Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pathology, New York University, New York, New York, USA.
J Clin Microbiol. 2019 Jan 2;57(1). doi: 10.1128/JCM.01406-18. Print 2019 Jan.
In the United States, laboratories frequently offer multiple different assays for testing of cerebrospinal fluid (CSF) samples to provide laboratory support for the diagnosis of central nervous system Lyme disease (CNSLD). Often included among these diagnostic tests are the same enzyme immunoassays and immunoblots that are routinely used to detect the presence of antibodies to in serum. However, performing these assays on CSF alone may yield positive results simply from passive diffusion of serum antibodies into the CSF. In addition, such tests are only U.S. Food and Drug Administration cleared and well validated for testing serum, not CSF. When performed using CSF, positive results from these assays do not establish the presence of intrathecal antibody production to and therefore should not be offered. The preferred test to detect intrathecal production of antibodies to is the antibody index assay, which corrects for passive diffusion of serum antibodies into CSF and requires testing of paired serum and CSF collected at approximately the same time. However, this assay also has limitations and should only be used to establish a diagnosis of CNSLD in conjunction with patient exposure history, clinical presentation, and other laboratory findings.
在美国，实验室经常提供多种不同的检测方法来检测脑脊液 (CSF) 样本，为中枢神经系统莱姆病 (CNSLD) 的诊断提供实验室支持。这些诊断检测通常包括与血清中存在的抗体检测相同的酶免疫分析和免疫印迹，用于检测 。然而，仅在 CSF 上进行这些检测可能会因血清抗体被动扩散到 CSF 中而产生阳性结果。此外，这些测试仅获得美国食品和药物管理局批准并经过良好验证，可用于检测血清，而不是 CSF。当使用 CSF 进行检测时，这些检测的阳性结果并不能确定针对 的鞘内抗体产生，因此不应提供这些检测。检测针对 的鞘内抗体产生的首选测试是抗体指数测试，该测试可纠正血清抗体向 CSF 的被动扩散，并且需要在大约相同的时间采集配对的血清和 CSF 进行检测。然而，该检测也存在局限性，并且仅应与患者暴露史、临床表现和其他实验室发现一起使用，以确立 CNSLD 的诊断。
