Ozeretskovskaia N N
Med Parazitol (Mosk). 2000 Oct-Dec(4):9-14.
The results of earlier clinical, pathomorphological, and immunological studies of organic visceral and tissue lesions in helminthic infections [2, 3, 8, 10, 11, 14, 46] and present clinical and immunological ones [4-6, 44, 45] were analyzed and discussed in the light of a fundamental literature data review. The chronic visceral pathology in tissue-dwelling helminthic infections is associated with super- and reinfections [1, 2, 16, 36], with an inadequate immune response of humans to the invasion of zoonotic agents [2, 6, 13, 20] and with an individual invalidity of an immune response to infections [1, 2, 6, 16, 54]. The persistent course of infections, especially zoonotic, leads to organic pathology, sometimes irreversible [2, 13, 15, 21, 34, 46] if an individual (population) does not respond by immunity or by acquired (inherited) tolerance of invasion [1, 2, 3, 11, 16, 20, 36]. Transplacental transfer of Opisthorchis felineus antigens in the hyperendemic foci of the infection does not prevent superinfections, but does prevent the acute phase of disease and significantly mitigates the organic lesions in the chronic phase in spite of a very high intensity of infection [7, 10, 11]. Paramyosines (Pmes), proteins expressed on the tegument of Schistosoma mansoni and S. japonicum, show their immunogenic effect [42]. Antibodies to PM of Lumbricoidea and to a cardiac muscle myosin peptide (alpha-mp), known to induce experimental allergic myosites [55], were revealed in the sera of 32 trichinellosis, toxocarosis, opisthorchiasis, and hydatid echinococcosis patients with organic visceral abnormalities. The levels of antibodies against alpha-mp correlated with the severity of pathology [44]. S. mansoni PM peptide smp97 is a homologue of alpha-mp [25]. This fact suggests that there is a relationship between the development of an immune response to Pmes immunological processes in helminthiases. The relationship between organic visceral pathology and a competitive with serum IgE serum IgG4 hyperproduction at the early [6] and late stages of the studied helminthic infections was revealed. One may resume that this balance of production of these isotypes is not beneficial for the development of disease as IgG4-antibody hyperproduction is not beneficial for reinfection resistance [26, 28, 54]. One of the mechanisms may be serum IgG4 blocking the antibody-dependent cytotoxic effect, as it was supposed for unspecific IgE hyperproduction [47]. The selected development of cardiomyopathy or obstructive fibrosis in the lung after trichinellosis [2, 6, 45], endomyocardiofibrosis in the foci of filariases [21, 31] suggests that their development like resistance or susceptibility to infections [54] should be programmed.
根据基础文献数据综述，对早期关于蠕虫感染中器官内脏和组织病变的临床、病理形态学及免疫学研究结果[2, 3, 8, 10, 11, 14, 46]以及当前的临床和免疫学研究结果[4 - 6, 44, 45]进行了分析和讨论。组织内寄生蠕虫感染中的慢性内脏病理学与重复感染和再感染[1, 2, 16, 36]、人类对人畜共患病原体入侵的免疫反应不足[2, 6, 13, 20]以及个体对感染的免疫反应无效[1, 2, 6, 16, 54]有关。感染的持续过程，尤其是人畜共患感染，如果个体（群体）没有通过免疫或对入侵的获得性（遗传性）耐受性做出反应，会导致器官病理学改变，有时是不可逆的[2, 13, 15, 21, 34, 46]。在感染的高度流行区，猫后睾吸虫抗原的经胎盘转移并不能预防重复感染，但尽管感染强度很高，却能预防疾病的急性期，并显著减轻慢性期的器官病变[7, 10, 11]。曼氏血吸虫和日本血吸虫体表表达的副肌球蛋白（Pmes）具有免疫原性[42]。在32例有器官内脏异常的旋毛虫病、弓蛔虫病、后睾吸虫病和包虫棘球蚴病患者的血清中，发现了对环节动物门副肌球蛋白和已知可诱导实验性过敏性肌炎的心肌肌球蛋白肽（α - mp）的抗体[55]。抗α - mp抗体水平与病理学严重程度相关[44]。曼氏血吸虫Pmes肽smp97是α - mp的同源物[25]。这一事实表明，蠕虫感染中对Pmes的免疫反应发展与免疫过程之间存在关联。在研究的蠕虫感染的早期[6]和晚期，揭示了器官内脏病理学与血清IgE竞争及血清IgG4过度产生之间的关系。可以推断，这些同种型产生的这种平衡对疾病发展不利，因为IgG4抗体过度产生不利于抵抗再感染[26, 28, 54]。其中一种机制可能是血清IgG4阻断抗体依赖性细胞毒性作用，就像非特异性IgE过度产生的情况一样[47]。旋毛虫病后心肌病或肺部阻塞性纤维化[2, 6, 45]、丝虫病病灶中的心内膜心肌纤维化[21, 31]的特定发展表明，它们的发展如对感染的抵抗力或易感性[54]一样应该是预先设定好的。
