Bartůnĕk P, Mrázek V, Gorican K, Bína R, Listvanová S, Zapletalová J
Department of Internal Medicine IV, Charles University School of Medicine I, Prague, Czech Republic.
Wien Klin Wochenschr. 2001 Jan 15;113(1-2):38-44.
Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date.
The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB.
Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels.
The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae.
Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.
尽管莱姆心肌炎的发病率不高，但在诊断方面却是最具挑战性的病症之一。迄今为止，尚无长期研究有助于扩大我们对其发病情况以及这种莱姆病（LB）最常见的人兽共患病形式的自然病程的认识。
作者试图描述和评估一种较罕见的莱姆心肌炎（LC）的后果。对以下方面进行了评估：a）LC较罕见临床表现的形式、自然史和后遗症；b）抗生素治疗对莱姆病晚期表现的作用。
从1987年至2000年随访期间连续60例确诊为LC的患者中选取3例。1号患者因心肌炎伴频发室性早搏接受随访，2号患者因心包炎接受随访，3号患者因扩张型心肌病作为莱姆病的晚期表现接受随访。除了入院时的常规检查外，患者还接受了标准的12导联心电图、连续24小时动态心电图监测、运动试验（自行车测力计）、酶联免疫吸附测定（ELISA）和免疫印迹法检测抗体、甲状腺检查（T3、T4、促甲状腺激素检测）和矿物质水平检测。
研究表明临床病程与特异性抗体水平之间无显著相关性。这证实了疾病初期抗生素治疗不足或未进行治疗对晚期后遗症的发生有重大影响这一观点。
基于对3例有较罕见但临床上紧急发现的患者的长期治疗，作者得出结论，即使是相对严重的临床病程，在数年之后对受影响个体也没有重大限制。
