【摘要】 目的 :了解钩端螺旋体 (以下简称钩体 )L型与钩体病眼、神经后发症的关系。方法 :对临床疑诊为钩体病后发症患者血、脑脊液作钩体及L型培养和显微镜凝集试验。用青霉素在患者体内诱导钩体L型和分离的钩体L型分别二次对豚鼠进行实验性感染 ,以了解引起的病理变化与临床后发症的关系。通过对L型的生物特性研究 ,了解其长期在体内存活的原因。结果 :从 186例患者血与脑脊液的检测表明钩体L型分离阳性率为 2 8.6 % ,远高于钩体原型 10 .2 % (P <0 .0 0 5 )。从感染动物病变见有血管壁增厚、管腔狭窄、脊髓前角神经元变性、眼葡萄膜与视网膜炎以及肾曲小管中见有L型存在。病变出现于L型感染动物多于原型感染动物。经微区图谱证明钩体L型的细胞膜比原型增厚 3倍。结论 :钩体L型细胞膜的增厚使其能延长在体内存活的时间。引起的病变证明与后发症有关。在肾曲小管中出现说明钩体L型可经尿排出 ,应予重视更多还原

【Abstract】 Objective:To study the relation between leptospira L forms and late complications in leptospirosis with involvement of ocular and nervous system.Methods:Blood and cerebral spinal fluid of patients with late complications of leptospirosis were taken for isolation and MAT.Experimental infections were performed twice in guinea pigs,one experiment with leptospira L forms induced by penicillin in vivo and another with stable L forms isolated from the patients to correlate their pathological changes occurred in the experimental animals with the clinical expressions in patients.The biological characters of leptospira L forms were studied to elucidate the reason of their prolong existence in the patients.Results:Among 186 cases examined,28.6% were isolated in L forms ,higher than that in the original forms 10.2%( P <0.005).The isolation rate was also higher than the positive rate in serum MAT.In experimental infection,thickening of vessel walls,and narrowing of the vessel lumen,degeneration of the nerve cells in the anterior horn of spinal cord,inflammation of retina and uvea and appearance of L forms in the convoluted tubules of kidneys were seen.These pathological pictures were seen more in animals infected with L forms than that with the original forms.In electron micrographic analysis,the cell membranes were shown to be 3×thicker in L forms than that in original forms.Conclusions:The thickening of cell membranes in L forms may account for their prolong existence in the body,that leads to occurrence of late complication.The appearance of L forms in kidneys may cause dissemination of the disease through urine excretion that should not be neglected.更多还原