Viotti R, Vigliano C, Armenti H, Segura E
Sección Enfermedad de Chagas, Hospital Interzonal de Agudos Eva Perón, San Martín, Provincia de Buenos Aires, Argentina.
Am Heart J. 1994 Jan;127(1):151-62. doi: 10.1016/0002-8703(94)90521-5.
Prescribing etiologic treatment for chronic Chagas' disease is highly controversial because of the difficulties involved in assessing its therapeutic efficacy--the low degree of parasitemia, the persistence of positive immunologic reactions, the lack of clinical findings to support each type of treatment, and the necessarily prolonged follow-up of the patient. An 8-year average follow-up was performed on 131 patients treated with benznidazole (5 mg/kg/day for 30 days) (TP) and 70 untreated patients (UTP) by serial electrocardiograms and analysis of the cardiomyopathic progress of the clinical groups, and by immunologic tests at both the beginning and end of the study. TPs presented less electrocardiographic changes during the follow-up period (4.2% vs 30%) and a lower frequency of deterioration in their clinical condition (2.1% vs 17%). The percentage of TPs who were serologically negative was 19.1% whereas 6% of the UTPs became serologically negative, a result that correlated with a lack of progress in the cardiomyopathy. Benznidazole treatment significantly decreased serologic titers, signifying parasitologic cure in two patients.
由于评估慢性恰加斯病的病因治疗疗效存在困难，包括寄生虫血症程度低、阳性免疫反应持续存在、缺乏支持每种治疗类型的临床发现以及患者必须进行长期随访等，因此对慢性恰加斯病进行病因治疗极具争议性。对131例接受苯硝唑治疗（5毫克/千克/天，共30天）的患者（治疗组）和70例未治疗的患者（未治疗组）进行了平均8年的随访，通过连续心电图和分析临床组的心肌病进展情况，以及在研究开始和结束时进行免疫测试。治疗组在随访期间心电图变化较少（4.2%对30%），临床状况恶化频率较低（2.1%对17%）。治疗组血清学阴性的百分比为19.1%，而未治疗组中有6%血清学转为阴性，这一结果与心肌病无进展相关。苯硝唑治疗显著降低了血清学滴度，表明两名患者实现了寄生虫学治愈。
