Departamento de Cardiología, Hospital Eva Perón, San Martín, Buenos Aires, Argentina.
Trans R Soc Trop Med Hyg. 2013 Jun;107(6):372-6. doi: 10.1093/trstmh/trt029. Epub 2013 Apr 23.
The cure in adult patients with chronic Chagas disease and the relationship between parasitological and clinical evolution is still under debate. The aim of this study was to analyze the clinical, epidemiological and progression features of the disease in a patient population who became serologically negative either spontaneously or post-etiological treatment.
We included 107 patients over 20 years old with three different confirmed reactive anti-Trypanosoma cruzi serologic tests on admission, and a minimum of two years of follow-up. Patients were assigned to clinical groups according to Kuschnir. Change of clinical group was considered a heart disease progression criterion, and seronegative conversion of two or three as parasitological cure criterion.
From 107 patients with parasitological cure, 82 had received treatment (77%) and 25 became spontaneously seronegative (23%). Forty-six (43%) and 61 (57%) patients had two and three negative serological tests, respectively. No differences in clinical groups, ECG, echocardiogram and heart disease progression were found in patients who became negative spontaneously or post-treatment. The clinical progression and ECG changes were observed in 5/107 (5%) and 11/107 (10%) respectively, in a mean of 10 years follow-up.
Adults with chronic Chagas disease can cure, mostly post-etiological treatment, but also spontaneously, showing a favourable clinical outcome.
成人慢性恰加斯病的治愈以及寄生虫学和临床演变之间的关系仍存在争议。本研究旨在分析经血清学检测证实为反应性抗克氏锥虫抗体的 107 例患者的临床、流行病学和疾病进展特征，这些患者在入院时至少进行了三次血清学检查，且随访时间至少为两年。根据 Kuschnir 标准，我们将患者分为不同的临床组。临床组别的变化被视为心脏病进展的标准，两次或三次血清学阴性转换被视为寄生虫学治愈的标准。
我们纳入了 107 例年龄超过 20 岁的患者，他们在入院时至少进行了三次血清学检查，且结果均为反应性抗克氏锥虫抗体，随访时间至少为两年。根据 Kuschnir 标准，我们将患者分为不同的临床组。临床组别的变化被视为心脏病进展的标准，两次或三次血清学阴性转换被视为寄生虫学治愈的标准。
在 107 例寄生虫学治愈的患者中，82 例接受了治疗（77%），25 例为自发性血清学阴性（23%）。46 例（43%）和 61 例（57%）患者分别进行了两次和三次阴性血清学检测。在自发性和治疗后血清学阴性的患者中，临床组、心电图、超声心动图和心脏病进展没有差异。在平均 10 年的随访中，分别有 5/107（5%）和 11/107（10%）的患者出现临床进展和心电图改变。
成人慢性恰加斯病可以治愈，大多数是在病因治疗后，但也有自发性治愈，且预后良好。
