CHRONIC NEUROLOGIC MANIFESTATIONS OF LYME-DISEASE
CHRONIC NEUROLOGIC MANIFESTATIONS OF LYME-DISEASE
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DOI：
10.1056/nejm199011223232102
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发表时间：
1990-11-22
影响因子：
158.5
通讯作者：
STEERE, AC
中科院分区：
文献类型：
--
作者：
LOGIGIAN, EL;KAPLAN, RF;STEERE, AC
背景和方法：莱姆病是由壁虱传播的伯氏疏螺旋体引起的疾病，与多种神经系统症状有关。为了进一步确定莱姆病的慢性神经系统异常，我们研究了27名患者(年龄范围从25岁到72岁)，既往有莱姆病的体征，目前有对伯氏杆菌免疫的证据，以及没有其他可识别原因的慢性神经系统症状。其中8名患者在感染发生后进行了8至12年的前瞻性随访。结果：在27名患者中，24名(89%)在发病1个月至14年后出现轻度脑病，以记忆力丧失、情绪变化或睡眠障碍为特征。在24名患者中，14名患者在神经心理测试中有记忆障碍，18名患者脑脊液蛋白水平升高，这是鞘内产生伯氏杆菌抗体的证据，或者两者兼而有之。27名患者中有19名(70%)患有多发性神经病，伴有神经根性疼痛或远端感觉异常；除了两名患者外，所有这些患者都有脑病。16例患者电生理检查为轴索性多发性神经病。1例白质脑炎伴不对称性痉挛双瘫，脑室周围白质病变，鞘内产生抗伯氏杆菌抗体。在27名患者中，相关症状包括疲劳(74%)、头痛(48%)、关节炎(37%)和听力损失(15%)。在检查时，慢性神经异常的出现时间从3个月到14岁，通常进展很小。在两周的静脉注射头孢曲松(每天2g)疗程6个月后，17名患者(63%)有改善，6名(22%)有改善但随后复发，4名(15%)病情没有变化。结论。在首次感染伯氏杆菌几个月到几年后，莱姆病患者可能会有慢性脑病、多发性神经病，或者不太常见的白质脑炎。这些慢性神经系统异常通常会在抗生素治疗后得到改善。
Background and Methods: Lyme disease, caused by the tick-borne spirochete Borrelia burgdorferi, is associated with a wide variety of neurologic manifestations. To define further the chronic neurologic abnormalities of Lyme disease, we studied 27 patients (age range, 25 to 72 years) with previous signs of Lyme disease, current evidence of immunity to B. burgdorferi, and chronic neurologic symptoms with no other identifiable cause. Eight of the patients had been followed prospectively for 8 to 12 years after the onset of infection. Results: Of the 27 patients, 24 (89 percent) had a mild encephalopathy that began 1 month to 14 years after the onset of the disease and was characterized by memory loss, mood changes, or sleep disturbance. Of the 24 patients, 14 had memory impairment on neuropsychological tests, and 18 had increased cerebrospinal fluid protein levels, evidence of intrathecal production of antibody to B. burgdoferi, or both. Nineteen of the 27 patients (70 percent) had polyneuropathy with radicular pain or distal paresthesia; all but two of these patients also had encephalopathy. In 16 patients electrophysiologic testing showed an axonal polyneuropathy. One patient had leukoencephalitis with asymmetric spastic diplegia, periventricular white-matter lesions, and intrathecal production of antibody to B. burgdorferi. Among the 27 patients, associated symptoms included fatigue (74 percent), headache (48 percent), arthritis (37 percent), and hearing loss (15 percent). At the time of examination, chronic neurologic abnormalities had been present from 3 months to 14 years, usually with little progression. Six months after a two-week course of intravenous ceftriaxone (2 g daily), 17 patients (63 percent) had improvement, 6 (22 percent) had improvement but then relapsed, and 4 (15 percent) had no change in their condition. Conclusions. Months to years after the initial infection with B. burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis. These chronic neurologic abnormalities usually improve with antibiotic therapy.