利用行政索赔数据对美国莱姆病与莱姆病治疗后综合征进行系统比较。
Systematic comparisons between Lyme disease and post-treatment Lyme disease syndrome in the U.S. with administrative claims data.
机构信息
Harvard Medical School, Boston, MA, USA.
Northeastern University, Boston, MA, USA.
出版信息
EBioMedicine. 2023 Apr;90:104524. doi: 10.1016/j.ebiom.2023.104524. Epub 2023 Mar 21.
BACKGROUND
Post-treatment Lyme disease syndrome (PTLDS) is used to describe Lyme disease patients who have the infection cleared by antibiotic but then experienced persisting symptoms of pain, fatigue, or cognitive impairment. Currently, little is known about the cause or epidemiology of PTLDS.
METHODS
We conducted a data-driven study with a large nationwide administrative dataset, which consists of more than 98 billion billing and 1.4 billion prescription records between 2008 and 2016, to identify unique aspects of PTLDS that could have diagnostic and etiologic values. We defined PTLDS based on its symptomatology and compared the demographic, longitudinal changes of comorbidity, and antibiotic prescriptions between patients who have Lyme with absence of prolonged symptoms (APS) and PTLDS.
FINDINGS
The age and temporal distributions were similar between Lyme APS and PTLDS. The PTLDS-to-Lyme APS case ratio was 3.42%. The co-occurrence of 3 out of 19 chronic conditions were significantly higher in PTLDS versus Lyme APS-odds ratio and 95% CI for anemia, hyperlipidemia, and osteoarthrosis were 1.46 (1.11-1.92), 1.39 (1.15-1.68), and 1.62 (1.23-2.12) respectively. We did not find significant differences between PTLDS and Lyme APS for the number of types of antibiotics prescribed (incidence rate ratio = 1.009, p = 0.90) and for the prescription of each of the five antibiotics (FDR adjusted p values 0.72-0.95).
INTERPRETATION
PTLDS cases have more codes corresponding to anemia, hyperlipidemia, and osteoarthrosis compared to Lyme APS. Our finding of hyperlipidemia is consistent with a dysregulation of fat metabolism reported by other researchers, and further investigation should be conducted to understand the potential biological relationship between the two.
FUNDING
Steven & Alexandra Cohen Foundation, Global Lyme Alliance, and the Pazala Foundation; National Institutes of Health R01ES032470.
背景
治疗后莱姆病综合征（PTLDS）用于描述那些经抗生素治疗清除感染后仍持续存在疼痛、疲劳或认知障碍等症状的莱姆病患者。目前，人们对 PTLDS 的病因或流行病学知之甚少。
方法
我们对一个大型全国性行政数据集进行了数据驱动研究，该数据集包含 2008 年至 2016 年间超过 980 亿次计费和 14 亿次处方记录，以确定可能具有诊断和病因价值的 PTLDS 独特方面。我们根据其症状定义了 PTLDS，并比较了患有莱姆病且无持续性症状（APS）和 PTLDS 的患者的人口统计学、合并症的纵向变化以及抗生素处方。
结果
莱姆病 APS 和 PTLDS 的年龄和时间分布相似。PTLDS 与莱姆病 APS 的病例比为 3.42%。PTLDS 比莱姆病 APS 更常出现 19 种慢性疾病中的 3 种（比值比和 95%置信区间分别为贫血 1.46（1.11-1.92）、高脂血症 1.39（1.15-1.68）和骨关节炎 1.62（1.23-2.12））。我们没有发现 PTLDS 和莱姆病 APS 在开具抗生素的种类数量（发病率比=1.009，p=0.90）和五种抗生素的每种抗生素的处方（经 FDR 调整的 p 值为 0.72-0.95）之间存在显著差异。
解释
与莱姆病 APS 相比，PTLDS 病例的贫血、高脂血症和骨关节炎相关代码更多。我们发现高脂血症与其他研究人员报告的脂肪代谢失调一致，应进一步进行调查以了解两者之间的潜在生物学关系。
资金
史蒂文和亚历山德拉科恩基金会、全球莱姆病联盟和帕扎拉基金会；美国国立卫生研究院 R01ES032470。
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