采用定量聚合酶链反应评估阿苯达唑对东帝汶马努法希地区美洲钩口线虫和蛔虫的疗效。
Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste.
机构信息
Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia.
Present Address: Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia.
出版信息
Parasit Vectors. 2018 Jun 28;11(1):373. doi: 10.1186/s13071-018-2838-0.
BACKGROUND
Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification.
RESULTS
A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10-14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9-95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3-100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4-64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0-97.0%).
CONCLUSIONS
The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way.
TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
背景
土壤传播的蠕虫（STHs）包括蛔虫、美洲钩虫、类圆线虫和鞭虫，是全球发病率显著的原因。为了减轻其疾病负担，在流行地区的高危人群定期接受驱虫药物的群体药物治疗，最常用的驱虫药物是阿苯达唑和甲苯达唑。评估驱虫药物的疗效对于证实这些方案是否有效以及是否出现耐药性非常重要。在这项研究中，我们旨在使用寄生虫检测和定量的定量聚合酶链反应（qPCR）方法，描述在东帝汶阿苯达唑对蛔虫和美洲钩虫的治疗效果。
结果
来自东帝汶 8 个社区的 314 名参与者在单次服用 400mg 阿苯达唑 10-14 天后提供了粪便样本。使用 qPCR 确定蠕虫感染状况和感染强度（以 Ct 值和相对荧光单位测量）。通过检查治愈率和感染强度降低率来确定疗效。阿苯达唑对蛔虫具有高度疗效，治愈率为 91.4%（95%CI：85.9-95.2%），感染强度降低率为 95.6%（95%CI：88.3-100%）。该药物对美洲钩虫的疗效较低，治愈率为 58.3%（95%CI：51.4-64.9%），感染强度降低率为 88.9%（95%CI：84.0-97.0%）。
结论
观察到的蛔虫治愈率和感染强度降低率以及在一定程度上的美洲钩虫治愈率和感染强度降低率表明，阿苯达唑对这些物种仍然有效，可作为东帝汶的群体化疗药物。此外，这项研究表明 qPCR 作为一种测量驱虫药物疗效的方法是有用的。需要进一步的研究来以系统的方式将 Ct 值转换为每克粪便中的卵数。
试验注册
澳大利亚和新西兰临床试验注册中心 12614000680662（2014 年 6 月 27 日注册）。
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