Visser A E, Verduyn Lunel F M, Veldink J H, van den Berg L H
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht.
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Neurol. 2017 Jan;24(1):227-230. doi: 10.1111/ene.13197. Epub 2016 Nov 7.
Previous studies, mostly case reports and uncontrolled studies, provide a low level of evidence for the hypothesized link between Lyme disease and amyotrophic lateral sclerosis (ALS). In order to make evidence-based recommendations regarding testing for Borrelia burgdorferi antibodies in the diagnostic work-up for ALS, the objective of this study was to explore the evidence for an association between these antibodies and ALS in a case-control design including age-, gender- and residency-matched controls.
A total of 491 patients with ALS were matched to 982 controls. IgG titers against B. burgdorferi were determined by an enzyme-linked immunosorbent assay and, in the case of positivity or borderline results, a western blot was performed. Conditional logistic regression and Fisher's exact tests were used to compare the antibody titers or positivity between patients and controls.
No difference in seroprevalence of Borrelia was found between patients (4.1%) and controls (5.9%). Clinical characteristics and survival were similar between seropositive and seronegative patients. Moreover, patients with a spinal onset were not more frequently seropositive compared with patients with a bulbar onset (P = 0.47), and neither were patients with a short diagnostic delay of <6 months compared with controls (P = 0.69). None of the 20 patients with a diagnostic delay of <3 months tested positive for IgM antibodies, suggestive of a recent infection.
This large case-control study provides evidence for a lack of association between B. burgdorferi antibodies and ALS, and therefore does not support the inclusion of routine testing for these antibodies in the diagnostic work-up in patients with classical ALS.
既往研究大多为病例报告和非对照研究，为莱姆病与肌萎缩侧索硬化症（ALS）之间的假定联系提供的证据水平较低。为了在ALS诊断检查中就检测伯氏疏螺旋体抗体提出循证建议，本研究的目的是在一项包括年龄、性别和居住地匹配对照的病例对照设计中，探索这些抗体与ALS之间关联的证据。
总共491例ALS患者与982例对照进行匹配。通过酶联免疫吸附测定法测定针对伯氏疏螺旋体的IgG滴度，对于阳性或临界结果，进行免疫印迹检测。采用条件逻辑回归和Fisher精确检验比较患者与对照之间的抗体滴度或阳性率。
患者（4.1%）和对照（5.9%）之间伯氏疏螺旋体血清阳性率无差异。血清阳性和血清阴性患者的临床特征和生存率相似。此外，与延髓起病的患者相比，脊髓起病的患者血清阳性的频率并没有更高（P = 0.47），与对照相比，诊断延迟<6个月的患者血清阳性的频率也没有更高（P = 0.69）。20例诊断延迟<3个月的患者中，无一例IgM抗体检测呈阳性，提示近期感染。
这项大型病例对照研究提供了证据，表明伯氏疏螺旋体抗体与ALS之间不存在关联，因此不支持在经典ALS患者的诊断检查中纳入这些抗体的常规检测。
