Christova I, Tasseva E, Stamenov B, Sabev K
National Center of Infectious and Parasitic Disease, Sofia, Bulgaria.
Int J Immunopathol Pharmacol. 2000 May-Aug;13(2):99-106.
Borrelia burgdorferi, the causative agent of Lyme borreliosis may affect both the central and the peripheral nervous system causing neuroborreliosis. In Europe neuroborreliosis is the most frequent manifestation of late Lyme borreliosis. In this study we investigated characteristics of intrathecal antibody synthesis in patients with neuroborreliosis. Our goal was also to reveal to what extend anti - B.burgdorferi antibody detection in serum correlates to anti - B.burgdorferi antibody detection in CSF. We examined 266 patients with clinically suspected neuroborreliosis, and found serologic evidence of B.burgdorferi infection in 94 (35 percent). By calculation of IgG and IgM specific antibody indices, we detected intrathecal antibody production in 49 (18 percent) of patients. IgM antibody response dominated in the cerebrospinal fluid (CSF) samples and IgG antibody response was prevalent in the serum samples. Manifestations of neuroborreliosis included cranial nerve affection (n=12), radiculitis (n=10), meningoradiculitis (n=11), encephalopathy (n=7), radiculomyelitis (n=6), and encephalitis (n=3). No patients with either MS-like syndrome (n=15) or motor neurone disease (n=8) had intrathecal B.burgdorferi-specific antibody production despite positive serum reaction for the specific antibodies. Most of the patients with documented intrathecal antibody synthesis (42/49-86 percent) improved significantly after etiologic treatment. In the rest of patients, mainly those with long-terming neurological disorders, the improvement was partial and temporal. We concluded, that detection of antibodies against B.burgdorferi in serum should always be completed with detection of intrathecal antibody synthesis in CSF in order to confirm clinical diagnosis of neuroborreliosis.
莱姆病螺旋体是莱姆病的病原体，可影响中枢神经系统和周围神经系统，导致神经型莱姆病。在欧洲，神经型莱姆病是晚期莱姆病最常见的表现形式。在本研究中，我们调查了神经型莱姆病患者鞘内抗体合成的特征。我们的目标还包括揭示血清中抗伯氏疏螺旋体抗体检测与脑脊液中抗伯氏疏螺旋体抗体检测的相关程度。我们检查了266例临床疑似神经型莱姆病的患者，发现94例（35%）有伯氏疏螺旋体感染的血清学证据。通过计算IgG和IgM特异性抗体指数，我们在49例（18%）患者中检测到鞘内抗体产生。脑脊液样本中以IgM抗体反应为主，血清样本中以IgG抗体反应为主。神经型莱姆病的表现包括颅神经受累（n = 12）、神经根炎（n = 10）、脑膜神经根炎（n = 11）、脑病（n = 7）、神经根脊髓炎（n = 6）和脑炎（n = 3）。尽管特异性抗体血清反应呈阳性，但15例疑似多发性硬化综合征患者和8例运动神经元病患者均未出现鞘内伯氏疏螺旋体特异性抗体产生。大多数有记录的鞘内抗体合成患者（42/49，86%）在病因治疗后有显著改善。其余患者，主要是那些患有长期神经系统疾病的患者，改善是部分的且是暂时的。我们得出结论，血清中抗伯氏疏螺旋体抗体的检测应始终辅以脑脊液中鞘内抗体合成的检测，以确诊神经型莱姆病的临床诊断。
