Department of Immunology of Parasitic Diseases, Research Institute of Epidemiology, Microbiology and Infectious Diseases, Tashkent, Uzbekistan.
Department of Surgery, Tashkent Medical Academy, Tashkent, Uzbekistan.
Acta Trop. 2021 Jan;213:105755. doi: 10.1016/j.actatropica.2020.105755. Epub 2020 Nov 11.
The aim of this study is to determine the prevalence of intestinal helminths and protozoa in patients with ulcerative colitis (UC) and to estimate the influence of the anti-parasitic therapy on the course of the disease.
The study was conducted at the Research Institute of Epidemiology, Microbiology and Infectious Diseases and Coloproctology Department of the Republic Clinical Hospital №1 of the Ministry of Health of the Republic of Uzbekistan. One hundred UC patients and 200 healthy individuals were examined by triple coproscopy. Additionally, 20, 25 and 22 UC patients with Blastocystis infection were treated with nitazoxanide (1.0 g/day), mesalazine (1.5-2 g/day) or a combination of nitazoxanide (1.0 g/day) and mesalazine (≥1.5-2 g/day) for 14 consecutive days, respectively. Parasitological, clinical and endoscopic examinations were conducted before therapy, immediately after and 6 and 12 weeks after therapy completion.
The overall prevalence of helminths in UC patients and control individuals was not significantly different: 14±3.4% and 8.5±1.9%, respectively (OR: 1.7524; 95% CI: 0.8258 to 3.7186; P=0.1). Giardia lamblia was the most prevalent parasite in both groups, but the difference compared to the control was insignificant (OR: 0.4565; 95% CI: 0.2020 to 1.0318; P=0.05). A significantly higher prevalence of Blastocystis sp., Chilomastix mesnili and Iodamoeba butschlii in UC patients compared to control individuals was found (P<0.0005): 65.0%, 14.0% and 22.0%, respectively. During all follow-up periods, the clinical response and clinical remission were not statistically different between the groups (P>0.05). Mucosal healing immediately and 6 weeks after therapy with a combination of nitazoxanide with mesalazine was significantly better than with a monotherapy of nitazoxanide, respectively (P<0.05). UC patients treated with a combination of nitazoxanide with mesalazine showed better mucosal healing than in patients treated with a monotherapy of mesalazine (P>0.05).
Diagnosis of Blastocystis sp. should be introduced in the complex examination of UC patients. Further clinical studies are necessary for assessment of the efficiency of anti-Blastocystis therapy in UC patients.
本研究旨在确定溃疡性结肠炎（UC）患者中肠道蠕虫和原虫的流行情况，并评估抗寄生虫治疗对疾病进程的影响。
该研究在乌兹别克斯坦共和国卫生部第一共和国临床医院的流行病学、微生物学和传染病研究所和肛肠科进行。通过三重粪便镜检检查了 100 名 UC 患者和 200 名健康个体。此外，20、25 和 22 名患有芽囊原虫感染的 UC 患者分别接受硝唑尼特（1.0 g/天）、美沙拉嗪（1.5-2 g/天）或硝唑尼特（1.0 g/天）和美沙拉嗪（≥1.5-2 g/天）联合治疗 14 天。在治疗前、治疗后立即以及治疗完成后 6 和 12 周进行寄生虫学、临床和内镜检查。
UC 患者和对照组的寄生虫总流行率无显著差异：分别为 14±3.4%和 8.5±1.9%（OR：1.7524；95%CI：0.8258 至 3.7186；P=0.1）。在两组中，蓝氏贾第鞭毛虫都是最常见的寄生虫，但与对照组相比差异无统计学意义（OR：0.4565；95%CI：0.2020 至 1.0318；P=0.05）。与对照组相比，UC 患者中芽囊原虫、滴虫和碘孢虫的流行率明显更高（P<0.0005）：分别为 65.0%、14.0%和 22.0%。在所有随访期间，各组之间的临床反应和临床缓解均无统计学差异（P>0.05）。与单独使用硝唑尼特相比，联合使用硝唑尼特和美沙拉嗪治疗后即刻和 6 周时的黏膜愈合明显更好（P<0.05）。与单独使用美沙拉嗪治疗的 UC 患者相比，联合使用硝唑尼特和美沙拉嗪治疗的 UC 患者黏膜愈合更好（P>0.05）。
应在 UC 患者的综合检查中引入芽囊原虫的诊断。需要进一步的临床研究来评估抗芽囊原虫治疗对 UC 患者的疗效。
