CENTRAL-NERVOUS-SYSTEM ABNORMALITIES IN LYME NEUROBORRELIOSIS
CENTRAL-NERVOUS-SYSTEM ABNORMALITIES IN LYME NEUROBORRELIOSIS
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DOI：
10.1212/wnl.41.10.1571
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发表时间：
1991-10-01
期刊：
影响因子：
9.9
通讯作者：
WU, P
中科院分区：
文献类型：
--
作者：
HALPERIN, JJ;VOLKMAN, DJ;WU, P
中枢神经系统莱姆病中经常发生鞘内产生抗伯氏疏螺旋体抗体，但神经疏螺旋体病的可靠诊断仍然被认为是困难且有争议的。因此，我们评估了该测量方法在 103 名莱姆病患者中的效用。在 15 名莱姆脑膜神经根炎患者和 41 名对照者中，诊断特异性为 93%，敏感性为 87%。应用这种方法可以识别罕见的伯氏疏螺旋体相关的多灶性脑炎（脑部感染），并将其与较轻微的脑病或精神错乱状态区分开来；后者可能不需要中枢神经系统细菌侵入。脑炎累及白质的情况多于灰质；严重程度差别很大。在 6 名患有这种抗生素反应性脑炎的患者中，有 5 名 HLA DQw3（DQw7）呈阳性。我们的结论是：(1) 鞘内抗体产生的测量是中枢神经系统感染的可靠指标，(2) 北美神经疏螺旋体病包括与欧洲描述的相同范围的神经功能障碍，(3) HLA 分型可能有助于进一步了解严重中枢神经系统受累。
Intrathecal production of anti-Borrelia burgdorferi antibody occurs frequently in CNS Lyme, yet reliable diagnosis of neuroborreliosis is still considered difficult and controversial. Therefore, we assessed the utility of this measurement in 103 Lyme patients. Among 15 patients with Lyme meningoradiculitis and 41 controls, diagnostic specificity was 93% and sensitivity 87%. Application of this method permits the identification of a rare B burgdorferi-associated multifocal encephalitis (brain infection) and its differentiation from a milder encephalopathy, or confusional state; the latter may not require CNS bacterial invasion. The encephalitis involves white matter more often than gray; severity varies widely. Of six patients with this antibiotic-responsive encephalitis, five were positive for HLA DQw3(DQw7). We conclude that (1) measurement of intrathecal antibody production is a reliable indicator of CNS infection, (2) North American neuroborreliosis includes the same spectrum of neurologic dysfunction as described in Europe, and (3) HLA typing may be useful in furthering our understanding of severe CNS involvement.