本文選題：伯氏疏螺旋體　切入點(diǎn)：萊姆病　出處：《中南大學(xué)》2013年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：萊姆病是一種由蜱傳播,伯氏疏螺旋體引起的自然疫源性疾病,其主要癥狀是游走性紅斑,萊姆神經(jīng)炎,萊姆心肌炎和萊姆關(guān)節(jié)炎。不同基因型的伯氏疏螺旋體,引起的萊姆病臨床癥狀以及嚴(yán)重程度不同。根據(jù)文獻(xiàn)報(bào)道,我國(guó)不同地區(qū)媒介蜱和動(dòng)物宿主中伯氏疏螺旋體的基因型與歐美地區(qū)存在差異。至今,我國(guó)萊姆病的主要臨床特征和致病基因型仍然不清楚。為了解我國(guó)萊姆病的臨床和病原特征,我們于2010-2011年在牡丹江林業(yè)醫(yī)院采用現(xiàn)場(chǎng)調(diào)查和實(shí)驗(yàn)室方法相結(jié)合的手段展開(kāi)此項(xiàng)研究。 首先根據(jù)萊姆病診斷的金標(biāo)準(zhǔn)(游走性紅斑)納入病例,然后對(duì)這些病人進(jìn)行流行病學(xué)問(wèn)卷調(diào)查和病歷信息采集；收集具有游走性紅斑和擴(kuò)散癥狀的病人的全血和紅斑組織,采用聚合酶鏈?zhǔn)椒磻?yīng),檢測(cè)伯氏疏螺旋體的基因型。 總共納入265例具有典型游走性紅斑的病人。我國(guó)萊姆病人的游走性紅斑比歐美國(guó)家的萊姆病人出現(xiàn)地早,直徑也較小,局部癥狀(癢痛和中央清除)出現(xiàn)較少(P0.001),但是水泡潰瘍出現(xiàn)地較多(P0.01)。我國(guó)萊姆病人的系統(tǒng)癥狀,關(guān)節(jié)腫痛和淋巴結(jié)腫大出現(xiàn)率較低(P0.001)�？偣膊杉�55例擴(kuò)散癥狀的游走性紅斑病人的全血樣本,其中15位病人的全血樣本中檢測(cè)到伯氏疏螺旋體。15份陽(yáng)性樣本中,11份為B. garinii,3份為B. afzelii和1份為B. valaisiana-related(B. yangtze. sp. nov)。三份組織標(biāo)本均為B. garinii。進(jìn)化發(fā)育關(guān)系分析顯示,來(lái)源于病人的序列與我國(guó)蜱和宿主中檢測(cè)分離到的序列最為相近。 我國(guó)萊姆病人臨床特征與美國(guó)和歐洲的萊姆病病人之間存在差異,原因可能是致病基因型不同。我國(guó)萊姆病致病基因型是B. garinii, B. afzelii, B. valaisiana-related,其中B. garinii是優(yōu)勢(shì)型別。這三種型別都可以引起游走性紅斑。另外,本次研究首次證明了B.valaisiana-related可以對(duì)人致病。因此,基于我國(guó)萊姆病的主要臨床和病原特征,建立我國(guó)的臨床診斷標(biāo)準(zhǔn)和治療方案是十分必要的。
[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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R514

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