Weil G J, Sethumadhavan K V, Santhanam S, Jain D C, Ghosh T K
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110.
Am J Trop Med Hyg. 1988 May;38(3):589-95. doi: 10.4269/ajtmh.1988.38.589.
This study was designed to reexamine the efficacy of diethylcarbamazine for bancroftian filariasis with special reference to changes in serum parasite antigen levels and antifilarial antibody titers after treatment. Patients with asymptomatic microfilaremia were treated with 6 mg/kg diethylcarbamazine daily for 12 days. Microfilaria counts fell dramatically after treatment, as expected. IgG antibody titers to adult and microfilarial antigens of B. malayi were increased 1 month after treatment in most patients. Titers fell slowly to or below pretreatment levels, but remained positive during subsequent months. Parasite antigen levels, measured by monoclonal antibody-based enzyme immunoassay, decreased to 72%, 58%, 53%, and 48% of pretreatment values 1, 3, 6, and 12 months after diethylcarbamazine treatment, respectively. Parasite antigen levels decreased similarly in subjects with and without residual microfilaremia after treatment. These results suggest that diethylcarbamazine has only partial macrofilaricidal activity against W. bancrofti with this dosage schedule. The sustained, impressive reductions in microfilaria counts after treatment despite significant persistence of parasite antigenemia may be explained by sublethal effects of the drug on adult worms. We believe that parasite antigen detection represents a valuable new approach for monitoring the efficacy of antifilarial drug therapy which we hope will lead to improved use of existing drugs and aid in the evaluation of new drugs for filariasis.
本研究旨在重新审视乙胺嗪治疗班氏丝虫病的疗效，特别关注治疗后血清寄生虫抗原水平和抗丝虫抗体滴度的变化。无症状微丝蚴血症患者每天接受6mg/kg乙胺嗪治疗，疗程为12天。正如预期的那样，治疗后微丝蚴计数显著下降。大多数患者在治疗1个月后，针对马来布鲁线虫成虫和微丝蚴抗原的IgG抗体滴度升高。滴度缓慢降至或低于治疗前水平，但在随后几个月仍呈阳性。通过基于单克隆抗体的酶免疫测定法测量的寄生虫抗原水平，在乙胺嗪治疗后1、3、6和12个月分别降至治疗前值的72%、58%、53%和48%。治疗后有或无残留微丝蚴血症的受试者中，寄生虫抗原水平下降情况相似。这些结果表明，按照此给药方案，乙胺嗪对班氏吴策线虫仅具有部分杀成虫活性。治疗后微丝蚴计数持续显著下降，尽管寄生虫抗原血症仍显著持续，这可能是由于该药物对成虫的亚致死效应所致。我们认为，寄生虫抗原检测是监测抗丝虫药物治疗疗效的一种有价值的新方法，我们希望这将有助于更好地使用现有药物，并有助于评估治疗丝虫病的新药。
