Praziquantel: Neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease?

The role of praziquantel in hydatid disease has not been well defined. This review evaluates the evidence on the use of praziquantel in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and case reports. Praziquantel may prevent the vesicular evolution of protoscoleces and inhibit the formation of secondary cysts. It may also contribute to the loss of viability of small cysts before cyst differentiation and development of the fibrous adventitial layer. There is some evidence to support a role for the use of praziquantel in combination with albendazole in pre- and post-intervention chemotherapy for hydatid disease. Combined therapy may reduce the risk of disease recurrence and intraperitoneal seeding of infection that develops via cyst rupture and spillage occurring spontaneously or during surgery or percutaneous procedures. At present, there is insufficient published evidence to support a clear recommendation for the use of praziquantel in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary. Randomised controlled studies to determine the efficacy and optimum duration of praziquantel treatment in combination with albendazole are required so that treatment recommendations for its use can finally be clarified.     

高强度聚焦超声波辐照细粒棘球蚴包囊的热效应

目的通过检测高强度聚焦超声波(HIFU)照射棘球蚴包囊后囊液、囊壁、包囊周围肝组织温度和原头蚴死亡率,了解HIFU处理后不同部位的升温效应,探索HIFU杀伤棘球蚴的方法和效果。方法采集感染细粒棘球绦虫的新鲜羊肝,选取囊壁较薄,触摸弹性较好,直径介于10mm到45mm之间的包囊42个。采用随机区组设计的方法分组,对照组用普通超声照射,实验组用200W声功率HIFU直线扫描的方法照射,照射时间分别为2min,4min,6min,8min,10min。照射后立即测定囊液、囊壁、距包囊5mm部位肝组织的温度。抽取囊液、涂片,经台盼兰染色后计数原头蚴的死亡率。结果HIFU照射后,棘球蚴囊壁、囊液、包囊周围肝组织的温度均有升高,其中囊壁的温度升高最为明显,且与囊液、包囊周围肝组织之间有显著差异;囊液中的原头蚴死亡率增加。结论HIFU照射使棘球蚴包囊的囊壁产生明显的升温效应,HIFU照射对原头蚴有杀伤作用。     

抗包虫药物的实验研究——Ⅰ.吡喹酮体外抗细粒棘球蚴原头节的作用

在20％小牛血清-RPMI1640中,吡喹酮对体外培养的细粒棘球蚴原头节有较强的杀灭作用,主要表现为外翻、皮层肿胀、泡状物形成、破裂,以及头钩排列紊乱和脱落等,24h后即出现死亡,3天内的死亡率达90％以上。吡喹酮对培养在囊液中的原头节亦有杀灭作用,但对培养在RPMI1640和HBSS中的则无。进一步观察的结果表明,吡喹酮在体外抗原头节的作用需赖于有蛋白质的存在。此外,小鼠口服吡喹酮后,其血清有抗原头节作用,主要成份为吡喹酮原药。     

吡喹酮在体内,体外抗细粒棘球蚴囊的作用（摘要）

吡喹酮在体内、体外抗细粒棘球蚴囊的作用（摘要）肖树华，杨元清，尤纪青，沈炳贵，柴君杰（中国预防医学科学院寄生虫病研究所，世界卫生组织疟疾、血吸虫病和丝虫病合作中心，上海２０００２５，中国；新疆地方病防治研究所，乌鲁木齐８３０００２，中国）关键词　细粒...     

细粒棘球绦虫原头节在NIH株小鼠体内发育的组织学及宿主细胞反应观察

本文的观察结果表明:接种后1周,原头节的皮层内已有实质细胞长入,虫周有较大空隙,宿主细胞反应轻微。死亡原头节则已被大量炎细胞紧密包围;2～4周,大部分原头节的实质组织消失而形成细粒棘球蚴生发层,宿主细胞反应基本消失。而死虫周围则有夏科-雷登氏结晶体出现;2个月后,生发层外均已出现角质层,死亡崩解虫周的细胞反应开始减轻;4～6个月,细粒棘球蚴囊不断增大,并在生发层内陆续出现不育囊结构,虫周纤维组织较少,而解体的原头节内均已有大量胶原及网状纤维长入。对生发层的组织发生学以及适宜中间宿主对原头节的细胞反应特点进行了简要讨论。     

吡喹酮在人体肝、肺包虫囊内的浓度测定

应用高效液相色谱法,首次检测了口服吡喹酮的25例患者体内肝、肺包虫囊液、囊壁组织中的药物浓度及血药浓度。结果表明,肝包虫囊液中,吡喹酮浓度为0.087±0.013μg/ml,囊壁中为0.149±0.031μg/g肺包虫囊液中为0.043±0.006μg/ml,囊壁中为0.067±0.009μg/g;包虫囊液中药物浓度均低于囊壁,并呈正相关。此外,患者血药浓度明显高于囊内药物浓度。作者认为,囊内药物浓度的差别是吡喹酮对肝包虫病的疗效优于肺包虫病的重要原因;包虫囊壁对吡喹酮的透入有一定阻碍作用,是影响疗效的因素之一。     

微囊法棘球蚴继发感染小鼠动物模型的建立

目的 通过体外培养原头蚴发育成微囊,经腹腔注射建立稳定的细粒棘球蚴和多房棘球蚴继发感染小鼠动物模型。方法 无菌条件下采集羊源细粒棘球绦虫原头蚴和鼠源多房棘球绦虫原头蚴,经胃蛋白酶消化后检测虫体活力并计数,于37℃、5%CO₂条件下进行体外培养至发育成微囊,以每鼠50个微囊的剂量经腹腔注射的途径分别接种BALB/c小鼠。接种6个月后,通过腹部解剖大体观察和病理检测分析各组小鼠的感染情况及包虫囊的生长情况。结果 原头蚴在体外培养60d时发育成微囊,显微镜下观察Eg具有明显的透明角质层结构,而Em微囊角质层较薄。小鼠细粒棘球蚴和多房棘球蚴的感染率均为100%,Eg包虫囊为游离单囊,成囊率达70%,囊内无原头蚴;Em包虫囊为类似肿瘤的团块状组织,病灶内有生发囊及原头蚴。结论 采用微囊法可建立稳定的棘球蚴继发感染小鼠动物模型,为疫苗研制、药物筛选和疗效判定提供研究动物模型。     

高强度聚焦超声辐照小鼠体内棘球蚴的形态变化

目的探索高强度聚焦超声波(highintensity focused ultrasound,HIFU)对动物体内细粒棘球绦虫棘球蚴的杀伤作用。方法用采自感染包虫病羊肝内棘球蚴的原头节接种小鼠腹腔,建立小鼠棘球蚴病模型。用HIFU照射小鼠腹腔棘球蚴,以肉眼、光镜及电镜观察HIFU杀伤棘球蚴的破坏作用,对照组予以普通超声照射。结果HIFU对棘球蚴有明显的破坏作用,随着HIFU照射时间延长,肉眼观察见棘球蚴囊塌陷变瘪。光镜观察见囊壁撕裂、生发层细胞脱落、细胞层变薄甚至消失,角皮层变薄,但层状结构未中断。扫描电镜显示生发层细胞脱落明显,角皮层板状结构疏松;透射电镜显示生发层细胞脱落、细胞间隙增宽,角皮层未见明显破坏;对照组棘球蚴囊壁结构完整。结论高强度聚焦超声能破坏小鼠体内棘球蚴,使棘球蚴的生发层损伤,但角皮层仍然完整。     

阿苯达唑治疗102例包虫病的临床观察

用阿苯达唑治疗人体包虫病１０２例，服药前后用超声显像和Ｘ线检查，观察包虫囊肿的大小及形态变化，随访０．５—３．５年。治愈率为２６．５％。好转率５５．９％，无效率１７．６％．肺包虫病治愈率明显高于肝包虫病。肝包虫病患者中，以单纯型囊肿，直径在６ｃｍ以下疗效较好。     

Albendazole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatidosis caused by Echinococcus granulosus

Summary objective  To compare the effects of a combined medication of albendazole (10 mg/kg/day) plus praziquantel (25 mg/kg/day) to those of albendazole alone at different doses (10 and 20 mg/kg/day).
method  The protoscoleces9 viability was studied in a consecutive series of patients affected by intra-abdominal hydatidosis caused by Echinococcus granulosus . In all cases the drugs were given during the month prior to surgery.
results  A significant increase of patients with nonviable protoscoleces was observed in the group treated with the scolicides combination compared to those treated with albendazole alone, both at a dose of 10 mg/kg/day ( P = 0.004) and at a dose of 20 mg/kg/day ( P = 0.03). Albendazole sulphoxide levels in serum and in cyst fluid were higher in patients given the combined therapy than in those who received only albendazole (10 mg/kg/day: P = 0.016; 20 mg/kg/day: P = 0.034). Levels in the cysts were not significantly different probably due to the sample size; nevertheless a lineal relation between the values obtained in serum and inside the cysts could be discerned in the patients treated with the combined medication.
conclusion  Albendazole plus praziquantel is more effective than monotherapy with albendazole in the preoperative treatment of intra-abdominal hydatidosis.