IFA、ELISA和WB用于莱姆病血清学诊断的比较研究

目的比较研究间接免疫荧光试验（IFA）、酶联免疫吸附试验（ELISA）和蛋白免疫印迹试验（WB）3种检测方法对莱姆病血清学的诊断效果。方法收集临床疑似莱姆病患者血清标本及其流行病学和临床资料,分别采用IFA、ELISA和WB进行血清抗伯氏疏螺旋体抗体（IgM和IgG）检测,结合流行病学和临床资料进行综合分析。结果实验共检测莱姆病疑似患者血清398份,ELISA阳性86例,阳性率21.61%,其中IgM阳性27例,IgG阳性59例;IFA阳性82例,阳性率20.60%,其中IgM阳性26例,IgG阳性56例;WB阳性83例,阳性率20.85%,其中IgM阳性31例,IgG阳性52例;并且实验表明,在对于游走性红斑病例的诊断上,WB法阳性率明显高于ELISA和IFA（χ2=6.34,P〈0.05）。结论在莱姆病的实验室诊断中,IFA、ELISA和WB3种方法结合运用,可提高诊断的灵敏性和特异性;WB在排除ELISA和IFA的假阳性结果中有着重要作用。     

北京奥运会期间的一例输入性莱姆病病例分析

目的分析拟诊莱姆病患者血清学检查结果,为有效诊治莱姆病提供科学依据。方法应用间接免疫荧光试验（IFA）、ELISA和蛋白免疫印迹（WB）3种实验方法,对此例患者进行血清抗伯氏疏螺旋体IgM和IgG抗体检查,并结合临床疾患进行综合分析。结果 3种试验方法IgG均为阳性,其中IFA的IgG抗体滴度达到1：128,WB的IgG有2条蛋白带P83和P39;3种试验方法IgM均为阴性。结论患者临床发展病程符合莱姆病的特征,实验室结果阳性,莱姆病的诊断可以成立。     

长白山区莱姆病调查与实验室分析

目的：了解长白山区莱姆病传播媒介－全沟硬埤的地理位置,分布及其病原携带情况。方法：用酶联免疫吸附试验,间接免疫荧光试验检测莱姆病特异IgG抗体,结果：长白山区抓捕的620只硬蜱,全沟硬蜱为593只,占总数的95．80％,用BSK培养基33度培养,分纯后共获得纯阳性和伯氏疏螺旋体培养物243株,用免疫抗美国B31特异性多克隆抗体和针对莱姆病螺旋体种属特异单克隆抗体,间接免疫荧光荧光抗体试验进行鉴定,证明其单克隆抗体反应与美国菌株稍有差异,与国内分离株M7相同,血检826人,IgG,IgM大于等于1：128（抗体滴度）有49例,阳性率为5．93％,IgG,IgM大于等于1：64（抗体滴度）有82例;二项合计为15．85％,结论：长白山区是莱姆病重要疫源地,人群中有莱姆病感染存在,并有莱姆病发生。     

肠出血性大肠埃希菌O157：H7引起的溶血性尿毒综合征患者血清抗体调查

目的 对1999年某地出现的一批先有腹泻病症状后继发急性肾功能衰竭（肾衰）的患者进行血清学调查和诊断。方法 使用基因克隆表达纯化的肠出血性大肠埃希菌（EHEC）-溶血素（Hly)和EHECO157脂多糖（LPS）为抗原，对采集自42例肾衰患者的血清标本进行蛋白印记试验。结果 EHEC-Hly的检测发现，IgG抗体阳性21份，阳性率50.0%；IgM抗体阳性16份，阳性率38.1%；在11份标本中同时检测到IgG和IgM抗体，阳性率26.2%；检测到IgG或IgM抗体阳性的标本26份，阳性率61.9%，EHECO157LPS的检测发现，24份标本分别检测到IgG和IgM抗体，阳性率各为57.1%；在29份标本中检测到IgG或IgM抗体，阳性率69.0%;在20份标本中检测到IgG和IgM抗体，阳性率47.6%，在42份血清标本中同时检测到EHEC-Hly和O157LPS的特异性抗体的标本22份，阳性率52.4%；检测到EHEC-Hly或O157LPS的特异性抗体的标本34份，阳性率81.0%。结论 结合细菌学和血清学诊断结果，临床症状和流行病学分析。可以认为这些患者感染了EHECO157：H7，在分离不到病原菌的情况下，检测患者血清标本的EHEC-Hly和/或EHECO157LPS的特异性抗体，不失为一种可以考虑的诊断方法。     

巴楚县2001年新疆出血热疫情的血清学证实

目的：以血清流行病学方法调查新闻出血热（XHF）病人，易感人群和主要宿主动物中疾病的感染情况。方法：分别收集2001年4－6月新疆巴县临床诊断为XHF的病人血清，易感人群血清和主要宿主动物的血清，用研制的诊断试剂以酶联免疫吸附试验（ELISA）检测XHF特异性IgG和IgM抗体；用抗原捕获ELISA检测XHF病毒抗原。结果：病人血清IgG抗体阳性率为39．62％（21／53）。IgM抗体阳性率为20．75％（11／53），抗原获ELISA有1份血清为XHF抗原阳性；易感人群血清IgG抗体阳性主为21．05％（4／19），IgM抗体检测和抗原捕获ELISA全部为阴性；羊血清IgG抗体阳性率为70％（56／80）。结论：血清流行病学研究证实该次疫情确系XHF、流行地区人畜均有较高水平的隐性感染。     

生物薄片技术在病毒性脑炎病原体特异性抗体检测的初步应用

目的探讨生物薄片技术免疫荧光法对小儿病毒性脑炎脑脊液病原体特异性抗体检测的临床应用价值。方法对56例病毒性脑炎患者应用生物薄片技术同时检测脑脊液中20种嗜神经病原体的特异性抗体，随机分为2组：A组检测12例稀释10倍后的脑脊液中的病原体特异性抗体IgG和IsM。B组检测16例不稀释脑脊液中病原体特异性IgG和IgM。结果A组中所有检验标本检测结果均为阴性，B组16例病原体特异性抗体IgG检测有13阳性，其中一种病原体特异性抗体阳性8例，二种病原体特异性抗体阳性3例，三种以上病原体特异性抗体阳性2例。病原体特异性IgM抗体，13例为阴性，仅3例阳性。结论间接免疫荧光法检测脑脊液中病原体特异性抗体，有重要的临床应用价值；该检测需直接应用未稀释的脑脊液；脑脊液中病原体特异性抗体IgM阳性率低，而IgG阳性率较高；应用该检测可诊断多种病原体混合感染。     

酶联免疫法检测弓形体感染初探

目的酶联免疫法正确有效诊断弓形体急性感染。方法对4 500例无偿献血者血浆样本分别检测弓形体IgM抗体、IgG抗体,对IgM抗体阳性和IgM抗体阴性且IgG抗体阳性的样本检测其IgG抗体亲合力。结果 4 500例样本中,弓形体IgM抗体阳性率为0.51%,IgG抗体阳性率为1.53%。其中22例为IgM（＋）IgG（＋）,1例为IgM（＋）IgG（-）,47例为IgM（-）IgG（＋）,4 430例为IgM（-）IgG（-）。在对69例弓形体IgG（＋）的样本进行IgG亲合力检测时,IgM（＋）IgG（＋）的22例样本中2例为IgG中等亲合力抗体,3例为IgG高亲合力抗体,但这5例样本的IgM抗体均为可疑,可能由于IgM抗体常年保持低水平,并非正处于弓形体急性感染期;IgG（＋）IgM（-）的47例样本中,3例为IgG低亲合力抗体,可能由于其中的弓形体IgM抗体在急性感染期后期,IgM抗体滴度太低无法检测到,仍可判定为处于急性感染期。最终确定弓形体急性感染的样本为20例,感染率0.44%。结论可同时检测弓形体IgM抗体和弓形体IgG抗体亲合力来诊断弓形体感染,IgM抗体阳性或IgG抗体低亲合力的样本均可判定为弓形体急性感染。     

弓形体IgG抗体亲和力指数在胎儿宫内感染中的临床意义

【目的】探讨弓形体（toxoplasma，TOX）IgG抗体亲和力指数，判断弓形体感染孕妇宫内感染的概率。【方法】ELISA法检测中晚期孕妇弓形体特异性抗体IgM和IgG，并对150例TOX—IgM或TOX—IgG阳性孕妇的胎儿或新生儿脐血进行TOX—IgM检测；采用尿素变性试验检测弓形体感染孕妇TOX-IgG抗体亲和力指数（avidityindex，AI）。【结果】孕妇弓形体IgM抗体阳性和IgG抗体阴性58例；弓形体IgM和IgG抗体阳性22例；弓形体IgM抗体阴性和IgG抗体阳性70例。胎儿或新生儿IgM阳性44例。原发性感染宫内感染率高于继发性感染（P〈0．05），活动性感染宫内感染率高于非活动性（P〈0．01），AI≤30％宫内感染率高于AI〉30％（P〈0．01）。【结论]IgG抗体亲和力指数AI≤30％结合IgM阳性有助于提高判断弓形体宫内感染的发生率。     

新疆沙湾林场莱姆病血清流行病学调查

目的：调查新疆沙湾林区人群莱姆病感染情况。方法：采用间接免疫荧光抗体法（IFAT）和蛋白免疫印迹法（Western blot)检测沙湾林区居民血清抗莱姆病螺旋体抗体（IgG)。结果：沙湾林区是莱姆病高感染区，人群血清抗莱姆病螺旋体抗体（IgG)阳性率为16.1%(37/230)，各年龄组间、哈族与汉族间的差异无显著性。结论：新疆沙湾林区人群中存在较高的莱姆病感染。可能是莱姆病的流行区之一。     

肺炎衣原体与呼吸系统感染性疾病的关系

目的 探讨肺炎衣原体（chlamydis pneumoniae,Cpn)与呼吸系统感生疾病的关系。方法 采用免疫荧光技术，对104例呼吸系统感染性疾病和40名正常人的血清进行了Cpn特异性IgG、IgA、IgM抗体的检测。结果 Cpn IgG抗体的阳性率患组与对照组之间差异无显性（P＞0.05)；慢性阻塞性肺疾病（COPD）、慢性支气管炎患Cpn IgA抗体的阳性率高于对照组（P＜0.01)；患组Cpn IgG抗体几何平均滴度（GMT）明显高于对照组（P＜0.05)。结论 Cpn特异性抗体的检测有助于呼吸系统急、慢性Cpn感染的诊断；持续高滴度的Cpn IgG或IgA抗体可作为慢性Cpn感染的重要指标。     

大兴安岭南段莱姆病的调查

1991年4～6月,我们在大兴安岭南段林区,对莱姆病进行了调查,应用间接免疫荧光抗体法检测496人居民血清,38人血清中抗莱姆病螺旋体IgG抗体效价≥1:128。根据临床表现和血清学调查,确诊莱姆病病例22例;从26只全沟硬蜱分离出4株莱姆病螺旋体。     

Lyme disease incidence in Wisconsin: a comparison of state-reported rates and rates from a population-based cohort

Few studies have assessed the accuracy and completeness of Lyme disease surveillance systems. Lyme disease cases were identified through review of medical records for residents of the Marshfield Epidemiologic Study Area (MESA), a population-based cohort of nearly 80,000 in north-central Wisconsin for which comprehensive medical care data are available through the Marshfield Clinic. These cases were compared with cases reported to the Wisconsin Division of Public Health to estimate the completeness of reporting. Annual incidence rates were calculated for MESA using the cases identified from chart review. Division of Public Health data were used to calculate statewide reported incidence rates, as well as rates for an eight-county region that surrounds and includes the MESA region. Of Lyme disease cases meeting the national case definition identified in MESA, 34% were reported to the state. The average incidence of Lyme disease (1992-1998) was 19.1 per 100,000 per year in MESA, 17.0 in the surrounding eight-county region, and 9.0 statewide. Trends in reported incidence across time, gender, and age in the surrounding eight-county region were generally comparable with those observed in MESA. These findings suggest that the passive surveillance system monitored trends in Lyme disease incidence reasonably well despite underreporting of cases.     

Cardiac manifestations of Lyme borreliosis

Lyme borreliosis is increasing in Poland in both incidence and recognition with 655 cases reported in 1997 and 3574 in 2003. Approximately 4% of patients will develop cardiac manifestations--the least well documented complication of Lyme disease. Cardiac involvement usually occurs within weeks to months of the infecting tick bite and includes varying degrees of atrioventricular block as the commonest manifestation and tachyarrhythmias, myopericarditis, mild cardiac muscle dysfunction. There has been evidence that long standing dilated cardiomyopathy may be associated with chronic Borrelia burgdorferi infection. Patients with atrioventricular block have good prognosis. Most cases resolve within 1 to 2 weeks. Temporary, but almost never permanent, cardiac pacing may be required for some patients. Cardiac manifestations of Lyme disease are treatable with antibiotics. Lyme carditis should be taken into consideration in patients with acute as well as chronic heart diseases.     

Underreporting of Lyme disease by Connecticut physicians, 1992.

To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.     

牡丹江林区莱姆病分布的地理特点

1989年在牡丹江林区对4个不同地理地貌的林场进行了莱姆病的调查。在访问和检查的2 718人中,发现74例患者,其中54例是慢性游走性红斑,12例是神经系统损伤,8例是关节炎。从深山区到丘陵地均有莱姆病患者存在和发生。4个林场的患病率分布在11.6~45‰,深山区莱姆病的患病率明显高于丘陵地带。
从1例精神紊乱病人血液中分离到1株莱姆病螺旋体。
全沟硬蜱季节消长曲线和慢性游走性红斑病例曲线相一致,确证全沟硬蜱的媒介作用。     

福建省莱姆病的发现

血清学调查证实福建省8个县(市)林区人群存在莱姆病感染。根据流行病学、临床学和血清学确诊莱姆病典型病例6例,疑似病例9例。从蜱类中肠涂片见到典型的莱姆病螺旋体。     

湖南省平江县莱姆病调查研究

目的：调查湖南省平江县莱姆病的分布情况。方法：采用间接免疫荧光抗体法和直接荧光抗体染色法,于1999－2000年在平江县选点调查。结果：共查山林地区居民500人,血清抗莱姆病螺旋体抗体（IgG)阳性者32人,阳性率6.40%。38例临床和血清学确诊的莱姆病患者,其主要的临床表现有环形或慢性游走性红斑、关节炎、面神经麻痹、多发性神经炎、脑膜炎和心脏损害等。当地的蜱类以二棘血蜱为优势种,占85％,该蜱中肠携带莱姆病螺旋体率为12.0%(6/50)。结论：平江县存在莱姆病的自然疫源地,人群中有莱姆病的发生和流行。     

Patterns of Lyme disease diagnosis and treatment by family physicians in a southeastern state

This study examined how often physicians in Georgia diagnose and treat Lyme disease as well as the criteria they use to reach a diagnosis of Lyme disease. A survey was sent to 1,331 family physicians in Georgia concerning how many cases of Lyme disease the physicians diagnosed, and the criteria used to make the diagnosis, during the preceding 12 months. Of 710 responses, 167 physicians treated 316 cases of Lyme disease without a firm diagnosis. In addition, 125 physicians diagnosed 262 cases of Lyme disease, 130 without serologic testing and 132 with serologic testing. Family Physicians in Georgia diagnose Lyme disease at a rate 40 times greater than the surveillance case rate reported in Georgia.     

Predisposing factors for individuals' Lyme disease prevention practices: Connecticut, Maine, and Montana.

OBJECTIVES: This study examined factors that predispose individuals to protect against Lyme disease. METHODS: Knowledge, attitude, and practice questions concerning Lyme disease prevention were included in the Behavioral Risk Factor Surveillance surveys in Connecticut, Maine, and Montana. A total of 4246 persons were interviewed. RESULTS: Perceived risk of acquiring Lyme disease, knowing anyone with Lyme disease, knowledge about Lyme disease, and believing Lyme disease to be a common problem were significantly associated with prevention practices. CONCLUSIONS: Predisposing factors differ substantially between states and appear related to disease incidence. Personal risk, knowing someone with Lyme disease, and cognizance about Lyme disease and acting on this information are consistent with social learning theories.     

No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders,United States, 2001–2010

Associations between Lyme disease and certain neurodegenerative diseases have been proposed, but supportive evidence for an association is lacking. Similar geographic distributions would be expected if 2 conditions were etiologically linked. Thus, we compared the distribution of Lyme disease cases in the United States with the distributions of deaths due to Alzheimer disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson disease; no geographic correlations were identified. Lyme disease incidence per US state was not correlated with rates of death due to ALS, MS, or Parkinson disease; however, an inverse correlation was detected between Lyme disease and Alzheimer disease. The absence of a positive correlation between the geographic distribution of Lyme disease and the distribution of deaths due to Alzheimer disease, ALS, MS, and Parkinson disease provides further evidence that Lyme disease is not associated with the development of these neurodegenerative conditions.