Bergquist N Robert, Leonardo Lydia R, Mitchell Graham F
Ingerod 407, S-45494 Brastad, Sweden.
Trends Parasitol. 2005 Mar;21(3):112-7. doi: 10.1016/j.pt.2005.01.001.
The present strong emphasis on gross organ pathology (liver, kidneys, bladder) in schistosomiasis needs to be replaced with a more balanced view of the disease that also takes into account systemic symptoms that are less easy to assess, such as retarded growth, cognitive development and the effect of continuing low-level blood loss. Access to better estimates of disease burdens, morbidity and mortality is delivering results that bring into question the wisdom of downgrading the impact of the disease. In this scenario, the simplistic approach of exclusive drug treatment might not be sufficient and, in the worst-case scenario, might even exacerbate pathology. To meet this challenge, the repositioning of vaccines within the totality of disease control through the combined use of chemotherapy and vaccination is recommended as the basis for a novel, more-versatile approach to control. Studies on human correlate responses in endemic areas have opened the way to assess the protective value of specific antigens through the cytokine responses and antibodies they elicit. Moreover, vaccine formulations based on novel adjuvants could improve the final outcome through selective manipulation of the immune response. Thus, the tools of vaccine-linked chemotherapy are in principle already available and could shortly be put to the test in clinical trials.
当前对血吸虫病主要侧重于大体器官病理学（肝脏、肾脏、膀胱）的研究，需要被一种对该疾病更全面的认识所取代，这种认识还应考虑到那些较难评估的全身症状，如生长发育迟缓、认知发展以及持续低水平失血的影响。获取关于疾病负担、发病率和死亡率的更准确估计正在产生一些结果，这些结果让人质疑降低该疾病影响的做法是否明智。在这种情况下，单纯的药物治疗这种简单方法可能并不足够，在最坏的情况下，甚至可能会加重病理状况。为应对这一挑战，建议通过联合使用化疗和疫苗接种，在疾病控制的整体框架内重新定位疫苗，以此作为一种新颖、更具通用性的控制方法的基础。在流行地区对人体相关反应的研究为通过特定抗原引发的细胞因子反应和抗体来评估其保护价值开辟了道路。此外，基于新型佐剂的疫苗配方可通过对免疫反应的选择性调控来改善最终结果。因此，与疫苗相关的化疗工具原则上已经具备，并且很快就能在临床试验中进行检验。
