Henson P M, Mackenzie C D, Spector W G
Bull World Health Organ. 1979;57(5):667-82.
This report concerns the host's reactions to the presence of the parasite both in the course of the natural disease and during drug treatment. The various stages of Onchocerca volvulus are discussed in terms of the type of tissue reaction seen. The discussion then turns to basic hypotheses concerning the etiology of these reactions, emphasis being placed on the fact that while pathological changes are considerable in some locations there is a remarkable lack of reaction in others. Some of the mechanisms possibly involved in this apparent absence of host response are discussed, including anti-complement factors, poor antigenicity, acquisition of host antigen, immune tolerance, and blocking antibodies. In any study of the inflammatory response it is recommended that critical evaluations be made of histological material, haematological studies, the definition of the antigenic nature of O. volvulus, characterization of immunological reactivity of patients, and the definition of the migratory pathways of the parasite.The marked host reactions seen following chemotherapy, especially those related to the interaction of the drug diethylcarbamazine with microfilariae, are discussed at some length. The etiology of these reactions is considered and recommendations are made for the experimental elucidation of the mechanisms involved. Emphasis is placed on the necessity for detailed sequential histopathological and immunopathological studies in the definition of the tissue lesions found in onchocerciasis. Characterization of these lesions will assist greatly the approach to control of the adverse reactions seen during treatment.The use of anti-inflammatory agents in clinical trials is discussed and comments are made concerning the most suitable clinical situations for testing drugs and the types of drug that should be tested.
本报告关注宿主在自然疾病过程中和药物治疗期间对寄生虫存在的反应。根据所观察到的组织反应类型，对盘尾丝虫的各个阶段进行了讨论。接着讨论了关于这些反应病因的基本假设，重点在于这样一个事实，即虽然某些部位的病理变化相当显著，但其他部位却明显缺乏反应。讨论了可能与这种明显缺乏宿主反应有关的一些机制，包括抗补体因子、抗原性差、获得宿主抗原、免疫耐受和封闭抗体。在任何关于炎症反应的研究中，建议对组织学材料、血液学研究、盘尾丝虫抗原性质的定义、患者免疫反应性的特征以及寄生虫迁移途径的定义进行批判性评估。详细讨论了化疗后出现的明显宿主反应，特别是与药物乙胺嗪与微丝蚴相互作用相关的反应。考虑了这些反应的病因，并就实验阐明所涉及的机制提出了建议。强调在定义盘尾丝虫病中发现的组织病变时，进行详细的序贯组织病理学和免疫病理学研究的必要性。这些病变的特征将极大地有助于处理治疗期间出现的不良反应。讨论了抗炎药在临床试验中的应用，并对测试药物的最合适临床情况以及应测试的药物类型发表了评论。
