Mirabile E, Solomon N, Fields P J, Macpherson C N L
School of Medicine, St. George's University, Grenada.
School of Medicine, St. George's University, Grenada; Windward Islands Research and Education Foundation, Grenada.
Acta Trop. 2019 Jan;189:6-9. doi: 10.1016/j.actatropica.2018.09.024. Epub 2018 Sep 27.
Cystic echinococcosis (CE) is a global parasitic zoonosis for which ultrasound (US) is the gold standard modality for diagnosis. In 2003, the WHO published a standardized US classification of CE, on which WHO treatment guidelines are based. In 2014, global adoption of the classification was questioned by a publication which indicated that, between 2004 and 2014, only half of studies utilizing a classification used the WHO classification. More recent studies have demonstrated that the WHO classification best reflects the natural history of CE, and is used with high reliability by experts in the field; despite these attributes, the classification's impact is ultimately limited by the extent of its adoption. A PubMed search using the terms "Echinococcus granulosus ultrasound," "Echinococcus granulosus classification," "cystic echinococcosis ultrasound," and "cystic echinococcosus classification" revealed publications on human CE utilizing a US classification. Classification(s) used, year of publication, and the country of the first author's institution were recorded. From 2004 to 2010, the WHO classification was used in 50% or fewer of included publications for 6 of the 7 years. After 2011, it appeared in a low of 75% (2013) to a high of 96% (2017) of included publications. Of all included studies published from 2004 to 2017, the WHO classification was referenced in 18% (3 of 17) from Africa, 64% (32 of 50) from Asia, 79% (89 of 113) from Europe, 89% (8 of 9) from North America, and 100% (9 of 9) from South America. Findings suggest that the WHO classification has been progressively taking preference to other classifications, with rate of adoption depending on continent of origin of the research. Residual use of the classification developed by Dr. Hassen Gharbi of Tunisia in 1982, used widely prior to development of the WHO classification (which reversed two stages in Gharbi's classification in order to more closely reflect the natural history of CE) suggests that adoption of a new classification takes time and varies regionally.
囊型棘球蚴病（CE）是一种全球性寄生虫人畜共患病，超声检查（US）是其诊断的金标准方法。2003年，世界卫生组织（WHO）发布了CE的标准化超声分类，其治疗指南即基于此。2014年，一篇出版物对该分类在全球的采用情况提出质疑，该出版物指出，在2004年至2014年期间，使用分类的研究中只有一半采用了WHO分类。最近的研究表明，WHO分类最能反映CE的自然病程，且该领域的专家使用时可靠性很高；尽管有这些优点，但该分类的影响最终受其采用程度的限制。在PubMed上使用“细粒棘球绦虫超声”“细粒棘球绦虫分类”“囊型棘球蚴病超声”和“囊型棘球蚴病分类”等关键词进行检索，发现了使用超声分类的关于人类CE的出版物。记录所使用的分类、出版年份以及第一作者所在机构的国家。在2004年至2010年期间，在7年中的6年里，纳入出版物中使用WHO分类的比例为50%或更低。2011年之后，其在纳入出版物中的占比低至75%（2013年），高至96%（2017年）。在2004年至2017年发表的所有纳入研究中，来自非洲的研究中有18%（17篇中的3篇）引用了WHO分类，来自亚洲的为64%（50篇中的32篇），来自欧洲的为79%（113篇中的89篇），来自北美的为89%（9篇中的8篇），来自南美的为100%（9篇中的9篇）。研究结果表明，WHO分类逐渐比其他分类更受青睐，采用率取决于研究的发源地所在大陆。1982年由突尼斯的哈森·加尔比博士制定的分类在WHO分类制定之前被广泛使用（WHO分类颠倒了加尔比分类中的两个阶段，以便更紧密地反映CE的自然病程），目前仍有残留使用情况，这表明采用新分类需要时间，且存在地区差异。
