多房棘球蚴病诊断抗原研究进展

多房棘球绦虫特异性和保护性抗原的研究是多房棘球蚴病免疫和诊断的基础。由于天然抗原来源有限,应用受到限制,重组抗原的研制则可解决质量控制和抗原来源的问题。本文就近年来国内外对多房棘球蚴病诊断抗原尤其是重组抗原的研究进展进行了综述。     

多房棘球蚴病新型诊断标志物研究进展

影像学与血清学技术在多房棘球蚴病诊断、治疗与评价中扮演着重要角色,但其在临床应用中的一些不足促使研究者对潜在诊断标志物进行探索。基于血清学、基因组学及蛋白质组学的新型诊断标志物单独或联合应用有望提高多房棘球蚴病早期诊断的灵敏度与特异度,在后续病程监测与预后评估中发挥重要作用。本文主要就多房棘球蚴病新型诊断标志物研究进展作一综述。     

多房棘球蚴病相关细胞信号通路的研究进展

多房棘球蚴病（AE）是一种在北半球高纬度地区流行、危害程度高的人兽共患寄生虫病。AE通常原发于肝组织,多房棘球蚴在患者体内呈浸润性生长,对累及脏器的形态及生理功能造成严重损伤。研究表明,多房棘球蚴及生发层细胞的增殖、机体免疫应答及免疫细胞的分化均与丝裂素原活化蛋白激酶（MAPK）、胰岛素（insulin,Ins）、程序性死亡受体-1 (PD-1)、生长转化因子-β (TGF-β)等细胞信号通路有较为密切的联系。本文从相关细胞信号通路在多房棘球蚴病中对多房棘球蚴及宿主产生的免疫调节作一综述。     

脑多房棘球蚴病误诊1例

本文报道1例被误诊的脑多房棘球蚴病病例。     

多房棘球蚴病的浸润和转移机制研究进展

多房棘球蚴感染宿主肝脏后,可通过多种途径向肝周围或肝外组织浸润和转移,使病情恶化。通过对多房棘球蚴病浸润和转移机制的研究,寻找阻断其浸润和转移的方法,对多房棘球蚴病的治疗和预后具有重要的意义。本文就目前在多房棘球蚴病浸润和转移机制研究方面的概况作一综述。     

阿苯达唑治疗多房棘球蚴病研究进展

多房棘球蚴病是由多房棘球绦虫感染引起的一种高致死率人兽共患寄生虫病。阿苯达唑为苯并咪唑类化合物之一,具有强大的杀灭寄生虫作用,且驱虫谱较广。对于不愿接受手术治疗、失去手术机会或身体状态差而无法耐受手术的多房棘球蚴病患者,使用阿苯达唑药物治疗可一定程度上延缓疾病进展。近年来,多房棘球蚴病相关实验研究取得大量成果。本文回顾了相关文献并对阿苯达唑治疗多房棘球蚴病研究进展进行综述,以期增加对阿苯达唑治疗多房棘球蚴病效果的认识,为未来用于临床治疗奠定基础。     

多房棘球蚴病中免疫细胞调控机制的研究进展

多房棘球蚴病(AE)是一类广泛分布于全世界并严重危害人类生产生活的人兽共患寄生虫病,人类AE常因误食多房棘球绦虫的虫卵而被感染所致,我国是AE流行高发国家之一。AE的病变部位通常在肝脏,通过浸润性生长造成邻近肝实质损伤、纤维化及衰竭。巨噬细胞、树突状细胞及T细胞等介导的免疫应答与AE的发生发展密切相关,巨噬细胞和树突状细胞在受到多房棘球蚴刺激后功能会发生相应转变,进而改变CD4~+T细胞的亚群,它们共同参与AE的免疫调节。本文从免疫细胞及相关细胞因子调控作用的角度,对AE的免疫机制作一概述,旨在为AE靶向治疗提供参考资料。     

小鼠肝细粒棘球蚴和多房棘球蚴病不同时期病灶周围组织纤维化对比

目的 本实验通过研究对比不同时间两种肝棘球蚴病灶周围组织纤维化情况,进一步了解肝棘球蚴病的病理生理发展过程,为肝棘球蚴病的诊治提供参考。方法 建立动物模型,使用HE,Masson染色以及COL1,COL3、α-SMA、TGF-β1免疫组化染色对比观察两种肝棘球蚴病在不同时间纤维化情况的不同。结果 随着时间的变化肝细粒棘球蚴病灶周围纤维化由弥漫到聚集,可形成连续致密的纤维外膜;肝多房棘球蚴病灶周围组织纤维化始终为弥漫性,无法形成连续质密的纤维外膜。细粒棘球蚴组病灶周围COL1(r=-0.768,P<0.05)、COL3(r=-0.781,P<0.05)、α-SMA(r=-0.867,P<0.05)、TGF-β1(r=-0.854,P<0.05)的表达强度与时间呈负相关,多房棘球蚴组病灶周围COL1(r=-0.349,P>0.05)、COL3(r=-0.037,P>0.05)、α-SMA(r=-0.107,P>0.05)、TGF-β1(r=-0.148,P>0.05)的表达强度与时间无相关性。 无相关性同时观察到两种包虫周围细胞外基质胶原含量不同,细粒棘球蚴组I、III型胶原比高于多房棘球蚴组(Z=-3.23,P<0.05)。结论 相较于多房棘球蚴,细粒棘球蚴病灶周围可产生连续致密的纤维外囊。细粒棘球蚴在外囊形成后纤维化进程减弱或停止,多房棘球蚴在整个病程中均有活跃的纤维化反应。细粒棘球蚴相较于多房棘球蚴外囊的I/III型胶原比值较高。     

超声在肝多房棘球蚴病诊疗中的应用进展

肝多房棘球蚴病因浸润性缓慢生长,感染者早期症状不明显,就诊时往往已为晚期,预后较差。因此,肝多房棘球蚴病早期诊断尤为重要。随着超声技术不断创新和发展,肝多房棘球蚴病诊断准确率不断提高,而且超声技术在治疗、评估疗效等方面也发挥了重要作用。本文主要就超声技术在肝多房棘球蚴病诊疗中的应用进展进行综述。     

泡状棘球蚴病动物模型及其防治研究进展

泡状棘球蚴病是由多房棘球绦虫幼虫感染引起的一种严重的人畜共患病,我国主要流行于西北和西南地区,给人类生命安全带来严重威胁,也给畜牧业带来巨大的损失。建立稳定、持续的动物模型可以帮助寻找合适的控制方法并筛选和研制有效的治疗药物。本文就泡状棘球蚴病的动物模型、防治现状等研究进展作了综述。     

Review: Molecular tools for the diagnosis of cystic and alveolar echinococcosis

In the past years, the diagnostic tools applied to identify alveolar (AE) and cystic echinococcosis (CE) in human patients have not only increased in number but also substantially improved in quality. The identification and characterization of species-specific parasite proteins/antigens allowed to generate subsequently recombinant or synthetic polypeptide antigens, as well as corresponding monoclonal antibodies. Some of these new tools have already demonstrated operating characteristics superior to conventional tests used for the immunodiagnosis of CE and AE, and thus may be suggested for routine laboratory application. Powerful molecular techniques, such as the polymerase chain reaction (PCR), have been developed and adapted to advance laboratory diagnosis of AE and CE. Detecting minute amounts of parasite DNA and mRNA, not only to identify but also to characterize the biological status of parasite material, thus becomes a complementary method to synergize immunodiagnostic techniques. This review focuses on recent developments of molecular tools, discussing their potential use as a primary or a supporting diagnostic element. We also outline some future developments to be undertaken in the field of molecular diagnosis, linked to clinical and laboratory problems.     

泡球蚴病的药物治疗进展

泡型棘球蚴病分布地域广泛,主要流行于畜牧业发达的地区,是一种严重危害人类健康和畜牧业生产的人兽共患病,现就治疗现状作一综述。     

Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans

The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance - Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively.For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended.For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2 cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE.The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update.     

棘球蚴病流行因素研究进展

棘球蚴病是一种严重危害人民健康和畜牧业发展的人兽共患寄生虫病,在世界范围内是一个重要的公共卫生和经济问题。该文概述了细粒棘球蚴病和多房棘球蚴病在全球的流行情况,从自然、宿主和社会三个方面,综述了细粒棘球蚴病和多房棘球蚴病的流行因素研究进展。遥感和地理信息系统作为疾病研究的新手段,已被应用到探索多房棘球蚴病自然因素的研究中。     

难治性肝泡型包虫病的多学科个体化治疗

肝泡型包虫病(HAE)是一种严重危害中国西部人群的人畜共患寄生虫病,严重影响患者的生活质量。近年来随着根治性手术切除率的不断提高,以往认为无法根治性切除的晚期HAE患者也有根治的可能,但部分无法根治性切除的患者仍然存在并发症多、生存质量差等问题,因此HAE被认为是难治性、复杂性疾病。单纯传统专业组讨论的经验性诊治模式不能准确地应用多个学科临床技能全方位专业化、规范化的诊治策略,无法满足晚期难治性HAE的治疗;多个学科协作诊治模式能够有机地结合目前各项治疗方式的优点,制订合理的个体化综合治疗方案。对当前HAE多学科个体化治疗作一综述,认为多学科协作综合个体化治疗是晚期难治性HAE的首选治疗方法,是患者获得长期生存的最佳手段。     

Development of Em18-immunoblot and Em18-ELISA for specific diagnosis of alveolar echinococcosis

Extensive experience has documented that Em2(plus)-ELISA, Em10-ELISA and Em18-immunoblot and Em18-ELISA are reliable serologic methods for detection of alveolar echinococcosis (AE) caused by the metacestodes of Echinococcus multilocularis. Among these, tests based on detection of antibodies to the specific Em18 antigen, either immunoblot or ELISA, appears to be the most specific for AE. Between 90 and 97% of AE cases with characteristic hepatic lesions detectable by image analysis have been positive in Em18-serology. In contrast Antigen B (8 kDa)-immunoblot is the most sensitive for all forms of echinococcosis, although it can not differentiate AE from cystic echinococcosis (CE). Primary serologic screening for echinococcosis, especially for CE using hydatid cyst fluid of Echinococcus granulosus appears to be highly sensitive in endemic areas. Glycoproteins (GPs) purified from cyst fluid of Taenia solium are highly specific for diagnosis of T. solium neuorcysticercosis (NCC). Using currently available antigens it is not difficult to differentiate these three larval cestodiases serologically. We recommend that (1) primary screening of CE in endemic areas should be carried out using hydatid cyst fluid of E. granulosus prepared from cysts in either sheep, human or mouse for immunoblot and from sheep or mouse for ELISA, (2) both primary screening and confirmation of AE in endemic areas should be carried out using Em18-ELISA, Em18-immunoblot or Em2(plus)-ELISA. Serodiagnosis in areas where both AE and CE are endemic, such as in China, should be carried out as a combination of (1) and (2), and (3) serology of NCC should be carried out using GP-ELISA or GP-immunoblot. All samples showing antibody to Em18 are exclusively from echinococcosis cases. There have been no false positive test reactions with sera from other diseases. Strongest Em18 responders are all from patients with AE but some weaker responses may be found in sera of persons with advanced complex lesions of CE. These highly reliable serodiagnostic methods using native, recombinant and synthetic antigens are briefly summarized and experiences with these methods in Japan is reviewed. We believe that use of these specific antigens in screening and confirmation programs for AE in Japan will improve specificity and reduce the confusion, anxiety and expense in persons whose sera give false positive reactions with crude echinococcal antigens.     

Liver alveolar echinococcosis in China： Clinical aspect with relative basic research

This paper deals with all aspects of liver alveolar echin-ococcosis (AE) including epidemiology, pathology, clinical manifestations, imaging examinations, diagnosis and differential diagnosis, surgical treatment and chemotherapy. The review is not only based on personal clinical experiences but also in combination with relative basic research such as proliferation and growth of alveococcus, preclinical studies of a novel compound extracted from TCM for treatment of liver AE, and molecular immunology used for specific AE diagnosis, etc.