Wilske B, Bader L, Pfister H W, Preac-Mursic V
Max-von-Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Universität München.
Fortschr Med. 1991 Jul 30;109(22):441-6.
The most common neurological manifestation of Lyme disease is lymphocytic meningoradiculitis (Banwarth's syndrome, stage II). In rare cases, chronic progressive encephalomyelitis (stage III) with symptoms similar to multiple sclerosis is observed. Antibodies against Borrelia burgdorferi are detectable in 70-90% of stage II cases, with IgM-antibodies predominating in the first two weeks, and IgG-antibodies thereafter. Detection of specific intrathecal antibodies is the best serodiagnostic parameter for diagnosing neuroborreliosis. With the aid of a CSF/serum index determination (on the basis of a comparison of IgG-antibody ELISA titers in CSF and serum with identical IgG concentrations) involvement of the nervous system was shown in 64% and 77%, respectively, of 76 stage II cases (diagnostic significance 98% and 100%, respectively). In particular when tertiary forms of the disease are suspected immunoblot techniques (Western blot, IEF-affinity blot) are recommended confirmatory tests.
莱姆病最常见的神经表现是淋巴细胞性脑膜炎神经根炎（班瓦特综合征，二期）。在罕见情况下，会观察到慢性进行性脑脊髓炎（三期），其症状与多发性硬化症相似。在二期病例中，70% - 90%可检测到抗伯氏疏螺旋体抗体，最初两周以IgM抗体为主，之后以IgG抗体为主。检测特异性鞘内抗体是诊断神经莱姆病的最佳血清学诊断参数。通过脑脊液/血清指数测定（基于脑脊液和血清中相同IgG浓度下IgG抗体ELISA滴度的比较），在76例二期病例中，分别有64%和77%显示神经系统受累（诊断意义分别为98%和100%）。特别是当怀疑疾病处于三期时，推荐使用免疫印迹技术（蛋白质印迹法、IEF亲和印迹法）作为确证试验。
