42例莱姆病抗生素治疗效果分析

The efficacy of antibiotics in the therapy on different types and stages of Lyme disease

目的探讨临床使用抗生素治疗不同类型、不同阶段莱姆病患者的效果,观查治疗前后莱姆抗体滴度的变化及其对临床转归的意义。方法对确诊的42例不同类型、不同阶段莱姆病患者使用抗生素治疗,治疗前后采用间接免疫荧光试验(IFA)、蛋白印迹试验(WB)方法,检测患者血清和脑脊液(CSF)中抗伯氏疏螺旋体IgM、IgG抗体。以自身对照方法,观测治疗后临床转归和抗伯氏疏螺旋体抗体滴度的动态变化。结果使用抗生素治疗早期局限性病变和急性神经系统病变患者,临床可治愈或好转,总有效率为83.33%。治疗一年后患者血清学反应转阴者32例。晚期中枢神经系统发生实质性受累者治疗效果不佳,血清及CSF抗体滴度变化均不明显。结论早期确诊对患者的治疗至关重要。治疗越早,效果越好,抗体滴度的变化可作为临床疗效的佐证之一。晚期中枢神经系统实质性受累者,难以治愈。

Objective To explore the efficacy of antibiotics in the therapy of different types and stages of Lyme disease and observe the changes of antibodies titer prior and post treatment and its significance of clinic turnover.Methods Forty-two cases were diagnosed as Lyme disease in different type and different period and were given antibiotics treatment.The sera and spinal fluids were collected to be detected the specific antibodies （IgM,IgG） against Lyme Borreliosis by using immunofluorescence assay （IFA） and Western blot test （WB）,the relationship between the clinic turnover and the dynamic state changes of antibodies titer were analyzed.Results The early localized lesions （the erythema migrans rash,flu-like symptoms,tiger eyes sign） and acute neuro-system damage （facial palsy,meningitis） may be cured by antibiotics therapy and total efficacy rate was 83.33%,the antibodies of some patients turned negative after treatment.The patients of late stage with center nerve damage were not improved and their antibodies titer of sera and CSF didn＇t change,four patients gave up treating and one died among them.Conclusions The early diagnosis and early treatment are extremely important for Lyme disease.The change of antibodies titre against Lyme Borreliosis in serological may be a key parameter of elinic effect.