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。

Investigation on Different Diagnostic Techniques for Lyme Disease

Aim:To investigate the sensitivity and specificity of different diagnostic tests for Lyme disease. Methods:The sera of 123 suspected cases and part of spinal fluids were collected to detect the specific antibodies (IgM,IgG) to Borrdlia burgdorferi by enzyme linked immunosorbent assay (ELISA),indirect flouorescent antibody (IFA) test,and Western blot (WB). Polymerase chain reaction (PCR) was used to amplify genomic DNA of B. burgdorferi in three urine samples.Results:43 patients were diagnosed as Lyme disease according to the diagnostic standard issued by China Disease Control Center. Among of them,31.7%(39/123) patients present the neurological disorders,while 1.62%(2/123) present skin damage and 1.62%(2/123) arthritis. By likelihood ratio,the sensitivity of IFA was 60.47%,while of ELISA 48.83% and WB 39.53%. The united sensitivity and specificity of three tests were 79.60% and 100%, respectively. Three cases detected by PCR were all positive.Conclusion:IFA,ELISA and WB test may provide valuable supportive information for the diagnosis of Lyme disease.