本文關(guān)鍵詞：血清伯氏疏螺旋體IgM抗體陽(yáng)性及弱陽(yáng)性的葡萄膜炎病例的臨床觀察　出處：《華中科技大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 萊姆病 伯氏疏螺旋體 葡萄膜炎 酶聯(lián)免疫吸附實(shí)驗(yàn) IgM抗體 IgG抗體

【摘要】：【目的】通過(guò)對(duì)血清伯氏疏螺旋體IgM抗體陽(yáng)性和弱陽(yáng)性的葡萄膜炎患者進(jìn)行觀察分析，掌握萊姆葡萄膜炎（Lyme uveitis）的臨床表現(xiàn)及治療方法，，探討IgM和IgG抗體效價(jià)的變化規(guī)律，以指導(dǎo)萊姆葡萄膜炎的臨床診療。 【方法】收集有疑似萊姆病(Lyme disease)臨床表現(xiàn)的16例葡萄膜炎患者和17例無(wú)血緣關(guān)系的健康者的血標(biāo)本，應(yīng)用酶聯(lián)免疫吸附實(shí)驗(yàn)（enzyme-linkedimmunosorbent assay，ELISA）對(duì)血清中伯氏疏螺旋體IgM和IgG抗體進(jìn)行檢測(cè)，并對(duì)IgM抗體檢測(cè)為陽(yáng)性及弱陽(yáng)性的14例葡萄膜炎患者的臨床表現(xiàn)及診治情況進(jìn)行回顧性研究及臨床隨訪觀察。 【結(jié)果】入選的14名患者血清伯氏疏螺旋體IgM抗體首次檢測(cè)為陽(yáng)性者4例，弱陽(yáng)性10例。血清伯氏疏螺旋體IgG抗體首次檢測(cè)為弱陽(yáng)性者7例，陰性7例，陽(yáng)性0例。其中有明確蜱叮咬史者1人，占7.14%；存在野外工作和灌木接觸史者3人，占21.43%；出現(xiàn)皮膚損害者1例，占7.14%；有神經(jīng)系統(tǒng)及其相關(guān)表現(xiàn)者3人，占21.43%；而所有患者均提及關(guān)節(jié)疼痛，以膝、腰骶及髖關(guān)節(jié)最常受累。眼部表現(xiàn)中出現(xiàn)角膜炎性損傷及一過(guò)性眼壓升高者各11人，分別占78.57%。葡萄膜炎反復(fù)發(fā)作者13人，占92.86%。其中一例IgM抗體陽(yáng)性、IgG抗體陰性的患者經(jīng)正規(guī)抗生素治療后，于起病后10個(gè)月起IgG抗體由陰性轉(zhuǎn)為弱陽(yáng)性，并持續(xù)存在，而IgM抗體于起病14個(gè)月后轉(zhuǎn)為陰性。另一名IgM抗體陽(yáng)性、IgG抗體弱陽(yáng)性的患者經(jīng)正規(guī)抗生素治療后，IgM抗體由陽(yáng)性轉(zhuǎn)為弱陽(yáng)性，IgG抗體呈弱陽(yáng)性持續(xù)存在。 【結(jié)論】湖北省存在伯氏疏螺旋體感染所致葡萄膜炎的散發(fā)病例。早期迅速正確的診斷，對(duì)協(xié)助指導(dǎo)臨床治療及患者的預(yù)后至關(guān)重要。由于萊姆病的臨床表現(xiàn)復(fù)雜多樣，累及多器官多系統(tǒng)，容易與許多疾病混淆，因此實(shí)驗(yàn)室檢查結(jié)果對(duì)明確診斷及鑒別診斷尤為重要，臨床應(yīng)普及伯氏疏螺旋體的實(shí)驗(yàn)室檢查。各科醫(yī)生在臨床診治工作中遇到有萊姆病相關(guān)表現(xiàn)的病例時(shí)，均應(yīng)考慮將萊姆病納入鑒別診斷中。對(duì)于缺乏實(shí)驗(yàn)室檢查結(jié)果，而臨床表現(xiàn)又高度懷疑的病例，應(yīng)考慮行抗生素診斷性治療，在沒有排除伯氏疏螺旋體感染的情況下，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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R773

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王展;萊姆病[J];國(guó)外醫(yī)學(xué).皮膚性病學(xué)分冊(cè);2002年02期

2 李永學(xué),王樹聲;萊姆病的實(shí)驗(yàn)室診斷[J];廣西預(yù)防醫(yī)學(xué);2005年05期

3 林軍;萊姆病實(shí)驗(yàn)室檢查研究進(jìn)展[J];醫(yī)學(xué)研究生學(xué)報(bào);2004年04期

4 聞華;萊姆病——“第二艾滋病”[J];家庭醫(yī)學(xué);1998年20期

5 李宛青;韓聯(lián)合;;蜱蟲簡(jiǎn)介[J];生物學(xué)教學(xué);2011年03期

6 周錦萍;張維誼;鞠厚斌;;蜱及蜱媒傳染病[J];上海畜牧獸醫(yī)通訊;2011年04期

7 蔣毅;萊姆病實(shí)驗(yàn)診斷研究進(jìn)展[J];中國(guó)公共衛(wèi)生;2004年02期

8 張哲夫;中國(guó)萊姆病研究的進(jìn)展[J];中華流行病學(xué)雜志;1999年05期

9 耿震;侯學(xué)霞;郝琴;胡桂蘭;萬(wàn)康林;;827例擬診萊姆病患者抗伯氏疏螺旋體抗體檢查結(jié)果分析[J];中國(guó)媒介生物學(xué)及控制雜志;2007年03期

10 耿震;萬(wàn)康林;;萊姆病流行病學(xué)研究新進(jìn)展[J];中國(guó)自然醫(yī)學(xué)雜志;2007年02期

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