Bechtold Kathleen T, Rebman Alison W, Crowder Lauren A, Johnson-Greene Doug, Aucott John N
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Arch Clin Neuropsychol. 2017 Mar 1;32(2):129-141. doi: 10.1093/arclin/acw098.
Understanding the Lyme disease (LD) literature is challenging given the lack of consistent methodology and standardized measurement of symptoms and the impact on functioning. This prospective study incorporates well-validated measures to capture the symptom picture of individuals with early LD from time of diagnosis through 6-months post-treatment.
One hundred seven patients with confirmed early LD and 26 healthy controls were evaluated using standardized instruments for pain, fatigue, depressive symptoms, functional impact, and cognitive functioning.
Prior to antibiotic treatment, patients experience notable symptoms of fatigue and pain statistically higher than controls. After treatment, there are no group differences, suggesting that symptoms resolve and that there are no residual cognitive impairments at the level of group analysis. However, using subgroup analyses, some individuals experience persistent symptoms that lead to functional decline and these individuals can be identified immediately post-completion of standard antibiotic treatment using well-validated symptom measures.
Overall, the findings suggest that ideally-treated early LD patients recover well and experience symptom resolution over time, though a small subgroup continue to suffer with symptoms that lead to functional decline. The authors discuss use of standardized instruments for identification of individuals who warrant further clinical follow-up.
鉴于莱姆病（LD）文献缺乏一致的方法以及症状测量和功能影响的标准化，理解该领域的文献具有挑战性。这项前瞻性研究采用了经过充分验证的测量方法，以捕捉早期莱姆病患者从诊断时到治疗后6个月的症状情况。
使用标准化工具对107例确诊为早期莱姆病的患者和26名健康对照者进行疼痛、疲劳、抑郁症状、功能影响和认知功能方面的评估。
在抗生素治疗前，患者经历的疲劳和疼痛症状在统计学上显著高于对照组。治疗后，两组之间没有差异，这表明症状得到缓解，并且在组分析水平上没有残留的认知障碍。然而，通过亚组分析发现，一些个体经历持续症状，导致功能下降，并且使用经过充分验证的症状测量方法，在标准抗生素治疗完成后可立即识别出这些个体。
总体而言，研究结果表明，理想治疗的早期莱姆病患者恢复良好，症状会随着时间推移得到缓解，尽管一小部分亚组患者仍遭受导致功能下降的症状困扰。作者讨论了使用标准化工具来识别需要进一步临床随访的个体。
