莱姆病临床病例分析及诊断体会  

Clinical case analysis and diagnosis of Lyme disease

作　　者：李小丽 栗绍刚 邹洋 LI Xiaoli;LI Shaogang;ZOU Yang(Beijing Tropical Medicine Research Institute,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院北京热带医学研究所,北京100050

出　　处：《中国感染控制杂志》2025年第2期242-246,共5页Chinese Journal of Infection Control

基　　金：国家自然科学基金项目(81702018);热带病防治研究北京市重点实验室开放课题(2017-3-3);友谊医院启动基金项目(yyqdkt2018-34)。

摘　　要：目的分析莱姆螺旋体感染病例的临床表现特征。方法收集2013年1月—2024年4月北京友谊医院住院治疗的25例莱姆病患者的病例资料,分析患者的临床特点。结果25例确诊莱姆病患者平均年龄(48.60±17.89)岁,20例(80.0%)患者有发热表现。8例(32.0%)患者出现关节痛,以膝关节、肘关节、腰椎及髋关节痛等大关节损伤为主。10例(40.0%)患者出现皮肤损伤,其中2例为游走性红斑,8例以斑丘疹为主。神经系统表现以四肢麻木、肌肉颤动、皮肤感觉异常为主(8例,32.0%),心血管损伤主要为心律失常(3例)及心包积液(1例)。23例(92.0%)患者的病程<6个月,但伴有多种合并症。所有患者莱姆病抗体(IgM或IgG)呈阳性。发病前,8例(32.0%)患者居住北京,7例(28.0%)旅居国外,10例(40.0%)居住在北京以外省份。所有患者均有蚊虫叮咬史,其中5例患者明确被蜱虫叮咬。结论莱姆病累及脏器较多,患者临床症状变化多样,蜱虫叮咬的流行病学史及相关抗体的实验室检测可提高该疾病的诊断率。Objective To analyze the characteristics of clinical manifestations of Lyme borreliosis cases.Methods Clinical data of 25 hospitalized patients with Lyme disease admitted to Beijing Friendship Hospital from January 2013 to April 2024 were collected,and clinical characteristics of patients were analyzed.Results The average age of 25 patients with confirmed Lyme disease was(48.60±17.89)years,20 patients(80.0%)presented fever.8 patients(32.0%)had joint pain,mainly in large joints such as knee joint,elbow joint,lumbar spine,and hip joint.10 patients(40.0%)had skin lesions,including 2 cases of erythema migrans and 8 cases predominantly with maculopapular rash.Neurological manifestations were mainly numbness in the limbs,muscle twitching,and abnormal skin sensations(n=8,32.0%),cardiovascular damage was mainly arrhythmias(n=3)and pericardial effusion(n=1).Disease course of 23 patients(92.0%)was<6 months,but were accompanied by multiple comorbidities.All patients tested positive for Lyme disease antibodies(IgM or IgG).Before the onset of the disease,8 patients(32.0%)lived in Beijing,7(28.0%)lived abroad,and 10(40.0%)lived in provinces other than Beijing.All patients had a history of mosquito bites,with 5 patients confirmed to have been bitten by ticks.Conclusion Lyme di-sease involves multiple organs,and patients have diverse clinical symptoms.Epidemiological history of tick bites and laboratory testing of related antibodies can improve the diagnosis rate of this disease.

关 键 词：莱姆病 伯氏疏螺旋体 临床特点 流行病学 诊断 病例分析 

分 类 号：R535[医药卫生—内科学]