关键词: 脑曼氏裂头蚴病, 吡喹酮, 外科手术, 临床结局, 12个月近期疗效

Abstract:

Objective To analyze the clinical outcomes and changes in serum IgG antibody titers against Sparganum mansoni after treatment, for further exploring the indicators in assessing the therapeutic effects for cerebral sparganosis. Methods Cases of cerebral sparganosis patients followed-up on continuous inpatient or outpatient treatment were collected from Jiangxi Provincial Institute of Parasitic Diseases, the First Affiliated Hospital of Nanchang University and Guangdong 999 Brain Hospital during 2013 to 2018. The patients were administrated with praziquantel 50 mg/(kg·d) for 10 days per cource, continuing for three cources at a 60-day interval. The surgical treatment includes craniotomy and CT-guided stereotactic aspiration. Twelve months after the treatment with praziquantel and surgery, the clinical manifestations of patients were followed-up, imaging examination (including brain MRI flat and enhanced scan) rechecked, and the serum IgG titer assayed. Statistical analysis was performed using SPSS 18.0 software. Results Eighty-seven cases of cerebral sparganosis were collected, of which 62 patients received praziquantel treatment (10 patients were treated with praziquantel prior to surgery), and 35 patients underwent surgical therapy. After 12 months of treatment, among the 71 patients with good outcomes, 57.7% (41/71) were asymptomatic, 42.3% (30/71) had clinical symptoms, among them 26.8% (19/71) with seizure, 14.1% (10/71) with paresis, and 1.4% (1/71) with diplopia. Radiography showed that 85.9% (61/71) of active enhanced foci were resolving, while 14.1% (10/71) foci remained, of them 12.7% (9/71) were single small nodular lesions. Serology examination revealed that 64.28% (52/71) cases were negative for IgG against Sparganum mansoni (antibody titer < 1 ∶ 100), 23.80% (12/71) had an antibody titer of 1 ∶ 100, and 11.90% (7/71) had the titer of 1 ∶ 200. After treatment for 12 months, 16 patients were of poor outcomes, showing 1/16 was free of symptom, and 15 had clinical symptoms, of them 12/16 patients with seizure, 3/16 with paresis, while headache, aggravating illness, no significant improvement and emerging new symptoms were found of 1 case each. Radiography indicated that among the cases, 6/16 showed no changes in lesion images, 1/16 had enlarged foci, 7/16 changes in lesion location, and 2/16 newly enhanced lesions. Serology examination on the patients showed 4/16 had an antibody titer of 1 ∶ 400, 8/16 had the titer of 1 ∶ 800 and 4/16 had the titer of 1 ∶ 1 600. Conclusion Most of the cerebral sparganosis cases had a good prognosis after praziquantel and surgery treatment. Serological tests could be used for assessment of recent therapeutic effect in 12 months, redeeming the limitations in appraisal by symptoms and imaging.

Key words: Cerebral sparganosis, Praziquantel, Surgery, Clinical outcome, 12-months short-term efficacy