Department of Internal Medicine and Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Location AMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
EBioMedicine. 2023 Dec;98:104825. doi: 10.1016/j.ebiom.2023.104825. Epub 2023 Nov 27.
Patients treated for Lyme borreliosis (LB) frequently report persistent symptoms. Little is known about risk factors and etiology.
In a prospective observational cohort study with a follow-up of one year, we assessed a range of microbiological, immunological, genetic, clinical, functional, epidemiological, psychosocial and cognitive-behavioral variables as determinants of persistent symptoms after treatment for LB. Between 2015 and 2018 we included 1135 physician-confirmed LB patients at initiation of antibiotic therapy, through clinical LB centers and online self-registration. Two reference cohorts of individuals without LB (n = 4000 and n = 2405) served as a control. Prediction analyses and association studies were used to identify determinants, as collected from online questionnaires (three-monthly) and laboratory tests (twice).
Main predictors of persistent symptoms were baseline poorer physical and social functioning, higher depression and anxiety scores, more negative illness perceptions, comorbidity, as well as fatigue, cognitive impairment, and pain in 295 patients with persistent symptoms. The primary prediction model correctly indicated persistent symptoms in 71.0% of predictions (AUC 0.79). In patients with symptoms at baseline, cognitive-behavioral responses to symptoms predicted symptom persistence. Of various microbiological, immunological and genetic factors, only lower IL-10 concentrations in ex vivo stimulation experiments were associated with persistent symptoms. Clinical LB characteristics did not contribute to the prediction of persistent symptoms.
Determinants of persistent symptoms after LB were mainly generic, including baseline functioning, symptoms and cognitive-behavioral responses. A potential role of host immune responses remains to be investigated.
Netherlands Organisation for Health Research and Development (ZonMw); the Dutch Ministry of Health, Welfare and Sport (VWS).
接受莱姆病（LB）治疗的患者常报告持续性症状。但对于其危险因素和病因知之甚少。
在一项为期一年的前瞻性观察队列研究中，我们评估了一系列微生物学、免疫学、遗传学、临床、功能、流行病学、心理社会和认知行为变量，作为治疗 LB 后持续性症状的决定因素。在 2015 年至 2018 年间，我们通过临床 LB 中心和在线自我注册，在开始抗生素治疗时纳入了 1135 名经医生确诊的 LB 患者。两个无 LB 的参考队列（n=4000 和 n=2405）作为对照。预测分析和关联研究用于识别从在线问卷（每三个月一次）和实验室测试（每两个月一次）收集的决定因素。
持续性症状的主要预测因素是基线时较差的身体和社会功能、较高的抑郁和焦虑评分、更消极的疾病认知、合并症，以及 295 名持续性症状患者的疲劳、认知障碍和疼痛。主要预测模型正确预测了 71.0%的持续性症状（AUC 0.79）。在基线有症状的患者中，对症状的认知行为反应可预测症状的持续存在。在各种微生物学、免疫学和遗传学因素中，仅体外刺激实验中较低的 IL-10 浓度与持续性症状相关。临床 LB 特征无助于预测持续性症状。
LB 后持续性症状的决定因素主要是一般性的，包括基线功能、症状和认知行为反应。宿主免疫反应的潜在作用仍有待研究。
荷兰健康研究与发展组织（ZonMw）；荷兰卫生部、福利和体育部（VWS）。
