非洲锥虫病的诊断和治疗

摘要/Abstract

摘要：

人类非洲锥虫病（human African trypanosomiasis,HAT）是一种被忽视的热带病,其诊断和治疗均较复杂。近年来,世界经济发展和人员流动频繁,输入性的HAT病例也逐渐增加。因此,对专业技术人员相关知识和技术的培训显得尤为重要。本文系统地整理了HAT的诊断技术和治疗方案,以供临床医师和疾病预防控制机构技术人员参考。

关键词: 人类非洲锥虫病, 诊断, 治疗

Abstract:

Human African trypanosomiasis (HAT) is a neglected tropical disease. The diagnosis and treatment of HAT is quite complicated. With the large-scale migration of populations and the globle economic activity, the imported cases of HAT are increasing these years. Therefore, the training of professionals and technicians on the related knowledge and technology is particularly important. In this paper, the diagnosis and treatment schemes of HAT are systemically summarized for the reference of clinicians and laboratory technicians.

Key words: Human African trypanosomiasis, Diagnosis, Treatment

中图分类号:

R531.9

刘琴, 陈木新, 李元元, 张仪, 李石柱, 陈家旭, 周晓农. 非洲锥虫病的诊断和治疗[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(5): 435-442.

Qin LIU, Mu-xin CHEN, Yuan-yuan LI, Yi ZHANG, Shi-zhu LI, Jia-xu CHEN, Xiao-nong ZHOU. Diagnosis and treatment of human African trypanosomiasis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(5): 435-442.

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类型	g-HAT	r-HAT
病原体	布氏锥虫冈比亚亚种	布氏锥虫罗德西亚种
分布	非洲中部和西部	非洲东部和南部
急性或慢性	通常为慢性	通常为急性
病例比例	95%以上的病例	5%以下的病例
主要传播媒介的种类	主要是Nemorhina 亚属的采采蝇	主要是Glossina亚属的采采蝇
保藏宿主	主要是人类	人畜共患病,多种野生动物及家畜均为保藏宿主
虫血症水平	很低（通常<100个锥虫/ml血）	相对较高,病原学检测较易
病程	进入第二阶段平均需要300~500 d	进入第二阶段平均需要3周~2个月
第一阶段一线治疗药物	戊烷脒	苏拉明
第二阶段一线治疗药物	硝夫替莫和依氟鸟氨酸联合用药（NECT）	美拉胂醇
是否有血清学检测	有	否
分子检测特异性基因	特异性的单拷贝布氏锥虫冈比亚亚种的可变抗原（TgSGP）基因	特异性的单拷贝的血清抗性相关（SRA）基因

镜检	白细胞计数
镜检	1~5个/μl血样	≥ 6个/μl血样
锥虫阴性	血淋巴期	脑膜脑炎期
	第一阶段	第二阶段
锥虫阳性	脑膜脑炎期	脑膜脑炎期
	第二阶段	第二阶段

g-HAT
阶段	第一线治疗药物		备选治疗药物		第一线治疗药物		备选治疗药物
阶段	药物名称	给药方案	药物名称	给药方案	药物名称	给药方案	药物名称	给药方案
第一阶段	戊烷脒	4 mg/(kg·d)肌内注射或是稀释于生理盐水在2 h内静脉注射,连续7 d			苏拉明	第1天4~5 mg/kg静脉注射（实验性给药）,然后20 mg/kg静脉注射,每周1次,连续5周（每次最大剂量不超过1 g,时间分别为第3、10、17、24和31天）	戊烷脒（在没有苏拉明的情况下使用,可延缓病情发展）	4 mg/(kg·d)肌内注射或是稀释于生理盐水在2 h内静注,连续7 d
第二阶段	硝夫替莫和依氟鸟氨酸联合用药（NECT）	硝夫替莫15 mg/(kg·d)分3次口服,连续10 d;依氟鸟氨酸400 mg/(kg·d),分两次静脉注射,每次溶于250 ml生理盐水,在2 h内注射完,连续7 d^a	依氟鸟氨酸（第二线药物）;美拉胂醇（第三线药物,只在复发时使用）	依氟鸟氨酸,剂量400 mg/(kg·d),分4次静脉注射,每次溶于100 ml生理盐水,在2 h注射完,连续14 d;美拉胂醇静脉注射,剂量2.2 mg/(kg·d),连续10 d	美拉胂醇	2.2 mg/(kg·d),静脉注射,连续10 d