西西西里岛包虫病的流行病学和临床特征：十年回顾。
Epidemiology and clinical features of cystic hydatidosis in Western Sicily: a ten-year review.
机构信息
Elisa Cappello, Bruno Cacopardo, Eleonora Caltabiano, Luciano Nigro, Department of Clinical and Molecular Biomedicine, Chair of Infectious Diseases, University of Catania, 95124 Catania, Italy.
出版信息
World J Gastroenterol. 2013 Dec 28;19(48):9351-8. doi: 10.3748/wjg.v19.i48.9351.
AIM
To assess retrospectively the epidemiological and clinical aspects of cystic echinococcosis (CE) and to evaluate follow-up and response to treatment in patients affected by CE.
METHODS
From January 2000 to December 2010, all patients affected by CE at the Infectious Diseases Units of the University of Catania and of Basilotta Hospital in Nicosia-Enna, were enrolled as participants in the study. Epidemiological, clinical and laboratory data were collected for each patient. Diagnosis of CE was performed using clinical imaging and laboratory parameters. Response to treatment was categorized as follows: "cure" as the disappearance or complete calcification of cyst/s; "improvement" as a reduction in the diameter and/or number of existing cysts; and "impairment" as an increase in the diameter and/or number of existing cyst/s and the onset of relapses (i.e., the onset of new cyst/s and an increase in the diameter of previously existing cyst/s and/or complications. Immunoglobulin E (IgE) titers and eosinophil percentages were evaluated at diagnosis, at six months after the initiation of treatment and again in the case of relapse. Hyper-eosinophilia was defined as an eosinophil percentage of ≥ 6%.
RESULTS
Thirty-two patients were diagnosed with CE in our Unit during the research period, with a male-female ratio of 2:1. At the time of diagnosis, 40% of patients presented a single CE cyst. Sixty percent showed multi-organ involvement. The liver-lung localization ratio was 2:1. Patients below the age of 50 at diagnosis were more likely to have multiple cysts (73.7% vs 35.5%, P < 0.05). Regarding treatment, 30 patients were treated medically and 16 surgically. Fourteen patients were treated both medically and surgically. Relapses were seen to be less frequent in patients treated with albendazole before and after surgery. Complete cure or an improvement was achieved in 23 patients. Impairment was observed in one patient. Two patients showed no improvement. Relapses were more frequent in those patients treated before 2005. At diagnosis, 71% of patients were positive for specific CE IgE, and 56.3% showed an eosinophil percentage of ≥ 6%. Patients who were diagnosed with hyper-eosinophilia developed complications more frequently than the other patients, but did not suffer relapses.
CONCLUSION
On the basis of our results, we propose cystic echinococcosis screening for family members of patients, appropriate pre- and post-surgery treatment and the assessment of anti-echinococcus IgE titer or eosinophil percentage as a therapy response marker in settings with limited resources.
目的
回顾性评估囊性包虫病（CE）的流行病学和临床特征，并评估接受 CE 治疗的患者的随访和治疗反应。
方法
本研究纳入了 2000 年 1 月至 2010 年 12 月期间在卡塔尼亚大学传染病科和尼科西亚-恩纳的巴西洛塔医院感染科接受治疗的所有 CE 患者。收集每位患者的流行病学、临床和实验室数据。使用临床影像学和实验室参数诊断 CE。治疗反应分为以下几类：“治愈”表示囊肿完全消失或完全钙化；“改善”表示囊肿直径和/或数量减少；“恶化”表示囊肿直径和/或数量增加以及复发（即新囊肿出现，以前存在的囊肿直径和/或并发症增加）。在诊断时、治疗开始后 6 个月以及复发时评估免疫球蛋白 E（IgE）滴度和嗜酸性粒细胞百分比。嗜酸性粒细胞百分比≥6%定义为高嗜酸性粒细胞血症。
结果
在研究期间，我们科室共诊断出 32 例 CE 患者，男女比例为 2:1。在诊断时，40%的患者存在单个 CE 囊肿。60%的患者有多个器官受累。肝肺定位比例为 2:1。诊断时年龄小于 50 岁的患者更有可能有多发性囊肿（73.7% vs 35.5%，P<0.05）。在治疗方面，30 名患者接受药物治疗，16 名患者接受手术治疗。14 名患者接受了药物和手术联合治疗。手术前后接受阿苯达唑治疗的患者复发率较低。23 名患者获得完全治愈或改善。1 名患者恶化。2 名患者无改善。2005 年前接受治疗的患者复发率较高。在诊断时，71%的患者对特定的 CE IgE 呈阳性，56.3%的患者嗜酸性粒细胞百分比≥6%。诊断为高嗜酸性粒细胞血症的患者比其他患者更容易出现并发症，但没有复发。
结论
根据我们的结果，我们建议对患者的家庭成员进行囊性包虫病筛查，在资源有限的情况下，为患者提供适当的术前和术后治疗，并评估抗包虫 IgE 滴度或嗜酸性粒细胞百分比作为治疗反应标志物。
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