University of Kent, Canterbury, CT2 7LR, UK.
Expert Rev Anti Infect Ther. 2010 Dec;8(12):1467-73. doi: 10.1586/eri.10.124.
In this article we focus on the pathogenesis and clinical characteristics of schistosomiasis infection on the lung vasculature. Overall, the basic biology and understanding of Schistosoma immune responses and their effect on the cardiopulmonary system is limited in both animal and human models, which hinders clinical care and drug development. The inflammatory response to the eggs in the lung appears to contribute to the remodeling of the pulmonary vessels. Portal hypertension caused by parasitemia also appears to contribute to the development of pathophysiologic alterations of the pulmonary vascular bed. Antischistosomal therapy, praziquantel, used for pulmonary hypertension secondary to schistosomiasis usually has no effect, but it is given to prevent further progression of disease. Currently, there are no clinical trials for the treatment of pulmonary vascular disease secondary to schistosomiasis. Specialty drugs such as phosphodiesterase type 5 or tyrosine kinase inhibitors exhibit some interesting activity, yet are prohibitively expensive, lack safety and efficacy studies in schistosomiasis endemic populations, and tend to be limited by safety, efficacy, route of administration and compliance problems.
本文重点介绍了血吸虫病感染肺部血管的发病机制和临床特征。总的来说，在动物和人类模型中，对血吸虫的免疫反应及其对心肺系统的影响的基本生物学和认识是有限的，这阻碍了临床治疗和药物的开发。肺部的虫卵引起的炎症反应似乎导致了肺部血管的重塑。由寄生虫血症引起的门静脉高压似乎也促成了肺血管床的病理生理改变的发展。用于治疗血吸虫病引起的肺动脉高压的抗血吸虫治疗药物，吡喹酮通常没有效果，但它被用于预防疾病的进一步进展。目前，还没有治疗血吸虫病引起的肺血管疾病的临床试验。磷酸二酯酶 5 型或酪氨酸激酶抑制剂等专科药物表现出一些有趣的活性，但价格昂贵，缺乏在血吸虫病流行地区人群中的安全性和疗效研究，并且往往受到安全性、疗效、给药途径和依从性问题的限制。
