伊维菌素和海群生治疗班氏丝虫病免疫学观察

EFFICACY OF IVERMECTIN FOR CONTROL OF MICROFILAREMIA RECURRING AFTER TREATMENT WITH DIETHYLCARBAMAZINE: IMMUNOLOGICAL OBSERVATION *

应用双盲法以单剂量伊维菌素和标准疗程海群生(DEC)各治疗30例班氏丝虫病,曾经海群生3-4疗程治疗后微丝蚴复现的患者、治疗前和服药后1、2、8、14、30、90、180、和360d检测血清中微丝蚴和成虫的抗原和抗体水平。 结果发现:治疗后1-2d,血清HC_(11),ES_(34)抗原水平呈短暂上升,抗ES抗体水平则明显下降。14d,抗ES、抗成虫抗体均明显升高。90d后ES_(34)、HC_(11)抗原下降、ES_(34)降至接近正常水平。但微丝锄复现者有回升趋势。伊维菌素组回升更为明显,表明治疗后血清ES_(34)、HC_(11)监测可能有助于考核药物杀灭成虫的疗效。治疗后初期的抗原上升、抗体下降,似反映有免疫复合物形成可能与副作用的出现有关。

We compared the effect of a single dose of ivermectin (100ug/kg) with that of a standard course of diethylcarbamazine (DEC) (6mg/kg) on several parameters of the host's an-tifilarial immune response in 60 patients with bancroftian filariasis enrolled in a double-blind drug trial. All participants had measurable serum levels of antifilarial antibodies and parasite antigens. Drug-induced clearance of microfilaremia was associated with a temporary increase in HC11 antigenemia and a decrease in serum levels of antibodies to soluble filarial antigens. Antigenemia progressively declined in patients who remained amicrofilaremic after treatment, but declined and then rose in persons with recurrent microfilaremia. Treatment triggered a sustained increase in serum levels of IL-1 ,IL-6,TNFβ and IFNγ in all patients. Although Ivermectin and DEC are believed to exert their antiparasite activity via different mechanisms, the same pattern of serological changes was observed in patients treated with either drug.