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巴西米纳斯吉拉斯州经媒介控制地区慢性恰加斯病患者在病因治疗前和治疗后 9 年的临床和实验室状况。

Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment.

机构信息

Departamento de Análises Clínicas, Escola de Farmácia.

出版信息

Mem Inst Oswaldo Cruz. 2009 Dec;104(8):1139-47. doi: 10.1590/s0074-02762009000800011.

Abstract

Twenty-eight Chagas disease patients (CD), 22 with the indeterminate clinical form (IND) and six with the cardiac or digestive form (CARD/DIG), were treated with benznidazole and underwent clinical and laboratorial analysis before (IND and CARD/DIG) and nine years after [patients after treatment (CDt), patients with the indeterminate clinical form at treatment onset (INDt) and with the cardiac or digestive form at treatment onset (CARD/DIGt)] treatment. The data demonstrate that 82.1% of CDt patients (23/28) remained clinically stable and 95.4% of the INDt (21/22) and 33.3% of the CARD/DIGt (2/6) patients showed unaltered physical and laboratorial examinations. The clinical evolution rate was 2%/year and was especially low in INDt patients (0.5%/year) relative to CARD/DIGt patients (7.4%/year). Positive haemoculture in treated patients was observed in 7.1% of the cases. None of the INDt (0/21) and 33.3% of the CARD/DIGt (2/6) patients displayed positive cultures. The PCR presented a positive rate significantly higher (85.2%, 23/27) than haemoculture and two samples from the same patient revealed the same result 57.7% of the patients. Conventional serology-ELISA on 16 paired samples remained positive in all individuals. Semi-quantitative ELISA highlighted significant decreases in reactivity, particularly in INDt relative to IND. Non-conventional serology-FC-ALTA-IgG, after treatment, showed positive results in all sera and 22 paired samples examined at seven and nine years after treatment, demonstrated significantly lower reactivity, particularly in INDt patients. This study was retrospective in nature, had a low number of samples and lacked an intrinsic control group, but the data corroborate other results found in the literature. The data also demonstrate that, even though a cure has not been detected in the none-treated patients, the benefits for clinical evolution were selectively observed in the group of INDt patients and did not occur for CARD/DIGt patients.

摘要

二十八例恰加斯病患者(CD),22 例为不确定临床形式(IND),6 例为心脏或消化系统形式(CARD/DIG),接受了苯并硝唑治疗,并在治疗前(IND 和 CARD/DIG)和治疗后 9 年(CDt 患者、治疗开始时具有不确定临床形式的患者(INDt)和治疗开始时具有心脏或消化系统形式的患者(CARD/DIGt))进行临床和实验室分析。数据表明,82.1%的 CDt 患者(23/28)临床稳定,95.4%的 INDt(21/22)和 33.3%的 CARD/DIGt(2/6)患者的身体和实验室检查未改变。临床进展率为每年 2%,尤其是 INDt 患者(每年 0.5%)相对较低,而 CARD/DIGt 患者为 7.4%。在治疗患者中观察到 7.1%的阳性血液培养。INDt 患者中无一例(0/21)和 CARD/DIGt 患者中 33.3%(2/6)显示阳性培养。PCR 的阳性率明显高于血液培养(85.2%,23/27),且同一患者的两个样本中有 57.7%的患者结果相同。16 对配对样本的常规血清学-ELISA 均保持阳性。半定量 ELISA 显示反应性显著降低,尤其是在 INDt 患者中。治疗后,非传统血清学-FC-ALTA-IgG 在所有血清和 22 对治疗后 7 年和 9 年的样本中均显示阳性结果,反应性显著降低,尤其是在 INDt 患者中。本研究为回顾性研究,样本量较少,缺乏内在对照组,但数据与文献中的其他结果相符。数据还表明,尽管未治疗患者未检测到治愈,但在 INDt 患者中选择性观察到临床进展的益处,而 CARD/DIGt 患者则没有。

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