阿苯达唑和吡喹酮交替联合用药治疗藏族牧民棘球蚴病的效果观察  

Efficacy of alternative and combined use of albendazole plus praziquantel in the treatment of echinococcosis for Tibetan herdsmen

作　　者：黄燕[1] 喻文杰[1] 尚婧晔[1] 何伟[1] 张光葭 王奇[1] 杨柳 廖沙[1] 李汭芮 姚人新 曾明才 张福斌 李树成 刘阳[1] 钟波[1] 王谦[1] HUANG Yan;YU Wen-jie;SHANG Jing-ye;HE Wei;ZHANG Guang-jia;WANG Qi;YANG Liu;LIAO Sha;LI Rui-rui;YAO Ren-xin;ZENG Ming-cai;ZHANG Fu-bing;LI Shu-cheng;LIU Yang;ZHONG Bo;WANG Qian(Sichuan Center for Disease Control and Prevention,Chengdu 610041,China;Sichuan Aba Prefecture Ruo Ergai Hospital,Ruo Ergai 624500,China;Sichuan Aba Prefecture Rangtang County Center for Disease Control and Prevention,Rangtang 624300,China;Sichuan Aba Prefecture Center for Disease Control and Prevention,Maerkang,624000,China)

机构地区：[1]四川省疾病预防控制中心,成都610041 [2]四川省阿坝州若尔盖县人民医院,若尔盖624500 [3]四川省阿坝州壤塘县疾病预防控制中心,壤塘624300 [4]四川省阿坝州疾控中心,马尔康624000

出　　处：《中国寄生虫学与寄生虫病杂志》2021年第2期171-177,共7页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：四川省科技计划(18ZDYF0972)。

摘　　要：目的观察阿苯达唑(ABZ)和吡喹酮(PQT)交替联合用药及ABZ单药治疗藏族牧民棘球蚴病的效果和不良反应,为药物治疗棘球蚴病提供参考依据。方法采用B超检查结合血清学检测对四川省阿坝州若尔盖县和壤塘县牧民进行棘球蚴病筛查,确诊患者纳入治疗和观察。将病例随机分为ABZ+PTQ交替联合用药治疗组(ABZ+PQT组)和ABZ单药治疗组(对照组,ABZ组)。ABZ+PQT组患者ABZ片剂15 mg/(kg·d),分2次服用,连服25 d,随后改服PQT片剂40 mg/(kg·d),顿服,连服5 d,依次交替服药,3个月为一个疗程,疗程中间不停药。ABZ组患者ABZ片剂15 mg/(kg·d),分2次服用,连续服药3个月,停药1周后开始下个疗程。两组患者的治疗时间均为2年。治疗期间,两组患者每半年进行一次影像学疗效评估、血清抗棘球蚴IgG抗体检测和肝功能指标监测。通过问卷调查和主要肝功能指标监测了解不良反应。结果纳入治疗随访观察的临床诊断棘球蚴病病例共97例。ABZ+PQT组共55例病例,其中细粒棘球蚴病(CE) 31例、多房棘球蚴病(AE) 24例;ABZ组共42例病例,其中CE 22例、AE 20例。通过2年的治疗和随访观察,ABZ+PQT组对CE的治愈率为19.4%(6/31),有效率为58.1%(18/31);对AE的治愈率为12.5%(3/24),有效率为50.0%(12/24)。ABZ组对CE的治愈率为9.1%(2/22),有效率为18.2%(4/22);对AE的治愈率为5.0%(1/20),有效率为20.0%(4/20)。两组在抗棘球蚴IgG抗体滴度变化差异不显著。血清抗棘球蚴IgG抗体检测结果显示,治疗前,ABZ+PQT组血清抗体吸光度(A450值)为0.39±0.06,服药3个月后上升至0.45±0.05,此后基本维持在相同水平,但在治疗12月后下降至0.38±0.07,后保持稳态;ABZ组血清抗体A450值变化趋势与ABZ+PQT组相似,服药前为0.41±0.07,服药3个月后升至0.43±0.08,治疗12个月时降为0.39±0.07,后基本平稳;不同疗程时间对血清抗体A450值的影响有统计学意义(P<0.05)。治疗期间总不良反应发生率为23.7%(23/97)Objective To observe the efficacy and side-effect of alternative and combined use of albendazole(ABZ) and praziquantel(PQT) in the treatment of human echinococcosis in Tibetan herdsmen. Methods Patients with liver echinococcosis were diagnosed by abdominal B ultrasound and sero-antibody detection in Ruo Ergai and Rangtang counties, Sichuan Province. The patients were randomly divided into two groups and were alternatively administered with oral ABZ and PQT(ABZ +PQT treatment group) or ABZ alone(ABZ control group). The ABZ +PQT group patients were given with 15 mg/kg ABZ daily dosed in 2 times for consecutive 25 days, followed by an alternative single dose of 40 mg/kg PQT for 5 days. The treatment was continued with the two regimes alternatively, a3-month dosing was defined as a treatment course, with no intervals between courses. For the ABZ group, patients were given with ABZ at a total daily dose of 15 mg/kg dispensed in two times for 3 months, followed by a new treatment course after an one-week intermittence. All the patients were treated for 2 years. During the treatment courses, all patients received B ultrasound examination, serum test for IgG antibody against Echinococcus metacestode and liver function monitoring, every 6 months. To understand the adverse effects of the drugs on liver function,questionnaire survey was performed. Results A total of 97 clinically diagnosed echinococcosis cases were for treatment and following up in this study, having 55 cases in the ABZ+PQT group, of them, 31 were cystic echinococcosis(CE) and 24 alveolar echinococcosis(AE) cases. In the ABZ control group, 47 patients(22 CE, 20 AE) were included. In the ABZ+PQT group, the cure rate and effective rate were 19.4%(6/31) and 58.1%(18/31) for CE cases;and 12.5%(3/24) and 50.0%(12/24) for AE cases, respectively. In the ABZ group, the cure rate and effective rate were 9.1%(2/22) and 18.2%(4/22) for CE cases;and 5.0%(1/20) and 20.0%(4/20) for AE cases,respectively. The serum anti-Echinococcus IgG antibody titer in the two groups du

关 键 词：阿苯达唑 吡喹酮 治疗 细粒棘球蚴病 多房棘球蚴病 疗效 

分 类 号：R532.32[医药卫生—内科学]