日本血吸虫病治疗后血清抗体消长观察

Changes of serum anti-schistosome antibody levels in schistosomiasis japonica patients after treatment

目的分析人群日本血吸虫病治疗后抗体滴度变化,为制订监测巩固方案提供科学依据。方法采用定群前瞻性研究法,以江陵县2014年检出的粪检阳性病人及血检阳性滴度1∶80以上(含1∶80)者为对象,先用吡喹酮2日疗法治疗,于治疗后半年、1年、2年分别采集血样、粪样,进行IHA抗体检测和集卵孵化法检测。结果 2014年粪检阳性病例251人,年龄以41岁以上为主,占93.23%(234/251);IHA法检测抗体高滴度病例581人,年龄以41岁以上为主,占89.16%(518/581)。粪检阳性人群治疗后半年、1年、2年粪检转阴率分别为99.60%(250/251)、100%(239/239)、100%(234/234),IHA法检测抗体转阴率分别是21.91%(55/251)、64.11%(156/239)和76.89%(193/234);IHA法检测抗体高滴度人群治疗后半年、1年、2年转阴率分别为38.04%(221/581)、64.11%(359/560)、77.86%(429/551);抗体转阴率进行χ~2检验,差异均有统计学意义(χ~2=77.538、183.412、25.469,P值均<0.001)。分别对两组人群治疗前后不同时间段抗体滴度的几何均值进行t检验,治疗前两组人群的抗体滴度几何均值差异有统计学意义(t=23.576,P<0.01);治疗后半年、1年、2年两组人群抗体滴度的几何均值差异均无统计学意义(t=-0.046、1.165、-0.132,P均>0.01)。结论日本血吸虫病治疗后人群血清中抗体水平消退缓慢,尚需开发特异的诊断技术以满足监测需求。

Objective To investigate the changes of serum anti-schistosome antibody titers in schistosomiasis japonica patients after treatment, in order to provide the evidence for formulating the schistosomiasis surveillance program in marshland and lake regions. Methods Upon prospective cohort study, the stool examination positive schistosomiasis patients and blood examination positive suspected patients （the titer was more than 1 ： 80, including 1 ： 80） were selected as the research objects in Jiangling County in 2014, and they received the 2-day praziquantel therapy. Half year, one year and two years after the treatment, their blood samples and fecal samples were collected for IHA anti-schistosome antibody detections and schistosome egg and miracidium detections. Results In 2014, the stool examination positives were 251, and the majority of them were over 41 years old, accounting for 93.23% （234/251） ; 581 cases of high antibody titers were detected by the IHA method, and the majority of them were over 41 years old, accounting for 89.16% （518/581 ）. Half year, one year and two years after the treatment, among the stool examination positives, the negative conversion rates of stool positives were 99.60% （250/251）, 100% （239/239） and 100% （234/234） respectively and the negative conversion rates of antibody positives were 21.91% （55/251） , 64.11% （156/ 239） and 76.89% （193/234） respectively. In the high antibody titer positives, the negative conversion rates were 38.04% （221/ 581 ）, 64.11% （359/560）, and 77.86% （429/551） respectively, Half year, one year and two years after the treatment. There were statistically significant differences among the antibody negative conversion rates by χ^2 test （χ^2 = 77.538, 183.412, 25.469 respectively, all P 〈 0.001 ）. The geometric mean values of antibody titers of different durations between 2 groups were analyzed by 2-independent-samples T test, and the geometric mean values of antibody titers between the 2 groups were different before the treatment （t = 23.576, P 〈 0.01 ）, but the geometric mean values of antibody titers between the 2 groups were not different 6 months, 1 year and 2 years after the treatment （ t = -0.046, 1.165, -0.132, P = 0.964, 0.245, 0.895 respectively）. Condu. sions The levels of serum anti- schistosome antibody degrade slowly in schistosomiasis japonica patients after the treatment, and the results of IHA tests cannot distinguish the current schistosome infection from previous sehistosome infection. Therefore, it is necessary to develop the specific diagnostic technology for schistosome infection in order to meet the need of monitoring.