Schutzer S E, Coyle P K, Belman A L, Golightly M G, Drulle J
Department of Medicine, University of Medicine and Dentistry-New Jersey Medical School, Newark 07103.
Lancet. 1990 Feb 10;335(8685):312-5. doi: 10.1016/0140-6736(90)90606-6.
To find out whether apparent seronegativity in patients strongly suspected of having Lyme disease can be due to sequestration of antibodies in immune complexes, such complexes were isolated and tested for antibody to Borrelia burgdorferi. In a blinded analysis the antibody was detected in all 10 seronegative Lyme disease patients with erythema chronicum migrans (ECM), in none of 19 patients with other diseases, and in 4 of 12 seronegative patients who probably had Lyme disease but had no ECM. These findings were confirmed by western blot, which also showed that immune complex dissociation liberated mainly antibody reactive to the 41 kD antigen and sometimes antibody to an approximate 30 kD antigen. Complexed B burgdorferi antibody was also found in 21 of 22 (95%) of seropositive patients with active disease, 3 additional seronegative but cell mediated immune reactive patients, and 3 other seronegative patients who eventually became seropositive. Apparent B burgdorferi seronegativity in serum immune complexes may thus be due to sequestration of antibody in immune complexes.
为了确定高度怀疑患有莱姆病的患者出现血清学阴性是否可能是由于抗体被隔离在免疫复合物中，对这些复合物进行了分离，并检测了抗伯氏疏螺旋体抗体。在一项盲法分析中，在所有10例患有慢性游走性红斑（ECM）的血清学阴性莱姆病患者中均检测到了抗体，在19例患有其他疾病的患者中均未检测到，在12例可能患有莱姆病但无ECM的血清学阴性患者中有4例检测到。这些发现通过蛋白质印迹法得到了证实，蛋白质印迹法还显示免疫复合物解离主要释放出对41 kD抗原具有反应性的抗体，有时还释放出对大约30 kD抗原的抗体。在22例血清学阳性的活动性疾病患者中的21例（95%）、另外3例血清学阴性但细胞介导免疫反应阳性的患者以及最终转为血清学阳性的其他3例血清学阴性患者中也发现了与伯氏疏螺旋体结合的抗体。因此，血清免疫复合物中出现的明显的伯氏疏螺旋体血清学阴性可能是由于抗体被隔离在免疫复合物中。
