基于哨点医院的莱姆病临床及病原特征分析

发布时间：2018-03-05 18:34

本文选题：伯氏疏螺旋体　切入点：莱姆病　出处：《中南大学》2013年硕士论文　论文类型：学位论文

【摘要】：莱姆病是一种由蜱传播,伯氏疏螺旋体引起的自然疫源性疾病,其主要症状是游走性红斑,莱姆神经炎,莱姆心肌炎和莱姆关节炎。不同基因型的伯氏疏螺旋体,引起的莱姆病临床症状以及严重程度不同。根据文献报道,我国不同地区媒介蜱和动物宿主中伯氏疏螺旋体的基因型与欧美地区存在差异。至今,我国莱姆病的主要临床特征和致病基因型仍然不清楚。为了解我国莱姆病的临床和病原特征,我们于2010-2011年在牡丹江林业医院采用现场调查和实验室方法相结合的手段展开此项研究。首先根据莱姆病诊断的金标准(游走性红斑)纳入病例,然后对这些病人进行流行病学问卷调查和病历信息采集；收集具有游走性红斑和扩散症状的病人的全血和红斑组织,采用聚合酶链式反应,检测伯氏疏螺旋体的基因型。总共纳入265例具有典型游走性红斑的病人。我国莱姆病人的游走性红斑比欧美国家的莱姆病人出现地早,直径也较小,局部症状(痒痛和中央清除)出现较少(P0.001),但是水泡溃疡出现地较多(P0.01)。我国莱姆病人的系统症状,关节肿痛和淋巴结肿大出现率较低(P0.001)。总共采集55例扩散症状的游走性红斑病人的全血样本,其中15位病人的全血样本中检测到伯氏疏螺旋体。15份阳性样本中,11份为B. garinii,3份为B. afzelii和1份为B. valaisiana-related(B. yangtze. sp. nov)。三份组织标本均为B. garinii。进化发育关系分析显示,来源于病人的序列与我国蜱和宿主中检测分离到的序列最为相近。我国莱姆病人临床特征与美国和欧洲的莱姆病病人之间存在差异,原因可能是致病基因型不同。我国莱姆病致病基因型是B. garinii, B. afzelii, B. valaisiana-related,其中B. garinii是优势型别。这三种型别都可以引起游走性红斑。另外,本次研究首次证明了B.valaisiana-related可以对人致病。因此,基于我国莱姆病的主要临床和病原特征,建立我国的临床诊断标准和治疗方案是十分必要的。
[Abstract]:Lyme disease is a naturally infectious disease caused by tick-borne Borrelia burgdorferi. Its main symptoms are migratory erythema, Lyme neuritis, Lyme myocarditis, and Lyme arthritis. Different genotypes of Borrelia burgdorferi. The clinical symptoms and severity of Lyme disease are different. According to the literature, the genotypes of Borrelia burgdorferi in vector ticks and animal hosts in China are different from those in Europe and America. In order to understand the clinical and pathogenic characteristics of Lyme disease in China, the main clinical features and pathogenic genotypes are still unclear. We conducted this study in Mudanjiang Forestry Hospital in 2010-2011 by combining field investigation with laboratory methods. Cases were first included according to the gold criteria for diagnosis of Lyme disease (walking erythema), and then epidemiological questionnaires and medical records were collected to collect the whole blood and erythema tissues of patients with walking erythema and spreading symptoms. Polymerase chain reaction was used to detect the genotypes of Borrelia burgdorferi. A total of 265 patients with typical walking erythema were included. The walking erythema of patients with Lyme disease in China appeared earlier and had a smaller diameter than that in Europe and the United States. Local symptoms (itching pain and central clearance) occur less frequently, but blister ulcers occur more frequently. Systemic symptoms of Lyme disease in China, The incidence of joint swelling and lymphadenopathy was low (P 0.001). A total of 55 patients with diffuse erythema were collected. Of the 15 patients, 11 were found to be B.gariniiae, 3 were B. afzelii and 1 was Bvalaisiana-relatedated B. yangtze. sp. nov.Three tissue specimens were B.garinii.Evolvement analysis showed, The sequences from patients are most similar to those detected in ticks and hosts in China. The clinical characteristics of Lyme disease patients in China are different from those in the United States and Europe. The reason may be the different genotypes of Lyme disease. In China, the genotypes of Lyme disease are B. garinii, B. afzelii, B. valaisiana-related. among them, B. garinii is the dominant type. All three types can cause migratory erythema. This study proves for the first time that B.valaisiana-related can cause human disease. Therefore, based on the main clinical and pathogenic characteristics of Lyme disease in China, it is necessary to establish clinical diagnostic criteria and treatment schemes in China.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R514

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