Bygott J M, Chiodini P L
Department of Clinical Parasitology, Hospital for Tropical Diseases, London WC1E 6JB, UK.
Acta Trop. 2009 Aug;111(2):95-101. doi: 10.1016/j.actatropica.2009.04.006. Epub 2009 Apr 16.
The role of praziquantel in hydatid disease has not been well defined. This review evaluates the evidence on the use of praziquantel in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and case reports. Praziquantel may prevent the vesicular evolution of protoscoleces and inhibit the formation of secondary cysts. It may also contribute to the loss of viability of small cysts before cyst differentiation and development of the fibrous adventitial layer. There is some evidence to support a role for the use of praziquantel in combination with albendazole in pre- and post-intervention chemotherapy for hydatid disease. Combined therapy may reduce the risk of disease recurrence and intraperitoneal seeding of infection that develops via cyst rupture and spillage occurring spontaneously or during surgery or percutaneous procedures. At present, there is insufficient published evidence to support a clear recommendation for the use of praziquantel in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary. Randomised controlled studies to determine the efficacy and optimum duration of praziquantel treatment in combination with albendazole are required so that treatment recommendations for its use can finally be clarified.
吡喹酮在包虫病中的作用尚未明确界定。本综述评估了来自体外和体内动物研究、人体临床研究及病例报告中关于吡喹酮用于治疗囊型包虫病的证据。吡喹酮可能会阻止原头蚴的泡状演变并抑制继发性囊肿的形成。它还可能导致小囊肿在囊肿分化和纤维外膜层发育之前丧失活力。有一些证据支持在包虫病的干预前和干预后化疗中使用吡喹酮联合阿苯达唑。联合治疗可能会降低疾病复发风险以及因囊肿自发破裂或在手术或经皮操作过程中破裂和溢出而发生的腹腔内感染播散风险。目前，尚无足够的已发表证据支持对不适合手术的已确诊包虫病进行长期化疗或在严重播散性疾病中使用吡喹酮的明确推荐，还需要进一步开展工作。需要进行随机对照研究以确定吡喹酮联合阿苯达唑治疗的疗效和最佳疗程，从而最终明确其使用的治疗推荐。
