莱姆病是由Borrelia Burgdorferi通过被感染的壁虱咬伤传播的细菌。它是美国和欧洲最常见的媒介传播感染，具有皮肤病，心脏，神经系统和关节炎表现。

莱姆关节炎患者中约有10％无法应对抗生素疗法，并继续持续存在关节炎症。此外，一些患者报告了抗生素治疗后的浓度和记忆的疼痛，疲劳或困难的持续症状，并且在没有持续感染的证据的情况下。有证据表明，在受影响的个体的大部分子集中，这些症状与持续的炎症机制有关。

部分原因是其多系统性质以及由于症状持久性的潜力，莱姆病被假定与几种慢性病有因果关系。由于某些提出的关联可能会对治疗或产生有关疾病病因和机制的重要线索产生重大影响，因此它们的仔细分析和审查可能尤其如此。例如，已发表的文章和在线帖子以前曾推测活跃的莱姆病与自闭症之间存在牢固的因果关系，从而引起了广泛的关注和关注。然而，随后的病例对照研究能够排除建议的关联。

Lyme disease and celiac disease parallels

Another disorder with an incompletely understood etiology and a speculated link to Lyme disease is celiac disease. Celiac disease is characterized by an aberrant inflammatory response to ingested gluten in wheat and related cereals that results in tissue damage in the small intestine, while also having several systemic manifestations.

There is evidence to indicate that exposure to infectious agents may increase the risk of celiac disease.

Because celiac disease can occur at any age, factors other than genes and gluten ingestion are believed to play a role in disease onset. In fact, there is evidence to indicate that exposure to infectious agents may increase the risk of celiac disease. Recent research has pointed to a potential mechanism by which an inflammatory response triggered by infection might contribute to the development of autoimmunity in celiac disease.

特别有趣的是，在过去的几十年中，腹腔疾病和莱姆病都在其频率稳定增加。此外，研究腹腔疾病患病率的区域差异的研究表明，与莱姆病的地理分布相似。在美国，已经发现乳糜泻在东北和中西部地区最普遍，那里发生了绝大多数莱姆病病例。所有这些都提出了一个问题，即伯氏感染的发生是否会增加患腹腔疾病的风险。

调查可能的链接

We decided to tackle this question by looking at a large population of celiac disease patients and controls, totaling roughly 94,000 individuals, in Sweden. The population-based design gave the study high statistical power to detect small effects. The setting of the study was also particularly relevant, because not only does Sweden have one of the highest rates of celiac disease in the world, but the majority of its population also lives in areas where Lyme disease is endemic.

这两个方向上的类似适度的关联可能表明了所谓的监视偏见，而不是真正的风险。

我们的最初发现表明，先前被诊断出患有莱姆病的患者患乳糜泻的风险略有增加。但是，经过进一步的分析，我们发现相反的情况也保持真实。也就是说，在被诊断出患有乳糜泻后，同样适度的增加了莱姆病的风险。

这两个方向上的类似适度的关联可能表明了所谓的监视偏见，而不是真正的风险。Here, the surveillance bias is driven by the possibility that physicians are more likely to investigate a patient presenting with Lyme disease for markers of celiac disease, and vice versa, given that there is some overlap between the systemic symptoms of the two.

这两个方向的风险在诊断出两种疾病后的最初随访时期最强，这一事实得到了加强。此外，在我们的研究中包括大量的腹腔疾病患者中，很小的比例（不到0.2％）以前患有莱姆病，提供了进一步的证据，表明莱姆病并不代表腹腔发展的实质性风险因素疾病。

从整体上看，我们的数据表明，尽管莱姆病的发生率增加，但感染与乳糜泻没有因果关系。研究识别负责触发乳糜泻的环境因素，并可能继续前进，可能会继续进行大量升高，重点关注其他候选人。此外，同样设计的未来分析可以帮助阐明莱姆病与其他慢性病之间的任何可疑联系。