聚合酶链法检测莱姆病患者尿液中伯氏疏螺旋体DNA(附17例报道)  

Evaluation of the Detection of Borrelia burgdorferi DNA in Urine Samples by Polymerase Chain Reaction for Diagnosing Lyme Disease

作　　者：谭毓绘[1] 刘勇 孙荷 龙江[1] 牛晓珊[1] 于鲁海 莫合塔尔[1] 阿斯亚[1] 李红燕[1] 朱沂[1] 

机构地区：[1]新疆维吾尔自治区人民医院神经内科 [2]新疆维吾尔自治区儿科研究所 [3]新疆维吾尔自治区临床药学研究所,830001

出　　处：《中国临床神经科学》2012年第4期372-376,共5页Chinese Journal of Clinical Neurosciences

基　　金：国家"十五"科技攻关课题(编号:2001BA705B07)

摘　　要：目的:评估聚合酶链反应(PCR)检测莱姆病患者尿液中伯氏疏螺旋体DNA的诊断价值。方法:2004至2006年来自新疆莱姆病自然疫源地临床疑似莱姆病患者17例(均有蜱暴露史和莱姆病临床证据者)和6例以前确诊并治疗后完全恢复的莱姆病患者,共23例为病例组;另选择25例非疑似莱姆病患者为对照组。应用PCR方法检测尿液中伯氏疏螺旋体DNA,采用间接免疫荧光(IFA)检测血清伯氏疏螺旋体抗体。结果:①17例莱姆病患者临床表现呈多系统损害。12/17例(70.59%)为神经型(周围神经病3例,其中1例合并下肢瘀积性皮炎;游走性红斑并发莱姆脑病2例;脑膜脑炎2例;脑炎2例;脑膜炎、脑干炎和脊髓炎各1例);流感样症状2例,其中伴皮疹1例;余心脏型、精神障碍和肝病型各1例。②PCR伯氏疏螺旋体DNA检测阳性17/17例(总阳性率100%)。4例血清IFA试验伯氏疏螺旋体抗体阳性。以前确诊并治疗者6例及对照组25例尿PCR伯氏疏螺旋体DNA和血清IFA试验伯氏疏螺旋体抗体均阴性。③10例完成抗生素治疗后3个月复查,9例PCR伯氏疏螺旋体DNA检测阴性(包括3例晚期莱姆病患者),1例2年复查时仍阳性;4例血清伯氏疏螺旋体抗体阳性者复查均阴性。④早期莱姆病多采用几周的抗生素治疗方案。结论:PCR检测尿液中伯氏疏螺旋体DNA是莱姆病一个有价值的诊断工具。Aim： To estimate the value of detecting Borrelia bugdorferi DNA in urine samples by polymerase chain reaction （PCR） for diagnosing Lyme disease. Methods： 17 patients suspected of Lyme disease come from nature foei and 25 cases with Non-Lyme disease evidence were enrolled from 2004 to 2006. Lyme serology was performed by IFA. Urine samples were examined by PCR. Results： 17 patients with Lyme disease showed sings of multisystem damage. The majority of them, accounting for 70.59%, was nervous system diseases called neuroborreliosis, which were categorized as meningitis, cranial neuritis, radiculoneuritis, parenchymal inflammation of brain and spinal cord, mild radiculoneuropathy. Urine specimens were PCRpositive in 17 cases （100%）. Only 4 patients was serological antibody positive. 9 urine samples were PCR negative when obtained more than 3 months after the treatment, including 3 patients with chronic Lyme disease. Only one case of Lyme disease was found to be positive 3 months after the treatment. And this patient had a positive result of DNA in the follow up. 4 cases with IFA positive after the treatment were negative. B. burgdorferi DNA of the 25 patients in the control group were not detectable by PCR. Conclusion： B. burgdorferi DNA by PCR in urine is a valuable diagnostic tool for Lyme disease.

关 键 词：莱姆病 聚合酶链反应 尿液标本 伯氏疏螺旋体 

分 类 号：R541[医药卫生—心血管疾病] R747.9[医药卫生—内科学]