Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
Department of Medical Chemistry and Clinical Biochemistry, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic.
Folia Microbiol (Praha). 2024 Dec;69(6):1355-1362. doi: 10.1007/s12223-024-01173-0. Epub 2024 Jun 13.
Lyme arthritis, one of the possible late manifestations of Lyme borreliosis, predominantly affects the supporting joints and in adults most often occurs in the form of monoarthritis of the knee. Early diagnosis is based on clinical findings and serology. PCR detection of Borrelia in synovial fluid has become an integral part of the laboratory testing algorithm. The clinical presentation and inflammatory markers in Lyme arthritis can resemble septic arthritis. Determining the levels of alpha-defensins (human neutrophil peptide (HNP 1-3)) in synovial fluid by liquid chromatography is a highly sensitive method revealing the presence of inflammatory process. Between 2020 and 2022, we examined eleven patients with Lyme arthritis of the knee. We measured levels of HNP 1-3 from synovial fluid by HPLC in patients, and we compared it with the corresponding C-reactive protein (CRP) levels in paired serum samples. In patients diagnosed with Lyme arthritis, HNP 1-3 levels in synovial fluid ranged from 2.5 to 261 mg/L, with a median of 46.5 mg/L. Average serum CRP was 43 mg/L. The results show that elevated HNP 1-3 can be consistent with not only septic arthritis or systemic disease, but also with Lyme arthritis, especially in patients with negative culture and 16S PCR from synovial fluid. Final diagnosis must be verified by examination for anti-Borrelia antibodies from serum and synovial fluid. The aim of this work is to introduce an HPLC method for the determination of alpha-defensins as one of the possible diagnostic markers.
莱姆关节炎，即莱姆病的一种可能的晚期表现，主要影响支持关节，在成年人中最常以单关节炎的形式发生，主要累及膝关节。早期诊断基于临床发现和血清学。聚合酶链反应（PCR）检测滑液中的伯氏疏螺旋体已成为实验室检测算法的一个组成部分。莱姆关节炎的临床表现和炎症标志物与脓毒性关节炎相似。通过液相色谱法测定滑液中α-防御素（人中性粒细胞肽（HNP 1-3））的水平是一种高度敏感的方法，可以揭示炎症过程的存在。在 2020 年至 2022 年间，我们检查了 11 例膝关节莱姆关节炎患者。我们通过高效液相色谱法测量了患者滑液中 HNP 1-3 的水平，并将其与配对血清样本中的相应 C 反应蛋白（CRP）水平进行了比较。在诊断为莱姆关节炎的患者中，滑液中 HNP 1-3 的水平为 2.5 至 261mg/L，中位数为 46.5mg/L。平均血清 CRP 为 43mg/L。结果表明，升高的 HNP 1-3 不仅与脓毒性关节炎或全身性疾病一致，而且与莱姆关节炎一致，尤其是在滑液培养和 16S PCR 均为阴性的患者中。最终诊断必须通过检查血清和滑液中的抗伯氏疏螺旋体抗体来验证。本工作的目的是介绍一种 HPLC 方法来测定α-防御素，作为可能的诊断标志物之一。
