囊型包虫病诊断抗原研究进展

国内外对应用免疫学方法诊断囊型包虫病作了广泛的研究,而合适抗原的应用是其成功的关键,因此,对囊型包虫病诊断抗原的研究受到高度关注.该文就囊型包虫病诊断抗原的研究进展作一综述.     

溧阳市囊型棘球蚴病回顾性调查

2008年10月在溧阳市范围内组织各医疗单位及村卫生室开展囊型棘球蚴（CE）疑似病例线索调查,对近5年来有线索的疑似病例,由疾控机构进行回顾性调查。全市共搜索到CE 7例,均为本地人口,其中4例为网络直报病例,3例为本次线索搜索病例。6例家中有养犬、羊或从事羊的收购、屠宰史;1例有疫区生活史。溧阳市原为CE非流行区,近年来出现本地感染的病例,作为该市新出现的传染病,研究确定该病传播的原因、传播环节和流行病学特征是今后的工作重点。     

Post-survey follow-up for human cystic echinococcosis in northwest China

In Hobukesar, Xinjiang Uygur Autonomous Region, (China), a mass-screening programme for human cystic echinococcosis (CE)was performed during 1995 and 1996. After the survey 51 cases were followed-up using ultrasound scan and serology for 1-8 years(1996-2003). These included 20 CE cases treated by surgery (endocystectomy), four CE cases treated by percutaneous drainage(PAIR), six untreated CE cases, five ultrasound 'query' cases, eight cases of isolated hepatic calcifications, four previous CE surgery cases whose ultrasound was now normal, and four seropositive cases who exhibited a normal hepatic ultrasound. Follow-up results indicated that in the untreated CE patients, one case exhibited a spontaneous cure within 4 years, another case changed from a hepatic hydatid cyst that contained a floating laminated membrane (type CE3) to a cyst that contained daughter cysts (type CE2)within 1 year of follow-up. In the 20 surgically treated cases, two recurrent CE cases occurred within 4 years, and five cases had had residual cavities for more than 4 or 8 years. Of the 4 PAIR treated cases, two recurrent cases of CE occurred within 4 or 8 years of follow-up. Serological follow-up data showed that specific IgG antibody levels were persistently positive in most CE cases, but exhibited a decreasing tendency in cases that were effectively treated by surgery; In contrast, serum IgG levels in the PAIR group or in the recurrent CE cases after surgery exhibited an increasing tendency. At least one persistent seropositive case with an isolated hepatic calcification was considered to be abortive CE.     

Surgical treatment of multiple cystic echinococcosis

BackgroundMultiple hydatid disease is a complex surgical problem, and its treatment can follow either conservative principles (drainage or obliteration of the cavity) or radical principles (cystoperi-cystectomy or liver or lung resection).MethodsA total of 220 patients with multiple cystic echinococcosis (428 cysts) were managed between 1967 and 1998 with conservative operations (group A) or radical operation (group B). There were 90 men and 130 women, with a mean age of 52 years (range 18–77 years). There were two cysts in 124 patients, three cysts in 40 patients, four in 15 and more than four in 41 patients. These multiple cysts were located at one anatomical site (n=140) or at more than one site (n=80). Multiple (2–3) hepatic cysts occurred in 142 patients, multiple (2–3) lung cysts in 15 and multiple peritoneal cysts in 13 patients. Hepatic cysts co-existed with lung cysts in another 32 patients, with peritoneal cysts in 14 patients and once each with splenic, splenic plus lung cysts and renal cysts, one retroperitoneal cyst coincided with small peritoneal cysts.ResultsThe operative procedure employed was dependent on the type and site of the parasite and the condition of the host. Three of 208 patients operated conservatively (group A) died postoperatively as opposed to receiving radical treatment. Morbidity rates were 8.8% and 12.5% in group A and B and mean hospital stay was 15.8 and 15.1 days, respectively. In group A there was an 8.6% recurrence rate, and recurrent disease was finally managed in each group the overall result could be considered satisfactory.DiscussionWe conclude that conservative surgery can provide good results in multiple cystic echinococcosis. Radical surgery, with its time-consuming major procedures, is ideal but only in properly selected cases.     

肝囊型棘球蚴病术后腐蚀性硬化性胆管炎1例

腐蚀性硬化性胆管炎是一种肝囊型棘球蚴病术后罕见并发症,此类疾病虽罕见但病情进展迅速、缺乏有效治疗措施,病人往往预后较差。本文回顾性分析1例肝囊型棘球蚴病术后腐蚀性硬化性胆管炎患者诊疗过程,从而为腐蚀性硬化性胆管炎诊治提供参考。     

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.     

囊型包虫病综合性防治试点研究初报

目的在新疆北部囊型包虫病流行区,开展以包虫病防治新技术为主的综合性防治措施。考核和评价预防控制效果,探讨现阶段适宜于这一地区的包虫病预防控制模式。方法选择地理条件、生产类型和民族组成诸方面有代表性的乡为单位开展试点工作。在政府主导下实施健康教育、以有偿服务的方式对居民进行包虫病普查、对病人进行药物治疗、对家犬皮下埋植吡喹酮缓释药棒控制传染源作为主要预防控制措施。以预防包虫病基本知识的问卷调查结果、7岁儿童血清抗体水平调查结果、1岁龄绵羊包虫病患病率调查结果和家犬粪抗原检测结果等为监测指标,考核和评价预防控制包虫病的效果。结果在试点第3年末进行考核的结果为:居民对预防包虫病的四项基本知识和感染包虫病的风险行为的知晓率提高了30%-70%;7岁儿童血清抗体阳性率从试点前的28%-37.7%下降至8.0%-16.0%;绵羊包虫病患病率从50.6%下降为13.6%;家犬粪抗原阳性率从19.5%-43.2%下降至1.0% -1.98%。3个试点县中有2个县通过有偿服务的收入支付防治工作的开支后略有节余。结论试点研究的结果表明本次执行的在政府主导下,以健康教育为先导,采取有偿服务的方式,推行综合性防治措施的模式具有支撑技术先进、高效;指标明确,易于掌握和操作;适应性强;深受群众和干部的欢迎。可在较短的时间内取得显著的预防控制效果并实现防治工作的可持续发展。     

复杂性肝棘球蚴病外科治疗策略研究进展

肝棘球蚴病是一种由棘球属绦虫幼虫所致的人畜共患性疾病。我国主要致病绦虫类型为细粒棘球绦虫和多房棘球绦虫,分别引起细粒棘球蚴病和多房棘球蚴病。目前,棘球蚴病治疗已经取得重大进展,但对于部分就诊时已出现一种或多种并发症以及病灶侵及肝门、重要血管及胆管的复杂性棘球蚴病病例的治疗仍存在一定困难。本文根据近年来文献报道,结合临床经验,对复杂性肝棘球蚴病的外科治疗策略进行综述。［关键词］     

胶体金免疫层析试条法检测囊型棘球蚴病患者血清特异性抗体效果评价

目的 建它一种快速、简便诊断囊型棘球蚴病的胶体金免疫层析试条方法 ,并对其进行评价.方法 采用柠檬酸三钠还原法制备胶体金,标记抗人IsG4单克隆抗体,并将其吸附于样品垫上;将羊肝棘球蚴包囊液抗原作为包被抗原包被于硝酸纤维素膜适当位置,制成检测特异抗体的免疫层析试条.用该试条检测确诊的囊型棘球蚴病患者血清155份,以评价其敏感性,检测健康者血清50份和其他寄生虫病患者血清50份(其中囊尾蚴病患者血清30份,血吸虫病、弓形虫病、并殖吸虫病、肝吸虫病患者血清各5份)以评价其特异性.均用单盲法检测,同时用酶联免疫吸附试验(enzyme-linked immu-nosorbent assay,ELISA)进行平行检测.结果试条法检测155份囊型棘球蚴病患者血清,133份为阳性,灵敏度为85.8%;其他寄生虫病患者血清50份,44份为阴性;50份健康者血清全部为阴性,总特异度为94.0%.该方法 与ELISA的符合率为97.1%,二者阳性检出率之间的差异无统计学意义(r=0.25,P>0.05).结论 快速诊断囊型棘球蚴病的胶体金免疫层析试条法灵敏度、特异度均较高.     

Survey on cystic echinococcosis in Tibetans,West China

Human cystic echinococcosis (CE) is a serious public health problem in West China. The Tibetan has a nature relation with these definitive and intermediate hosts in West China. Although Tibet is CE endemic, a few community studies have been reported. Eight hundred and eighty two Tibetans residing in the three rural communes of Tianzhu County, Gansu province of West China were investigated by serology and ultrasound scanning. 11.2% serum antibody positive rate in ELISA test was found out, and a 12.1% ultrasound rate of hepatic CE was found in the sero-positive population. Seropositivity rates varied for communes between 7.6 and 13.7%. Overall, females had a significantly greater risk of infection than males-ratio was about 2:1. The local behaviors were investigated and showed that family dog and grazing could not effect the infectious rates, but the number of sheep owned a family had a positive correlation with the infection rates. The infectious rate of hunting population was significantly higher than that of no-hunting population. The educated level of Tibetans in school had no effect on the infected rates.     

Albendazole-soybean oil emulsion for the treatment of human cystic echinococcosis: evaluation of bioavailability and bioequivalence

A single 12.5 mg/kg dose of albendazole (Abz) in tablet form (AbzT) followed 2 weeks later by an equivalent dose of Abz emulsified in 30% soybean oil (AbzE) was administered orally 2 h after the first morning meal to 7 male adult patients with cystic echinococcosis caused by Echinococcus granulosus. Serum samples were taken 1, 3, 5, 7, 8, 9, 11, 14, 18, 24, 36, and 48 h post medication from each patient to measure the serum concentrations of albendazole sulfoxide (AbzSOX), the principal bioactive metabolite of Abz. AbzSOX concentrations were measured by reverse phase HPLC. The data were subjected to pharmacokinetic analysis to compare the relative bioavailability and bioequivalence of AbzT and AbzE. The results demonstrated that the mean peak concentrations (C(max)) for AbzT and AbzE were 1.06+/-0.38 mg/l and 1.71+/-0.47 mg/l, respectively; the area under the concentration-time curves (AUC) were 13.24+/-4.93 mg x h/l and 21.01+/-7.54 mg x h/l, respectively. The relative bioavailability of AbzE was F(Flu)=1.59. Two one-sided tests procedure and (1-2 alpha) 90% confidence interval methods were used to evaluate the bioequivalence of AbzE and AbzT. The results demonstrated that the bioavailability of AbzE was greater than AbzT.     

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。     

左侧股骨原发性细粒棘球蚴病1例

本文报道左侧股骨原发细粒棘球蚴病1例。     

我国非青藏高原流行区囊型棘球蚴病聚类分析

目的 目的 对我国非青藏高原流行区囊型棘球蚴病以县 （市、 区、 旗） 为单位, 进行综合评判并分类, 了解该地区囊型 棘球蚴病的流行特点及规律, 为提出针对性的预防控制措施提供依据。 方法 方法 根据2012年全国包虫病流行情况调查数 据库中174个非青藏高原县 （市、 区、 旗） 囊型棘球蚴病调查资料, 综合人群患病率、 家畜感染率、 犬棘球绦虫粪抗原阳性率 等指标, 采用样本聚类法进行分析。 结果 结果 174个囊型棘球蚴病非青藏高原县 （市、 区、 旗） 可分为4类主要的空间分布区 域。其中第一类区域包括3县, 其人群患病率高, 家畜感染率低, 犬棘球绦虫粪抗原阳性率低; 第二类区域包括20县 （市、 区）, 其人群患病率低, 家畜感染率高, 犬棘球绦虫粪抗原阳性率低; 第三类区域包括39县 （市、 区、 旗）, 其人群患病率低, 家 畜感染率低, 犬棘球绦虫粪抗原阳性率高, 第四类区域包括112县, 以上3个指标值均较低。 结论 结论 聚类结果与我国囊型 棘球蚴病非青藏高原地区流行区情况相符, 4类地区的流行特点及地理分布可为该区域棘球蚴病防治工作的分类管理与 指导提供依据。     

Human cystic echinococcosis in South Africa

Cystic echinococcosis is recognised as causing considerable morbidity and even mortality in South Africa, but the epidemiology of the disease is to date unknown. From current evidence there are also concerns that co-infections with HIV and tuberculosis (TB) considerably increase CE-associated morbidity. The aim of this analysis was to characterise clinical features and disease burden of CE in South Africa in preparation for a prospective study.Retrospective case note analysis of patients presenting to two large academic hospitals in Johannesburg, South Africa, for clinical and demographic data was performed. In addition, data of the National Health Laboratory Service were accessed for requested serological and microscopic investigations for CE and the numbers of positive results evaluated.According to a recently published definition, 14 cases of confirmed CE and 9 cases of probable CE were identified at both hospitals. When accessing the national database it became apparent that even with the most conservative estimate at least 137 patients per year present with CE in South Africa. However, numbers are likely to be much higher for a variety of reasons. Further prospective analysis is necessary to shed more light on the epidemiology, clinical presentation and risk factors for CE, which is currently underway.     

Ultrasonographic diagnosis and medical treatment of human cystic echinococcosis in asymptomatic school age carriers: 5 years of follow-up

Hydatidosis or cystic echinococcosis (CE) caused by Echinococcus granulosus is endemic in the Province of Río Negro, Argentina. The objective of this investigation was to evaluate the results of a program carried out in endemic areas of the Province of Río Negro, Argentina, in the years 1997-2002. Abdominal ultrasonography was used, classifying the cases detected according to WHO guidelines. A treatment algorithm was defined which included observation, albendazol therapy, PAIR or surgery, according to cyst type and size. A total of 5745 schoolchildren were evaluated, detecting hydatid cyst carriers in 70 (1.2%). Of these; 40 (57.1%) were included in follow-up protocol, 25 (35.7%) in treatment protocol with albendazol, 2 (2.9%) with PAIR and 3 (4.3%) with conventional surgery. After a mean of 44 months, among 25 cases treated with albendazol, in 2 (8%) cysts underwent total involution, in 17 (68%) they presented positive changes, in one (4%) they remained unchanged and in 4 (16%) they progressed to type II, while 1 (4%) displayed negative evolutionary changes. Out of 39 cases under observation alone protocol, in 8 cases (21%) cysts underwent total involution, in 7 (18%) they presented positive changes, in 11 (28%) they remained unchanged, in 2 (5%) they progressed to Type II and in 11 (28%) they presented negative evolutionary changes and had to be included in the other protocol types. In this study, conventional surgery, was applied to 10% of detected cases. The combination of ultrasonographic screening and albendazol treatment showed promising results.     

Economic effects of echinococcosis

Cystic echinococcosis (CE) has a number of important economic effects. The most tangible of these is the cost of expensive medical treatment for human cases. Each confirmed case of CE can cost the health services or individual several thousand dollars. In addition to these costs, the additional cost of loss of edible offal from agricultural animals is well known. This may result in the entire loss of an infected organ or at least the trimming and downgrading of that organ, depending on local legislature. However, these losses may only be a relatively small percentage of the economic losses attributed to CE. Recent evidence suggests, through quality of life surveys, that patients treated for CE never fully recover and have a significant and permanent decreased quality of life. This has yet to be translated into monetary terms, but it almost certainly will result in the loss of income, possibly through a lower paid job, and/or the additional expense of increased ill health. Furthermore, in most reports, between 1 and 2% of CE cases are fatal. The death of these individuals results in the loss of the potential lifetime's economic output of these individuals. With alveolar echinococcosis the mortality rate is much higher and such consequences more severe. There is also a considerable amount of Soviet literature, and small amounts published elsewhere which suggests that CE also significantly affects animal productivity. Thus, infected sheep tend to give birth to fewer lambs, have lower levels of food conversion, produce less milk and have poorer quality fleeces then non-infected sheep. The total cost of the disease is the sum of the various costs to the health services, costs of morbidity and losses in animal productivity. Due to the uncertainty of many of these costs, it is appropriate to model these losses using techniques that can give a range of cost estimates. By using analytical techniques such as Monte-Carlo analysis, on parameters that are difficult to determine accurately, all such variables can be randomly varied simultaneously along likely frequency distributions. The results of this give a useful sensitivity analysis of economic costs. In addition, the purchasing power of money in the local economy must also be taken into account. One US $ buys much more in a developing country than in an industrialized economy. Consequently, each lost $ will be more acutely felt in poor countries. Estimates of the financial burden of disease are beneficial in deciding priorities for control. They are also potentially useful tools to lobby donors or non-governmental organizations to fund control programs in poor countries.     

79例肝棘球蚴病患者影像学分析

目的 回顾性分析79例肝棘球蚴病患者的影像学表现,为该病诊断与鉴别诊断提供参考。方法 收集2014-2017年在青海省人民医院行影像学检查并经病理检查证实的79例肝棘球蚴病患者病历资料,对其影像学表现进行回顾性分析。结果 79例肝棘球蚴病患者中,细粒棘球蚴病57例,多房棘球蚴病22例;细粒棘球蚴病患者中,单囊型21例,多子囊型16例,内囊塌陷型9例,实变型4例,钙化型7例。79例患者中,62例为常见影像学征象。单囊型细粒棘球蚴病表现为肝内囊性水样病灶,囊壁薄厚均匀、无强化;多子囊型表现为“囊中囊”、“玫瑰花瓣”、“轮辐征”等;当内囊塌陷分离时表现为“飘带征”、“双环征”等征象;囊壁钙化时呈弧线状、蛋壳状,囊内容物呈现絮状或者整个病灶钙化。多房棘球蚴病表现为肝内实性肿块,密度及信号不均匀,边缘不规则;病灶强化不明显,病灶内散在或者群簇状分布的“小囊泡”,常伴有钙化,整个病灶呈“地图样”外观。另外17例患者表现为复杂少见的影像征象;其中6例细粒棘球蚴病囊内含脂肪,影像表现为囊内单发或多发脂肪密度结节灶,CT值为-28～-84 HU;4例病灶破入胆管,邻近胆管密度增高,胆管壁增厚,周围胆管扩张;4例合并原发性肝癌,影像表现为肝内细粒或多房棘球蚴病合并实性强化肿块,增强呈“快进快出”表现;3例合并感染,影像学表现为囊壁明显增厚且强化明显,其中2例囊内见气体影,1例囊肿合并感染并侵及腹壁。结论 肝棘球蚴病影像学表现复杂多样,在临床工作中需认真分析,做好鉴别诊断。     

Retrospective study of human cystic echinococcosis in Italy based on the analysis of hospital discharge records between 2001 and 2012

Cystic echinococcosis (CE) is an important zoonotic parasitic infection. The European Centre for Disease Control highlights that Italy lacks a surveillance system for CE. Due to the lack of official data, we analysed the Hospital Discharge Records (HDRs) drawn from the National Ministry of Health. The aim of this study was to analyse data from the HDRs with CE-related diagnoses in Italy from 2001 to 2012 to assess the current status and trend of disease epidemiology. A total of 16,550 HDRs related to the admission of 10,682 Italian patients were examined. The HDRs were analysed according to the patient's region and province code to evaluate the demographic and clinical characteristics of each case, together with the annual incidence rates of hospital cases (AIh) in administrative divisions in rural and urban areas. Lesions occurred frequently in the liver (83.6%) and lungs (8.4%). Patients ranged in age from 1 to 100 years (mean 59.8), and 57% were over 60 years old. The highest average AIh was registered in the Islands with 4.6/10⁵ inhabitants (6.9/10⁵ in Sardinia and 4.3/10⁵ in Sicily), followed by the South with an average AIh of 1.9/10⁵ inhabitants (5.4/10⁵ inhabitants) and the Centre with an average AIh of 1.07/10⁵ inhabitants (there was an AIh of 1.65/10⁵ in Latium). The analysis for trend showed a statistically significant decrease in the AIh throughout the study period (e.g., in the Islands r² = 0.98, p < 0.001). An AIh over 2/10⁵ inhabitants was observed in 31/110 provinces. Rural areas with comprehensive development problems had a relative risk of CE of 5.7 (95% CI, 5.3 to 6.9) compared to urban areas. The relative risk increased between areas where sheep breeding is widespread compared to those where it is less prevalent. This study shows a detailed picture of the geographic distribution and the epidemiological situation of CE in Italy, indicating that CE continues to be a significant public health problem in Italy. The retrospective study of HDRs is useful for the evaluation of the status of disease epidemiology; however, a surveillance system is needed to report confirmed cases of human CE.     

Progress in control of cystic echinococcosis in La Rioja,Spain: decline in infection prevalences in human and animal hosts and economic costs and benefits

The Autonomous Community of La Rioja is a region in the north of Spain where the mean annual number of surgical cases of cystic echinococcosis (CE) was 50 (19 per 100000 inhabitants) during the years 1984-1987. This high clinical incidence prompted local authorities to implement a control program in 1986, whose methods and results are reported here. Initially, the program consisted in documenting the prevalence of CE in sheep and humans, communicating an awareness of the disease risks among the population, and treating all registered dogs with praziquantel at intervals of 45 days. Stray dogs were collected systematically, euthanized, and their intestines were examined for Echinococcus granulosus infection. Epidemiological data collected during the course of the program demonstrated that the major reservoirs of E. granulosus were the stray dogs, precisely the ones not receiving periodic praziquantel treatment. Therefore, the program emphasis was shifted to targeting critical points in the transmission of E. granulosus, including improved control of stray dogs, echinococcidal treatments of working sheep dogs, providing means for safe disposal of slaughtered sheep offal and safe disposal of dead sheep in sanitary pits. These measures led to a decline in prevalence of E. granulosus in dogs from 7.0% at the beginning of the program to 0.2% in 2000, i.e. a reduction of 97.2%. Prevalence of infection in adult sheep declined from 82.3 to 20.3%, i.e. a reduction of 75.4%, while the mean number of cysts per infected animal decreased from 6.5% to 0.58 (91% reduction). The rate of diagnoses of new cases in humans between these two dates dropped by 78.9%, from 19 to 4 per 100000 population. In terms of economic costs, these reductions were estimated to yield an increasing cumulative cost/benefit balance that was already positive on year 8 of the program (1994), and that reached 1.96 in year 2000.