脑曼氏裂头蚴病治疗后的临床结局与抗体水平变化的多中心研究

Clinical outcome and change of antibody level in cerebral sparganosis mansoni patients after treatment:a multicenter study

目的分析脑曼氏裂头蚴病经临床治疗后的临床结局和血清曼氏裂头蚴抗体IgG滴度变化,以进一步探讨考核该病疗效的指标。方法收集2013—2018年江西省寄生虫病防治研究所、南昌大学第一附属医院、广东三九脑科医院住院及门诊连续治疗随访的脑曼氏裂头蚴病病例。吡喹酮治疗患者给予吡喹酮50 mg/(kg·d),连续给药10 d后,间隔60 d,重复给药3个疗程;手术治疗患者采用开颅手术和CT引导立体定向抽吸术。吡喹酮治疗和手术治疗后12个月,随访患者的临床表现,影像学(头颅MRI平扫及增强)复查,测定曼氏裂头蚴血清IgG抗体水平。采用SPSS 18.0统计学软件进行统计分析。结果共收集87例脑曼氏裂头蚴病病例,其中吡喹酮治疗62例(其中10例吡喹酮治疗后转手术治疗),手术治疗35例。治疗后12个月,临床结局优的患者有71例,无症状患者占57.7%(41/71),有临床症状者占42.3%(30/71),其中抽搐占26.8%(19/71),轻瘫占14.1%(10/71),复视占1.4%(1/71);影像学检查显示,活动性强化病灶消退占85.9%(61/71),仍有病灶者占14.1%(10/71),其中单个小结节状病灶的占12.7%(9/71);血清学检测显示,曼氏裂头蚴血清IgG抗体滴度<1∶100(阴性)的患者占64.28%(52/71),1∶100的患者占23.80%(12/71),1∶200的患者占11.90%(7/71)。治疗后12个月,治疗结局差的患者有16例,无症状者占1/16,有临床症状者占15/16,其中抽搐占12/16,轻瘫占3/16,头痛、病情加重、无明显改善、出现新发症状者各1例;影像学显示,病灶无变化占6/16,病灶增大占1/16,病灶位置变化占7/16,出现新的强化病灶占2/16;血清学检测显示,抗体滴度为1∶400的患者占4/16,1∶800的患者占8/16,1∶1600的患者占4/16。结论脑曼氏裂头蚴病经吡喹酮和手术治疗后多数预后良好;患者血清学检测可用于考核12个月的近期疗效,可弥补症状和影像学的局限。

Objective To analyze the clinical outcomes and changes in serum IgG antibody titers against Sparganum mansoni after treatment,for further exploring the indicators in assessing the therapeutic effects for cerebral sparganosis.Methods Cases of cerebral sparganosis patients followed-up on continuous inpatient or outpatient treatment were collected from Jiangxi Provincial Institute of Parasitic Diseases,the First Affiliated Hospital of Nanchang University and Guangdong 999 Brain Hospital during 2013 to 2018.The patients were administrated with praziquantel50 mg/(kg·d)for 10 days per cource,continuing for three cources at a 60-day interval.The surgical treatment includes craniotomy and CT-guided stereotactic aspiration.Twelve months after the treatment with praziquantel and surgery,the clinical manifestations of patients were followed-up,imaging examination(including brain MRI flat and enhanced scan)rechecked,and the serum IgG titer assayed.Statistical analysis was performed using SPSS 18.0 software.Results Eighty-seven cases of cerebral sparganosis were collected,of which 62 patients received praziquantel treatment(10 patients were treated with praziquantel prior to surgery),and 35 patients underwent surgical therapy.After 12 months of treatment,among the 71 patients with good outcomes,57.7%(41/71)were asymptomatic,42.3%(30/71)had clinical symptoms,among them 26.8%(19/71)with seizure,14.1%(10/71)with paresis,and 1.4%(1/71)with diplopia.Radiography showed that 85.9%(61/71)of active enhanced foci were resolving,while 14.1%(10/71)foci remained,of them 12.7%(9/71)were single small nodular lesions.Serology examination revealed that 64.28%(52/71)cases were negative for IgG against Sparganum mansoni(antibody titer<1∶100),23.80%(12/71)had an antibody titer of 1∶100,and 11.90%(7/71)had the titer of 1∶200.After treatment for 12 months,16patients were of poor outcomes,showing 1/16 was free of symptom,and 15 had clinical symptoms,of them 12/16patients with seizure,3/16 with paresis,while headache,aggravating illness,no significant improvement and emerging new symptoms were found of 1 case each.Radiography indicated that among the cases,6/16 showed no changes in lesion images,1/16 had enlarged foci,7/16 changes in lesion location,and 2/16 newly enhanced lesions.Serology examination on the patients showed 4/16 had an antibody titer of 1∶400,8/16 had the titer of 1∶800 and 4/16had the titer of 1∶1600.Conclusion Most of the cerebral sparganosis cases had a good prognosis after praziquantel and surgery treatment.Serological tests could be used for assessment of recent therapeutic effect in 12months,redeeming the limitations in appraisal by symptoms and imaging.