Department of Clinical Chemistry, Kalmar County Hospital, SE-391 85 Kalmar, Sweden.
BMC Infect Dis. 2010 Feb 5;10:20. doi: 10.1186/1471-2334-10-20.
Persistent symptoms after treatment for neuroborreliosis are common for reasons mainly unknown. These symptoms are often unspecific and could be caused by dysfunctions in endocrine systems, an issue that has not been previously addressed systematically. We therefore mapped hormone levels in patients with previous confirmed Lyme neuroborreliosis of different outcomes and compared them with a healthy control group.
Twenty patients of a retrospective cohort of patients treated for definite Lyme neuroborreliosis were recruited 2.3 to 3.7 years (median 2.7) after diagnosis, together with 23 healthy controls. Lyme neuroborreliosis patients were stratified into two groups according to a symptom/sign score. All participants underwent anthropometric and physiological investigation as well as an extensive biochemical endocrine investigation including a short high-dose adrenocorticotropic hormone stimulation (Synacthen) test. In addition to hormonal status, we also examined electrolytes, 25-hydroxy-vitamin D and interleukin-6.
Eight patients (40%) had pronounced symptoms 2-3 years after treatment. This group had a higher cortisol response to synacthen as compared with both controls and the Lyme neuroborreliosis patients without remaining symptoms (p < 0.001 for both comparisons). No other significant differences in the various baseline biochemical parameters, anthropometric or physiological data could be detected across groups.
Apart from a positive association between the occurrence of long-lasting complaints after Lyme neuroborreliosis and cortisol response to synacthen, no corticotropic insufficiency or other serious hormonal dysfunction was found to be associated with remaining symptoms after treatment for Lyme neuroborreliosis.
神经莱姆病治疗后持续存在症状的原因主要未知。这些症状通常是不特异的，可能是内分泌系统功能障碍引起的，而这个问题以前没有被系统地解决过。因此，我们绘制了不同结局的既往确诊莱姆神经Borreliosis 患者的激素水平，并将其与健康对照组进行了比较。
我们招募了 20 名回顾性队列中接受过明确莱姆神经Borreliosis 治疗的患者，在诊断后 2.3 至 3.7 年（中位数 2.7 年）时入组，同时还招募了 23 名健康对照组。根据症状/体征评分，将莱姆神经Borreliosis 患者分为两组。所有参与者均接受了人体测量学和生理学检查，以及广泛的生化内分泌检查，包括短期高剂量促肾上腺皮质激素刺激（Synacthen）试验。除了激素状态外，我们还检查了电解质、25-羟维生素 D 和白细胞介素-6。
8 名患者（40%）在治疗后 2-3 年出现明显症状。与对照组和无残留症状的莱姆神经Borreliosis 患者相比，该组对 Synacthen 的皮质醇反应更高（两者比较 p < 0.001）。在各组之间，没有发现其他基线生化参数、人体测量学或生理学数据的显著差异。
除了莱姆神经Borreliosis 后长期存在的投诉与 Synacthen 皮质醇反应之间存在正相关外，在莱姆神经Borreliosis 治疗后仍存在症状的患者中，未发现促皮质激素不足或其他严重的激素功能障碍。
