吡喹酮治疗晚期血吸虫病肝纤维化效果的临床研究

目的  评价吡喹酮治疗晚期血吸虫病肝纤维化的临床疗效和安全性。 方法  60例晚期血吸虫病肝纤维化确诊病例随机分为2组。对照组给予常规护肝治疗；治疗组在常规治疗的基础上加用60 mg/kg 吡喹酮，每月1次。治疗前和治疗6个月后，采用彩色多普勒超声诊断仪测定门静脉内径、脾厚度、脾静脉宽度，测定患者血清透明质酸（HA）、层黏连蛋白（LN）、Ⅳ型胶原蛋白（C-Ⅳ）和Ⅲ型前胶原肽（P ⅢP）含量以及血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST），评价吡喹酮治疗晚期血吸虫病肝纤维化的效果。观察患者口服吡喹酮后24h内出现的不良反应。 结果  对照组患者平均门静脉内径、脾静脉宽度和脾厚度治疗前后差异均无统计学意义（P >0.05），治疗组患者平均门静脉内径、脾静脉宽度和脾厚度治疗6个月后较治疗前显著降低（P <0.05）。两组患者治疗后血清AST和ALT酶活性均下降，但是治疗组下降幅度更大；对照组治疗前后HA、LN、C-Ⅳ和PⅢP差异均无统计学意义（P >0.05），而治疗组治疗后血清肝纤维化四项指标均较治疗前显著降低（P 均 <0.05）。口服吡喹酮后，3例患者出现恶心、1例患者出现头晕症状，且症状均在2 d内消失。 结论  吡喹酮治疗晚期血吸虫病肝纤维化安全、有效，值得临床扩大应用。

Clinical observation on the efficacies of praziquantel for liver fibrosis in patients with advanced schisto-somiasis

Objective  To evaluate the clinical efficacies and safety of praziquantel for treatment of advanced schistosomal liver fibrosis. Methods  A total of 60 advanced schistosomiasis patients with hepatic fibrosis were randomly assigned to two groups. Patients in the control group received conventional liver protective medication, whereas those in the treatment group were given additional praziquantel in dose of 60 mg/kg, once a month on the conventional therapy protocol basis. Color Doppler ultrasonography was performed to measure the inner diameter of portal vein, spleen thickness and the width of splenic vein, and the serum concentrations of hyaluronic acid (HA), laminin (LN), type Ⅳ collagen (C-Ⅳ), procollagen Ⅲ propeptide (PⅢP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined 6 months before invention and after 6 months of medication to evaluate the therapeutic efficacies of praziquantel. The adverse reactions were also observed within 24h of praziquantel administration. Results  There were no significant differences in the inner diameter of portal vein, spleen thickness and the width of splenic vein in the control group before and after treatment (all P values >0.05), whereas those index were significantly decreased in the treatment group after 6 months of medication(all P values < 0.05). Serum AST and ALT activities were declined in patients in the two groups, yet the decline was significant in treatment group. The control group had no significant difference regarding serum HA, LN, C-IV and PⅢP concentrations(all P values >0.05), yet the difference was significant for the treatment group (all P values <0.05). Adverse reactions occurred in patients treated with praziquantel, including nausea in 3 cases and dizziness in 1, and symptoms disappeared within 2 days. Conclusion  Praziquantel is effective and safe agent for patients with schistosome-induced hepatic fibrosis, and worthy of wider clinical use.