Department of Neurology, Sørlandet Hospital HF, Kristiansand, Norway.
Eur J Neurol. 2010 Jan;17(1):118-23. doi: 10.1111/j.1468-1331.2009.02756.x. Epub 2009 Jul 23.
To chart remaining complaints 1 year after treatment for neuroborreliosis, and to identify risk factors for a non-favorable outcome.
We followed patients treated for neuroborreliosis prospectively, and assessed outcome by a composite clinical score. The impact on outcome of clinical, demographic and laboratory factors were analyzed by univariate analyses and logistic regression.
Out of 85 patients 41 (48%) had remaining complaints; 14 had objective findings and 27 subjective symptoms. Remaining complaints were associated with pre-treatment symptom duration >or=6 weeks (OR = 4.062, P = 0.044), high pre-treatment cerebrospinal fluid (CSF) cell count (OR = 1.005, P = 0.001), and female gender (OR = 3.218, P = 0.025). Presence of CSF oligoclonal bands (OCBs) was not analyzed in the logistic regression model due to many missing observations, but was found to be more frequent both pre-treatment (P = 0.004) and after 12 months (P = 0.015) among patients with remaining complaints as compared to patients with complete recovery. Further evaluation showed that objective remaining findings, and not subjective symptoms, were associated with pre-treatment symptom duration >or=6 weeks. No difference in outcome was observed between patients treated with IV ceftriaxone and patients treated with oral doxycycline.
Remaining complaints are common after neuroborreliosis. The majority of the complaints are subjective. Pre-treatment symptom duration >or=6 weeks, high pre-treatment CSF cell count, and female gender seem to be risk factors for remaining complaints. Presence of CSF OCBs may also predict a non-favorable outcome, but this should be further studied. Whether subjective and objective complaints are associated with different risk factors is also an issue for future studies.
绘制神经莱姆病治疗 1 年后的剩余症状，并确定不良结局的风险因素。
我们前瞻性地随访了接受神经莱姆病治疗的患者，并通过综合临床评分评估了结局。通过单变量分析和逻辑回归分析了临床、人口统计学和实验室因素对结局的影响。
85 例患者中有 41 例（48%）存在剩余症状；14 例有客观发现，27 例有主观症状。剩余症状与治疗前症状持续时间≥6 周（OR=4.062，P=0.044）、高治疗前脑脊液（CSF）细胞计数（OR=1.005，P=0.001）和女性（OR=3.218，P=0.025）相关。由于许多缺失的观察结果，CSF 寡克隆带（OCB）的存在未在逻辑回归模型中进行分析，但发现在有剩余症状的患者中，无论是治疗前（P=0.004）还是治疗后 12 个月（P=0.015），OCB 的出现频率均高于完全康复的患者。进一步评估显示，与治疗前症状持续时间≥6 周相关的是客观的剩余发现，而不是主观症状。接受静脉头孢曲松治疗和口服多西环素治疗的患者之间，结局没有差异。
神经莱姆病后常见剩余症状。大多数症状是主观的。治疗前症状持续时间≥6 周、高治疗前 CSF 细胞计数和女性似乎是剩余症状的风险因素。CSF OCB 的存在也可能预示着不良结局，但这需要进一步研究。主观和客观症状是否与不同的风险因素相关，也是未来研究的问题。
