肝囊型包虫病药物治疗疗效标准的研究

目的　进一步研究和评价囊型包虫病药物治疗的疗效判定标准。　方法　采用前瞻性随机对照观察的研究方法。对 4 9例肝囊型包虫病病人进行了研究 ,其中治疗组 31例为经过不同时间阿苯达唑乳剂治疗的病人。对照组 18例为未经任何治疗的病人。以外科手术、粗针穿刺抽吸和常规细针穿刺的方法采集包虫囊内容物观察其性状。囊壁组织石腊切片观察组织学变化。收集原头节通过镜下形态及活动的观察、染料排斥试验、犬胆汁激活试验及接种小鼠腹腔 6个月后剖检观察有无包虫囊生长的方法判定囊内原头节的死活。结合 CT及 B超影像特征进行比较评价。　结果　治疗组病人中87.1% (2 1/ 31)的包虫囊 B超影像显示不同程度的退行变性 ,育囊率为 2 2 .6 %。对照组病人包虫囊的 B超影像显示退行变性的占 11.1% (2 / 18) ,育囊率为 6 1.1%。治疗组判定为痊愈的 15例病人的育囊率为 13.3% (2 / 15 )。疗效标准与 B超影像反映的包虫囊变性死亡的过程一致 ,与寄生虫学和囊壁组织学变化趋势相符。177例停药后随访 1～ 4年的肝囊型包虫病病人的转归证明了这一标准的可靠性。　结论　本研究提出的以 B超影像为基础的肝囊型包虫病药物治疗疗效指标反映了包虫囊在药物作用下从正常生长到变性死亡的过程 ,是一个比较客观、合理的疗效标

EVALUATION OF CRITERION FOR ASSESSING THE EFFICACY IN PHARMCOTHERAPY OF LIVER CYSTIC ECHINOCOCCSIS

Objective A new criterion for judgement of efficacy in pharmacotherapy of echinococcosis has been presented. To further evaluate the reliability and usefulness of the criterion in this study. Methods A prospective randomized controlled study was used in total of 49 cases treated with emulsion albendazole by different courses and 18 cases never treated with any measure have been examined either by surgical operation or percutaneous puncture drainage and curettage or routine fine needle puncture to collect the substrates in hydatid cysts. The viability of cysts were tested by histological examination of cyst wall, morphology and activity of protoscoleces, dye exclusive test of protoscoleces, dog's bile stimulation test of protoscoleces and intraperitoneal inoculation of protoscoleces into mice. The results of these tests were used in evaluation associated with CT and ultrasonography image characteristics. Results Different degenerative changes in image of ultrasonography were found in 87.1% (21/31) of cases treated while it was 11.1% (2/18) in untreated cases. The fertility rate of hydatid cyst was 22.6% in treated and was 61.1% in untreated. The intensity of therapeutic efficacy judged according to the criterion correspond with the process from growth to degenoration and death of cysts in ultrasonographic, pathological and parasitological examination. The reliability of the criterion is demonstrated also by the prognosis of 177 cases treated after 1 4 year follow up. Conclusion The present criterion is a objective and reliable tool for judgement of therapeutic efficacy in pharmacotherapy of cystic echinococcosis.