臺灣博碩士論文加值系統

萊姆病(Lyme disease)是由一種硬蜱節肢動物叮咬所導致之疾病，致病原是伯氏疏螺旋體（Borrelia burgdorferi）。全球估計年發病人數約為30萬人左右。台灣也係屬多山叢林國家，但是萊姆病盛行率仍無詳細報導。本篇研究將探討台灣北部地區居民（包括城市地區居民及山地區居民）之樣本共311件（男性131件，女性180件，平均年歲為58.43±17.74歲）之萊姆病盛行率。本研究取得當地居民血液有效樣本，進行Borrelia-IgG Enzyme-linked immunosorbent assay(ELISA)試驗，並以伯氏疏螺旋體B31 IgG西方墨點法(Western blot)作為確認試驗。因為螺旋菌屬間共同抗原造成實驗交叉反應之可能性，所以，本研究同時進行血清學Rheumatoid Factor test (RF)、Rapid Plasma Reagin test (RPR)、Treponema pallidum hacmagglutination test (TPHA)、Systemic Lupus Erythematosus (SLE) latex agglutination test及Anti-nucleus antibody Indirect Immunofluorescence test (ANA-IFA)等試驗。研究結果顯示以ELISA分析法測得Borrelia burgdorferi抗體血清盛行率為13.2%，經WB反應交叉比對後，與ELISA結果之一致性達85.7％，經WB校正後血清盛行率亦維持在11.31%。在RF、RPR、TPHA、SLE-Latex、ANA-IFA實驗中結果各為10.03％、1.29%、2.57%、0%及0%。可能性萊姆病血清盛行率雖然在居住區域(城市樣本vs山地區樣本；11.3% vs 15.2%，P=0.316）、性別差異（男性 vs 女性；17.56% vs 14.44%，P=0.396）及老年及中壯之年齡差異（≧65歲vs <65歲；15.2% vs 12.37%，P=0.398）的分析上均無顯著性差異，但已證實台灣北部地區居民確實有可能性萊姆病的存在。因此，衛生相關單位有必要進一步確認及分析台灣地區居民受到萊姆菌侵犯之實際情況。

Lyme disease is caused by bites from Ixodes, an arthropod, and the cause agent is originating from Borrelia spirochete (Borrelia burgdorferi). The incidence of Lyme disease is about 300 thousand people around the globe each year. Taiwan, as a mountainous jungle country, still does not have any detailed report on the prevalence of Lyme disease so far. This study was investigated the prevalence of Lyme Disease in northern Taiwan. We enrolled randomly the 311 subjects that live in urban areas and aboriginal townships (131 male, 180 female, average age of 58.43 ± 17.74 years). All blood sample was detected the antibodies of Borrelia spirochete by performing the Borrelia-IgG Enzyme-linked immunosorbent assay (ELISA) and Borrelia burgdorferi B31 IgG Western blot (WB). All blood sample also performed other associated serological tests including Rheumatoid factor (RF), Rapid Plasma Reagin (RPR), Treponema pallidum hemagglutination tests (TPHA), systemic lupus erythematosus(SLE) latex agglutination tests, and anti-nucleus antibody-indirect immunofluorescence tests (ANA-IFA) to exclude the possible interfering factors. . The results showed that the seroprevalence of Borrelia burgdorferi was 13.2% by ELISA, and after recalculated to 11.31% by WB method. The results for RF, RPR, TPHA, SLE-Latex, and ANA-IFA were 10.03%, 1.29%, 2.57%, 0%, and 0%, respectively. The seroprevalence of Lyme disease were no significant differences between residential areas (urban sample vs mountain region; 11.3% vs 15.2%, P = 0.316), gender variation (male vs female; 17.56% vs 14.44%, P = 0.396) and age difference (≧65 year vs <65 year; 15.2 % vs 12.37%, P = 0.398) . This study was confirmed that there was the probable Lyme disease in northern Taiwan. The study findings gave emphasis to the importance of increasing surveillance to clarify the true incidence of Lyme diseases in Taiwan.

致 謝....................I
中文摘要..................II
英文摘要..................III
目 錄....................V
圖目錄....................VII
表目錄....................VIII
第一章 緒 論............1
1.1 研究背景和動機..........1
1.2 研究目的................1
第二章 文獻回顧............2
2.1 萊姆病..................2
2.2.1 流行病學..............3
2.2.2 萊姆病診斷定義.........4
2.2.3 實驗室診斷.............4
第三章 材料與方法.............5
3.1 檢體....................5
3.1.1 檢體來源...............5
3.1.2 檢體收集及儲存..........5
3-2 血清學試驗分析............5
3.2.1 Borrelia-IgG酵素免疫分析法(ELISA)......5
3.2.2 伯氏疏螺旋體B31 IgG西方墨點法分析（Borrelia B31 IgG ViraStripe Western bolting）................6
3.2.3 梅毒血清抗體反應素試驗(Rapid Plasma Reagin test；RPR).........................7
3.2.4 梅毒血清抗體反應 (Treponema pallidum hacmagglutination；TPHA)........................8
3.2.5 類風濕性關節炎因子(Rheumatoid Factor；RF)試驗..........8
3.2.6 紅斑性狼瘡乳膠凝集(SLE latex agglutination)試驗........9
3.2.7 抗核抗體間接免疫螢光法（ANA Indirect Immunofluorescence)..........9
3.3 統計分析..................11
第四章 結 果..................12
4.1 有效樣本...................12
4.1.1 血清學盛行率分析結果......12
4.1.2 診斷為可能性萊姆病樣本之生物特性評估...................13
4.1.3 酵素免疫分析法與西方墨點法在萊姆菌血清抗體診斷上評估.....13
第五章 結 論...................15
參考文獻.......................29

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