例HIV阴性的神经梅毒诊断

目的 分析HIV阴性的神经梅毒的临床特点及诊断.方法 回顾18例HIM阴性的神经梅毒患者的临床分型、临床特点、血清及脑脊液检查和影像学改变.结果 患者年龄33～62岁,平均(46.0±9.2)岁;分为脑膜血管型3例,麻痹性痴呆8例,脊髓痨3例,视神经萎缩1例,混合型3例.最常见的症状是认知减退、阿一罗氏瞳孔、步态不稳和共济失调、双下肢腱反射消失、精神行为异常等.误诊率高达72.2％,其中误诊为病毒性脑炎4例.血清梅毒螺旋体特异性抗体检测均为阳性,血清和CSF梅毒螺旋体明胶凝集试验(TPPA)阳性率高,CSF白细胞数增加、蛋白升高;影像学表现缺乏特异性.结论 无法根据单一的实验室检查或临床表现确诊神经梅毒.血清梅毒螺旋体特异性抗体是重要的初筛实验,血清、脑脊液RPR和TPPA可作为确证实验,将临床表现与脑脊液白细胞计数、蛋白含量、神经影像学特点结合起来,综合分析,才能避免误诊和漏诊.     

PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients.

We used the polymerase chain reaction (PCR), a method useful in the detection of Borrelia burgdorferi in vitro, to evaluate CSF in patients thought to have neuroborreliosis. Nested pairs of oligonucleotide primers were designed to recognize the C-terminal region of B burgdorferi OspA. CSF samples were obtained from (1) patients with immunologic evidence of systemic B burgdorferi infection and clinical manifestations suggestive of CNS dysfunction, (2) seronegative patients with clinical disorders consistent with Lyme borreliosis, and (3) patient and contamination controls; all were analyzed in a blinded fashion. PCR detected B burgdorferi OspA DNA in CSF of (1) 10 of 11 patients with Lyme encephalopathy, (2) 28 of 37 patients with inflammatory CNS disease, (3) seven of seven seronegative patients with Lyme-compatible disorders, and (4) zero of 23 patient controls. Zero of 83 additional contamination controls were PCR-positive. In eight patients from whom we obtained CSF before and after parenteral antimicrobial therapy, PCR results invariably predicted clinical outcome accurately.     

Borrelia burgdorferi antibodies in multiple sclerosis patients

Lyme disease is said to produce a late syndrome resembling multiple sclerosis. We analyzed serum antibodies to Borrelia burgdorferi in 100 patients referred for possible MS. All lived in an area endemic for Lyme disease. Only 1 of 89 definite MS patients and 2 of 11 non-MS patients were antibody positive. Infection with Borrelia burgdorferi is rare in MS, and Lyme disease is unlikely to play a significant role in the differential diagnosis of MS.     

PCR in lyme neuroborreliosis: a prospective study

OBJECTIVES: DNA proof is the only widely available direct diagnostic tool in Lyme borreliosis. Sensitive PCR detecting of spirochetal DNA was prepared and a prospective study in neuroborreliosis was performed. MATERIALS AND METHODS: 57 hospitalised patients with active neuroborreliosis and proved CSF antibodies synthesis were examined. Nested-PCR (utilizing three targets) was used for the detection of specific DNA in plasma, CSF and urine. RESULTS: Before treatment 36 positive patients (63.1%) were found in all tested specimens in parallel, 28 patients (49.1%) were positive in urine, 20 in CSF (35.0%) and 16 in plasma 28.0%). Later only urine was tested and the following results were obtained: 17 positive patients (30.0%) immediately after treatment, 8 (14.0%) after 3 months and one patient persisted positivity after 6 months. CONCLUSIONS: The highest sensitivity of PCR was achieved in the acute period of neuroborreliosis - 63.1% in three body fluids comparing with CSF antibody synthesis.     

Magnetic Resonance Imaging of Meningoradiculomyelitis in Early Disseminated Lyme Disease

Lyme disease, a multisystem illness caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. There are 3 clinical stages of Lyme disease: early localized, early disseminated, and late persistent disease. Neuroborreliosis, infection of the nervous system by B. burgdorferi, may occur during early disseminated or late persistent disease. Spinal cord involvement in early disseminated disease is extremely rare. In patients with early disseminated neuroborreliosis, treatment with antibiotics often leads to rapid recovery and may prevent further complications of Lyme disease. The authors present the clinical and radiographic findings, both before and after treatment, in a patient with meningoradiculomyelitis due to early disseminated Lyme disease.     

Borrelia burgdorferi induces matrix metalloproteinases by neural cultures

Matrix metalloproteinases (MMPs) are associated with chronic neurologic diseases such as multiple sclerosis and senile dementia. Lyme disease is a multisystemic infection involving the nervous system, skin, joints, and heart. Neurologic manifestations of chronic Lyme disease include encephalopathy and cranial and peripheral neuropathy. Borrelia burgdorferi, the spirochaete causing Lyme disease, has been cultured from the cerebrospinal fluid (CSF), and B. burgdorferi DNA is frequently detected in the CSF of patients with Lyme neuroborreliosis. We used cerebral and cerebellar primary cultures to determine whether B. burgdorferi induces the production of MMPs by primary neural cultures. B. burgdorferi in a dose- and time-dependent manner induced the expression of MMP-9 by primary neural cultures but had no effect on the expression of MMP-2. Human and rat type I astrocytes expressed MMP-9 when incubated with B. burgdorferi in the same manner as primary neural cultures. This response may play a role in the symptomatology and the pathogenesis of Lyme neuroborreliosis.     

Frequency and clinical significance of Lyme seropositivity in patients with isolated optic neuritis

We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease. Four (20%) patients had positive serology. All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM. One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease. We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved. The other two patients received oral antibiotics and showed excellent recovery of visual acuity. We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease.     

直接脑血运重建手术治疗儿童烟雾病

目的 探讨直接脑血运重建手术治疗儿童烟雾病的效果。方法 对首都医科大学附属北京天坛医院神经外科自2007年7月至2009年2月收治的儿童烟雾病患者20例进行回顾性分析，男10例，女10例，年龄4～15岁（中位年龄9岁）。根据Suzuki的分期标准，I期3例，II期8例，III期7例，IV期2例。以缺血为首发症状者19例，出血为首发症状者1例。20例患者均行颞浅动脉与大脑中动脉（superficial temporal artery-middle cerebral artery，STA－MCA）搭桥术或STA-MCA搭桥术联合应用脑-硬脑膜-动脉贴敷术（encephalo-duro-arterio synangiosis，EDAS），术中均采用脑血管吲哚菁绿荧光造影以确定重建血管通畅程度，术后随访记录患者症状改善情况，并采用全脑数字减影血管造影（digital subtraction angiography，DSA）、经颅多普勒（transcranial doppler sonography，TCD）、单光子发射断层扫描（emission computed tomography，ECT）等影像学检查观察重建血管血流及侧枝循环形成情况。结果 患者行直接脑血运重建手术15例，直接血运重建联合间接血运重建术5例。术中吲哚菁绿荧光血管造影（indocyanine green angiography）显示吻合口血流通畅19例（95%），吻合血管血流缓慢1例（5%）。患者随访时间为术后3～22个月，平均（12.5±4.5）个月，术后症状完全缓解11例（55%），症状明显改善8例（40%），症状改善不明显1例（5%）。本组患者无手术死亡，无术后颅内出血及脑缺血事件发生。术后随访行DSA、计算机断层扫描血管成像（computed tomography angiography，CTA）或磁共振血管成像（magnetic resonance angiography，MRA）检查的17例患者均出现颈外动脉向大脑中动脉供血的情况。行ECT检查的4例（20%）患者患侧血流灌注均较术前有所改善。结论 直接脑血运重建手术治疗儿童烟雾病能够早期迅速增加脑血运，改善脑缺血症状和神经系统功能缺损，术中吲哚菁绿荧光血管造影在手术中具有重要作用。     

肾移植术后尿液DYZ-1检测的临床意义

背景：对移植受者尿液成分进行定期监测可以作为判断移植肾功能、状态的一种方法。 目的：分析肾移植受者尿液中供者细胞出现与急性排斥反应的关系及临床意义。 方法：选取60例供者为男性、受者为女性的肾移植受者,分为移植后早期检测组40例、急性排斥组10例、移植后功能稳定组10例。定期提取尿液中细胞DNA,利用PCR检测Y染色体上特异的基因片段DYZ-1。 结果与结论：在手术第1日受者的尿液中可检测到供者细胞DNA,随着时间的延长,尿液中供者细胞DNA量逐渐减少,至术后1个月,有8例受者的尿液中供者细胞DNA消失,其中1例发生急性排斥反应;另外32例受者的尿液中仍有供者细胞DNA的出现,其中7例发生了急性排斥反应;存活3个月以上发生急性排斥反应10例患者,7例尿液标本中能检测到供者细胞DNA,对急性排斥者进行治疗后1个月,71.4%转为阴性;而在稳定期的10例肾功能良好受者,仅1例受者尿液中DYZ-1基因阳性。提示对肾移植受者尿中供者细胞DNA的进行定期检测,可以作为监测急性排斥反应发生及预后的一种手段。     

文拉法辛缓释剂与帕罗西汀治疗抑郁症的对照研究

目的:探讨文拉法辛缓释剂和帕罗西汀治疗抑郁症(MD)的疗效和安全性。方法:将57例MD患者随机分为文拉法辛缓释剂组(28例)和帕罗西汀组(29例),并给予相应的药物治疗6周。分别于治疗前、治疗后3、7、10、14 d及6周应用汉密尔顿抑郁量表17项(HRSD)进行评定;治疗3、7、10及14 d应用治疗过程中出现的症状量表(TESS)评估药物不良反应。结果:治疗14 d分组与时间存在交互作用(F=6.608,P=0.001)。文拉法辛缓释剂组治疗第7 d起、帕罗西汀组治疗第10 d起HRSD评分较治疗前明显下降(P均0.01);治疗7及14 d文拉法辛缓释剂组HRSD评分明显低于帕罗西汀组(P均0.01);6周后两组间疗效及药物不良反应率差异无统计学意义。结论:与帕罗西汀相比,文拉法辛缓释剂治疗MD起效快,但疗效和不良反应相当。