St Mary's Hospital, Department of Medicine, Waterbury, CT, USA.
Lupus. 2011 Nov;20(13):1372-7. doi: 10.1177/0961203311414098. Epub 2011 Jul 5.
Antiphospholipid antibody (aPL) positive patients and patients with purported chronic Lyme disease ('CLD') share many clinical features. After identifying significant aPL in sera of several index patients with 'CLD', we performed aPL tests on all patients referred in whom 'CLD' was suspected, diagnosed or treated.
All patients with suspected, diagnosed or treated 'CLD' and reportedly 'positive' Lyme assays were studied. aPL testing included anticardiolipin antibodies (aCL), anti-beta-2-glycoprotein-1 antibodies (anti-β2GP1) and lupus anticoagulant (LAC). Patients were classified into four newly described categories of CLD and data was analyzed.
One hundred and six patients were evaluated, of whom 82% had neurologic symptoms and 51% rheumatologic symptoms. Eighty-eight of 106 (83%) patients had positive Lyme serologies (enzyme-linked immunosorbent assay [ELISA] 62/106, 58.4%; western blot [WB] 64/106, 60%), while 18/106 (16.9%) were negative or equivocal. aPL was found in all 'CLD' categories. aCL and/or anti-β2GP1 were positive in 85/106 (80%), with aCL present in 69/106 (65%) and anti-β2GP1 present in 69/106 (65%). For all assays, IgM isotypes predominated: WB 55/64 (85%), aCL 63/69 (91%), anti-β2GP1 52/69 (75%), aCL and/or anti-β2GP1 74/85 (87%). Anti-β2GP1 assays occurred in higher titer than aCL: 36/69 (52%) versus 63/69 (91%), p<0.001. Seventeen patients had aPL-related events. Only 12/106 (11.3%) had true post-Lyme syndromes (PLS), category IV, or late Lyme disease (LLD). Most patients had been treated for Lyme: 82/106 (79%).
aPL occurs frequently in patients with 'CLD'. IgM anti-β2GP1, IgM aCL and IgM WB were frequently found. Documented PLS or LLD was uncommon. The role of aPL in patients with 'CLD' needs further investigation.
抗磷脂抗体 (aPL) 阳性患者和所谓的慢性莱姆病 ('CLD') 患者有许多共同的临床特征。在确定了几个疑似 'CLD' 的索引患者血清中存在显著的 aPL 后，我们对所有疑似、确诊或接受治疗的 'CLD' 患者进行了 aPL 检测。
研究了所有疑似、确诊或接受治疗的 'CLD' 和据称 '阳性' 的莱姆病检测的患者。aPL 检测包括抗心磷脂抗体 (aCL)、抗β-2-糖蛋白 1 抗体 (anti-β2GP1) 和狼疮抗凝剂 (LAC)。患者被分为新描述的四种 CLD 类别，并进行数据分析。
评估了 106 名患者，其中 82%有神经系统症状，51%有风湿症状。106 名患者中有 88 名（83%）的莱姆血清学检测呈阳性（酶联免疫吸附试验 [ELISA] 62/106，58.4%；Western blot [WB] 64/106，60%），而 18/106（16.9%）为阴性或不确定。所有 'CLD' 类别均发现 aPL。106 名患者中有 85/106（80%）aCL 和/或抗-β2GP1 阳性，其中 69/106（65%）有 aCL，69/106（65%）有抗-β2GP1。所有检测中，IgM 同种型为主：WB 55/64（85%）、aCL 63/69（91%）、抗-β2GP1 52/69（75%）、aCL 和/或抗-β2GP1 74/85（87%）。抗-β2GP1 检测的滴度高于 aCL：36/69（52%）与 63/69（91%）相比，p<0.001。17 名患者发生了与 aPL 相关的事件。仅有 12/106（11.3%）为真正的莱姆后综合征（PLS），类别 IV 或晚期莱姆病（LLD）。大多数患者曾接受过莱姆病治疗：82/106（79%）。
aPL 在 'CLD' 患者中频繁发生。IgM 抗-β2GP1、IgM aCL 和 IgM WB 经常发现。有记录的 PLS 或 LLD 并不常见。aPL 在 'CLD' 患者中的作用需要进一步研究。
