Analysis of Borrelia burgdorferi Genotypes in Patients With Lyme Arthritis High Frequency of Ribosomal RNA Intergenic Spacer Type 1 Strains in Antibiotic-Refractory Arthritis
Analysis of Borrelia burgdorferi Genotypes in Patients With Lyme Arthritis High Frequency of Ribosomal RNA Intergenic Spacer Type 1 Strains in Antibiotic-Refractory Arthritis
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DOI：
10.1002/art.24812
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发表时间：
2009-07-01
影响因子：
--
通讯作者：
Steere, Allen C.
中科院分区：
文献类型：
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作者：
Jones, Kathryn L.;McHugh, Gail A.;Steere, Allen C.
Objective.大多数伯氏疏螺旋体基因型已从莱姆病患者的游走性红斑（EM）皮肤病变中分离出来。OspC K型菌株是16 S-23 S核糖体RNA基因间间隔区2型（RST 2）菌株，最常回收，但在血液中可检测到较高百分比的OspC A型菌株（RST 1），其次是最常回收的类型。本研究的目的是确定B burgdorferi基因型在关节莱姆关节炎患者。通过半巢式聚合酶链反应（PCR）和测序分析了30年内观察到的124例患者的关节液样本的OspC类型，并通过巢式PCR和限制性片段长度多态性分析分析了RST。这些结果与临床结果相关。在124份关节液样本中的49份（40%）中鉴定出OspC和OspB基因型。在这49份样本中，在21份样本（43%）中鉴定出OspC K型菌株（RST 2），在11份样本（22%）中鉴定出OspC A型菌株（RST 1），在其余17份样本（35%）中鉴定出8种其他OspC类型和所有3种RST。但在17例按照现行指南使用抗生素的患者中，感染RST 1菌株的7例患者均发生难治性关节炎，而感染RST 2菌株的6例患者中有4例发生难治性关节炎，感染RST 3菌株的4例患者中仅有1例发生难治性关节炎（P = 0.03）。大多数B burgdorferi基因型，特别是OspC K型（RST 2），在莱姆关节炎患者的关节液中发现，关节中发现的基因型频率反映了EM皮肤病变中的基因型频率。然而，RST 1菌株在难治性关节炎患者中最常见。本研究结果有助于进一步了解B burgdorferi菌株的致病性差异。
Objective. Most of the Borrelia burgdorferi genotypes have been isolated from erythema migrans (EM) skin lesions in patients with Lyme disease. OspC type K strains, which are 16S-23S ribosomal RNA intergenic spacer type 2 (RST2) strains, are most commonly recovered, but a higher percentage of OspC type A strains (RST1), the next most commonly recovered type, is detectable in blood. The goal of this study was to determine the B burgdorferi genotypes in the joints of patients with Lyme arthritis.Methods. Joint fluid samples from 124 patients seen over a 30-year period were analyzed for OspC types by semi-nested polymerase chain reaction (PCR) and sequencing, and for RSTs by nested PCR and restriction fragment length polymorphism analysis. These results were correlated with clinical outcome.Results. OspC and RST genotypes were identified in 49 of the 124 joint fluid samples (40%). In these 49 samples, OspC type K strains (RST2) were identified in 21 samples (43%), OspC type A strains (RST1) were identified in 11 samples (22%), and 8 other OspC types and all 3 RSTs were identified among the remaining 17 samples (35%). However, among the 17 patients who had been treated with antibiotics according to current guidelines, all 7 patients who were infected with RST1 strains had antibiotic-refractory arthritis, compared with 4 of 6 patients infected with RST2 strains and only I of 4 infected with RST3 strains (P = 0.03).Conclusion. Most of the B burgdorferi genotypes, particularly OspC type K (RST2), were identified in the joint fluid of patients with Lyme arthritis, and the genotype frequencies found in joints reflected those in EM skin lesions. However, RST1 strains were most frequent in patients with antibiotic-refractory arthritis. Our results help to further the understanding of the differential pathogenicity of strains of B burgdorferi.