Gajović Olgica, Todorović Zoran, Nesić Ljiljana, Lazić Zorića
Klinika za infektivne bolesti, Klinicki centar Kragujevac, Kragujevac.
Med Pregl. 2010 Nov-Dec;63(11-12):839-43. doi: 10.2298/mpns1012839g.
Lyme borreliosis is a multi-systemic disease caused by spirochete Borrelia burgdorferi sensu lato. The specific response is influenced by phenotypic characteristics of Borrelia, different antigen structure, their different geographic distribution, and the patient's capability to react to the infection. The immune response to Borrelia burgdorferi sensu lato develops relatively late, whereas in some patients it never develops. The immune response in the early phase of Lyme borreliosis is very similar to the one of healthy population.
Clinical manifestation, detailed anamnesis and epidemiological data are crucial for making the diagnosis. The majority of patients in the late phase of Lyme borreliosis have IgG antibody response, which could be followed by IgM also throughout this period of time. The number of serologically positive findings increases with the duration of the infection. Specific borrelial antigens can be detected by a Western blot test. In patients with neuroborreliosis, antibodies could be synthesized only intrathecally. IgG and IgM antibody response can persist for many years after the treatment. There is no positive serological test, which could be the indicator of the disease activity on its own; even if it demonstrates high antibody titre. If there are no clinical signs of Lyme borreliosis, the diagnosis of Lyme borreliosis should be primarily based on clinical findings, and serological results should be used only to confirm but not to make the diagnosis of Lyme borreliosis. Specific antibodies from the IgM class can be proved in about 50% of patients, 2 to 4 weeks after the onset of primary infection, but an early administration of the antibiotics can postpone or inhibit that response.
When interpreting the serological test results with high level of sensitivity and specificity used for making diagnosis of Lyme borreliosis, it is necessary to take into consideration the seroprevalence in a certain region. In the population with a low prevalence of the disease, the tests will have a low positive predicative value, i.e. the probability of indicating the real disease will be lower. According to the recommendations given by the Centre for Disease Control in North America, all extreme and positive results of EA and IFA are to be confirmed by a Western blot test.
The main problem in making diagnosis of Lyme borreliosis is underestimation and overrating of the diagnosis. Not a single positive serologic test is the indicator of the disease activity on its own, regardless of the antibodies titre level, when clear clinical signs are scarce.
莱姆病是一种由伯氏疏螺旋体狭义种引起的多系统疾病。具体反应受伯氏疏螺旋体的表型特征、不同的抗原结构、其不同的地理分布以及患者对感染的反应能力影响。对伯氏疏螺旋体狭义种的免疫反应发展相对较晚，而在一些患者中它从未发展。莱姆病早期的免疫反应与健康人群的免疫反应非常相似。
临床表现、详细的病史和流行病学数据对做出诊断至关重要。莱姆病晚期的大多数患者有IgG抗体反应，在此期间IgM也可能出现。血清学阳性结果的数量随感染持续时间增加。特定的伯氏疏螺旋体抗原可通过蛋白质印迹试验检测。在神经莱姆病患者中，抗体仅在鞘内合成。IgG和IgM抗体反应在治疗后可能持续多年。没有一种阳性血清学检测结果本身可以作为疾病活动的指标；即使它显示出高抗体滴度。如果没有莱姆病的临床症状，莱姆病的诊断应主要基于临床发现，血清学结果仅用于确诊而非用于诊断莱姆病。在原发性感染开始后2至4周，约50%的患者可检测到IgM类特异性抗体，但早期使用抗生素可推迟或抑制该反应。
在解释用于诊断莱姆病的具有高灵敏度和特异性的血清学检测结果时，有必要考虑特定地区的血清流行率。在疾病患病率低的人群中，检测的阳性预测值较低，即表明真正疾病的概率较低。根据北美疾病控制中心的建议，酶联免疫吸附试验（EA）和间接荧光抗体试验（IFA）的所有极端和阳性结果都要用蛋白质印迹试验确认。
莱姆病诊断的主要问题是对诊断的低估和高估。当缺乏明确的临床症状时，没有一个阳性血清学检测结果本身可以作为疾病活动的指标，无论抗体滴度水平如何。
