Duray P H, Steere A C
Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111.
Ann N Y Acad Sci. 1988;539:65-79. doi: 10.1111/j.1749-6632.1988.tb31839.x.
Lyme disease is capable of producing a wide variety of clinical pathologic conditions and lesions having in common histologic features of collagen-vascular disease. The plasma cell is an omnipotent inflammatory responder in most tissues involved by Lyme disease, ranging from relatively acute to lesions that have gone on for years. Vascular thickening also seems to be prominent, and in the dermis is accompanied by scleroderma-like collagen expansion. The disease in some ways resembles the responses seen in lupus erythematosus such as mild cerebritis with lymphocytes and plasma cells in the leptomeninges. Lymphoplasmacytic panniculitis of Lyme disease resembles lupus profundus, both in the infiltrate and the plasma cell-blood vessel relationship. The onion skin thickened vessels of the synovia resemble the vessels of lupus spleens, while the scleradermoid thickening of the dermis and various skin lesions of stage III Lyme disease suggest a collagen-vascular disorder. Finally, the perivascular lymphoid infiltrate in clinical myositis does not differ from that seen in polymyositis or dermatomyositis. All of these histologic derangements suggest immunologic damage in response to persistence of the spirochete, however few in number.
莱姆病能够引发多种临床病理状况和病变，这些病变具有胶原血管病的共同组织学特征。在大多数受莱姆病影响的组织中，浆细胞是一种全能的炎症反应细胞，病变范围从相对急性到持续数年的病变。血管增厚似乎也很显著，在真皮层会伴有硬皮病样的胶原增生。该疾病在某些方面类似于红斑狼疮所出现的反应，比如软脑膜有淋巴细胞和浆细胞浸润的轻度脑脊髓炎。莱姆病的淋巴细胞浆细胞性脂膜炎在浸润情况以及浆细胞与血管的关系方面类似于深部红斑狼疮。滑膜的洋葱皮样增厚血管类似于狼疮脾脏的血管，而真皮的硬皮病样增厚以及莱姆病三期的各种皮肤病变提示存在胶原血管疾病。最后，临床性肌炎中的血管周围淋巴细胞浸润与多发性肌炎或皮肌炎中的情况并无差异。所有这些组织学紊乱表明，尽管螺旋体数量很少，但机体对其持续存在会产生免疫损伤。
