血清伯氏疏螺旋体IgM抗体阳性及弱阳性的葡萄膜炎病例的临床观察

发布时间：2018-01-04 05:03

本文关键词：血清伯氏疏螺旋体IgM抗体阳性及弱阳性的葡萄膜炎病例的临床观察　出处：《华中科技大学》2013年硕士论文　论文类型：学位论文

【摘要】：【目的】通过对血清伯氏疏螺旋体IgM抗体阳性和弱阳性的葡萄膜炎患者进行观察分析，掌握莱姆葡萄膜炎（Lyme uveitis）的临床表现及治疗方法，，探讨IgM和IgG抗体效价的变化规律，以指导莱姆葡萄膜炎的临床诊疗。【方法】收集有疑似莱姆病(Lyme disease)临床表现的16例葡萄膜炎患者和17例无血缘关系的健康者的血标本，应用酶联免疫吸附实验（enzyme-linkedimmunosorbent assay，ELISA）对血清中伯氏疏螺旋体IgM和IgG抗体进行检测，并对IgM抗体检测为阳性及弱阳性的14例葡萄膜炎患者的临床表现及诊治情况进行回顾性研究及临床随访观察。【结果】入选的14名患者血清伯氏疏螺旋体IgM抗体首次检测为阳性者4例，弱阳性10例。血清伯氏疏螺旋体IgG抗体首次检测为弱阳性者7例，阴性7例，阳性0例。其中有明确蜱叮咬史者1人，占7.14%；存在野外工作和灌木接触史者3人，占21.43%；出现皮肤损害者1例，占7.14%；有神经系统及其相关表现者3人，占21.43%；而所有患者均提及关节疼痛，以膝、腰骶及髋关节最常受累。眼部表现中出现角膜炎性损伤及一过性眼压升高者各11人，分别占78.57%。葡萄膜炎反复发作者13人，占92.86%。其中一例IgM抗体阳性、IgG抗体阴性的患者经正规抗生素治疗后，于起病后10个月起IgG抗体由阴性转为弱阳性，并持续存在，而IgM抗体于起病14个月后转为阴性。另一名IgM抗体阳性、IgG抗体弱阳性的患者经正规抗生素治疗后，IgM抗体由阳性转为弱阳性，IgG抗体呈弱阳性持续存在。【结论】湖北省存在伯氏疏螺旋体感染所致葡萄膜炎的散发病例。早期迅速正确的诊断，对协助指导临床治疗及患者的预后至关重要。由于莱姆病的临床表现复杂多样，累及多器官多系统，容易与许多疾病混淆，因此实验室检查结果对明确诊断及鉴别诊断尤为重要，临床应普及伯氏疏螺旋体的实验室检查。各科医生在临床诊治工作中遇到有莱姆病相关表现的病例时，均应考虑将莱姆病纳入鉴别诊断中。对于缺乏实验室检查结果，而临床表现又高度怀疑的病例，应考虑行抗生素诊断性治疗，在没有排除伯氏疏螺旋体感染的情况下，葡萄膜炎患者慎用激素。
[Abstract]:[objective] to observe and analyze the patients with uveitis with IgM antibody positive and weak positive in serum of Borrelia burgdorferi. In order to guide the clinical diagnosis and treatment of Lyme uveitis, the clinical manifestations and treatment methods of Lyme uveitis were studied, and the changes of antibody titers of IgM and IgG were discussed in order to guide the clinical diagnosis and treatment of Lyme uveitis. [methods] Blood samples were collected from 16 patients with uveitis and 17 healthy controls with suspected Lyme disease. Enzyme linked immunosorbent assay (assay) was used for enzyme linked immunosorbent assay (Elisa). Elisa was used to detect IgM and IgG antibodies of Borrelia burgdorferi in serum. The clinical manifestations, diagnosis and treatment of 14 cases of uveitis with positive and weak positive IgM antibodies were studied retrospectively and followed up. [results] among the 14 patients, 4 were positive for the first time and 10 were weakly positive for the IgM antibody of Borrelia burgdorferi, and 7 were weakly positive for the first time. 7 cases were negative, 0 cases were positive, among them, 1 case (7.14%) had definite history of tick bite; There were 3 people who had the history of field work and shrub contact, accounting for 21.43; Skin damage occurred in 1 case (7.14%). There were 3 cases with nervous system and related manifestations, accounting for 21.43%; All patients mentioned joint pain, with knee, lumbosacral and hip joints most frequently involved. There were 13 patients with recurrent uveitis, accounting for 92.86. among them, one patient with negative IgM antibody was treated with regular antibiotics. Ten months after the onset of the disease, the IgG antibody changed from negative to weakly positive, and continued to exist, while the IgM antibody became negative 14 months after the onset of the disease. Another IgM antibody was positive. The patients with weak positive IgG antibody continued to be weakly positive after regular antibiotic treatment from positive to weakly positive. [conclusion] there are sporadic cases of uveitis caused by Borrelia burgdorferi infection in Hubei Province. It is very important to assist in guiding clinical treatment and prognosis of patients. Because the clinical manifestations of Lyme disease are complex and diverse, involving multiple organs and systems, it is easy to be confused with many diseases. Therefore, the results of laboratory examination is particularly important for the diagnosis and differential diagnosis. Clinical laboratory examination of Borrelia burgdorferi should be popularized. All patients with Lyme disease should be considered for differential diagnosis. Antibiotic diagnostic therapy should be considered for cases with a lack of laboratory results and highly suspected clinical manifestations. Patients with uveitis were careful to use hormones without excluding Borrelia burgdorferi infection.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R773

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