Dressler F, Whalen J A, Reinhardt B N, Steere A C
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111.
J Infect Dis. 1993 Feb;167(2):392-400. doi: 10.1093/infdis/167.2.392.
There are currently no accepted criteria for positive Western blots in Lyme disease. In a retrospective analysis of 225 case and control subjects, the best discriminatory ability of test criteria was obtained by requiring at least 2 of the 8 most common IgM bands in early disease (18, 21, 28, 37, 41, 45, 58, and 93 kDa) and by requiring at least 5 of the 10 most frequent IgG bands after the first weeks of infection (18, 21, 28, 30, 39, 41, 45, 58, 66, and 93 kDa). When these definitions were tested in a prospective study of all 237 patients seen in a diagnostic Lyme disease clinic during a 1-year period and in 74 patients with erythema migrans or summer flu-like illnesses, the IgM blot in early disease had a sensitivity of 32% and a specificity of 100%; the IgG blot after the first weeks of infection had a sensitivity of 83% and a specificity of 95%. Among patients with indeterminate IgG responses by ELISA, 6 of 9 patients with active Lyme disease had positive blots compared with 2 of 34 patients with other illnesses (P < .001). Thus, Western blotting can be used to increase the specificity of serologic testing in Lyme disease.
目前莱姆病中尚无公认的蛋白免疫印迹阳性标准。在一项对225例病例和对照受试者的回顾性分析中，通过要求早期疾病中8种最常见的IgM条带（18、21、28、37、41、45、58和93 kDa）中至少出现2条，以及感染最初几周后10种最常见的IgG条带（18、21、28、30、39、41、45、58、66和93 kDa）中至少出现5条，可获得最佳的检测标准鉴别能力。当在一项前瞻性研究中对一家诊断性莱姆病诊所1年期间诊治的所有237例患者以及74例患有游走性红斑或夏季流感样疾病的患者进行这些定义测试时，早期疾病中的IgM印迹敏感性为32%，特异性为100%；感染最初几周后的IgG印迹敏感性为83%，特异性为95%。在ELISA检测IgG反应不确定的患者中，9例活动性莱姆病患者中有6例印迹呈阳性，而34例患有其他疾病的患者中有2例印迹呈阳性（P<0.001）。因此，蛋白免疫印迹可用于提高莱姆病血清学检测的特异性。
