Fabbro Diana L, Streiger Mirtha L, Arias Enrique D, Bizai María L, del Barco Mónica, Amicone Norberto A
Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina.
Rev Soc Bras Med Trop. 2007 Jan-Feb;40(1):1-10. doi: 10.1590/s0037-86822007000100001.
The efficacy of treatment with nifurtimox and/or benznidazole among adults with chronic Chagas disease with no previous electrocardiographic disturbances was evaluated over a mean follow-up of 21 years, by means of conventional serology, xenodiagnosis, clinical examination, electrocardiograms and chest X-ray. One hundred and eleven patients, between 17 and 46 years old, were studied: 54 underwent treatment (nifurtimox 27, benznidazole 27) and 57 remained untreated (control group). Xenodiagnosis was performed on 65% of them: 36/38 of the treated and 9/34 of the untreated patients had previous positive xenodiagnosis. Post-treatment, 133 xenodiagnoses were performed on 41 patients, all resulting negative. In the control group, 29 xenodiagnoses were performed on 14 patients; 2 resulted positive. Sera stored during the follow-up were simultaneously analyzed through conventional serology tests (IHA; DA-2ME; IIF). The serological evolution in the treated group was: a) 37% underwent negative seroconversion (nifurtimox 11, benznidazole 9); b) 27.8% decreased titers (nifurtimox 9, benznidazole 6), 9 showed inconclusive final serology (nifurtimox 7, benznidazole 2); c) 35.2% remained positive with constant titers (nifurtimox 7; benznidazole 12). The control group conserved the initial antibody levels during the follow-up. In the clinical evolution, 2/54 (3.7%) of the treated and 9/57 (15.8%) of the untreated patients showed electrocardiographic disturbances attributable to Chagas myocardiopathy, with a statistically relevant difference (p<0.05). Treatment caused deparasitation in at least 37% of the chronically infected adults and a protective effect on their clinical evolution.
通过传统血清学、虫媒接种诊断法、临床检查、心电图和胸部X光检查，对平均随访21年的无既往心电图异常的慢性恰加斯病成年患者使用硝呋莫司和/或苯硝唑治疗的疗效进行了评估。研究了111名年龄在17至46岁之间的患者：54人接受了治疗（硝呋莫司27人，苯硝唑27人），57人未接受治疗（对照组）。其中65%的患者进行了虫媒接种诊断：治疗组38人中的36人以及未治疗组34人中的9人既往虫媒接种诊断呈阳性。治疗后，对41名患者进行了133次虫媒接种诊断，结果均为阴性。在对照组中，对14名患者进行了29次虫媒接种诊断；2次结果呈阳性。随访期间储存的血清通过传统血清学检测（间接血凝试验；二巯基乙醇处理；间接免疫荧光法）同时进行分析。治疗组的血清学演变情况为：a）37%发生血清学阴转（硝呋莫司11人，苯硝唑9人）；b）27.8%滴度降低（硝呋莫司9人，苯硝唑6人），9人最终血清学结果不确定（硝呋莫司7人，苯硝唑2人）；c）35.2%保持阳性且滴度恒定（硝呋莫司7人；苯硝唑12人）。对照组在随访期间保持了初始抗体水平。在临床演变方面，治疗组54人中的2人（3.7%）以及未治疗组57人中的9人（15.8%）出现了可归因于恰加斯心肌病的心电图异常，差异具有统计学意义（p<0.05）。治疗使至少37%的慢性感染成年人实现了寄生虫清除，并对其临床演变产生了保护作用。
