单次和双次阿苯达唑治疗土源性线虫感染的疗效观察

doi:10.12140/j.issn.1000-7423.2024.02.011

中国寄生虫学与寄生虫病杂志 ›› 2024, Vol. 42 ›› Issue (2): 204-210.doi: 10.12140/j.issn.1000-7423.2024.02.011

单次和双次阿苯达唑治疗土源性线虫感染的疗效观察

严信留¹(), 杜尊伟¹, 杨亚明¹, 汪丽波², 吴方伟¹, 李奔福¹, 李鸿斌³, 陈然⁴, 字金荣¹, 彭佳¹, 蔡璇¹, 保雪莹⁵, 唐小英⁶, 杨恒林¹^,^*()

1 云南省寄生虫病防治所，普洱 665000
2 普洱学院，云南普洱 665000
3 西双版纳州疾病预防控制中心，云南西双版纳 666100
4 勐海县疾病预防控制中心，云南西双版纳 666200
5 砚山县疾病预防控制中心平远分中心，云南文山 663101
6 勐海县布朗山乡卫生院，云南西双版纳 666213

收稿日期:2023-11-03 修回日期:2024-01-27 出版日期:2024-04-30 发布日期:2024-04-24
通讯作者: * 杨恒林（1955—），男，主任医师，硕士导师，从事疟疾等寄生虫病防治与研究工作。E-mail：yanghenglin2014@126.com
作者简介:严信留（1987—），男，本科，主治医师，从事寄生虫病防治工作。E-mail：597238871@qq.com

Therapeutic effect of once and twice doses of albendazole for soil-transmitted helminth infection

YAN Xinliu¹(), DU Zunwei¹, YANG Yaming¹, WANG Libo², WU Fangwei¹, LI Benfu¹, LI Hongbin³, CHEN Ran⁴, ZI Jinrong¹, PENG Jia¹, CAI Xuan¹, BAO Xueying⁵, TANG Xiaoying⁶, YANG Henglin¹^,^*()

1 Yunnan Institute of Parasitic Diseases, Pu’er 665000, China
2 Pu’er University， Pu’er 665000, Yunnan, China
3 Xishuangbanna Prefecture Center for Disease Control and Prevention, Xishuangbanna 666100, Yunnan, China
4 Menghai County Center for Disease Control and Prevention, Xishuangbanna 666200, Yunnan, China
5 Yanshan County Center for Disease Control and Prevention Pingyuan Branch Center, Wenshan 663101, Yunnan, China
6 Menghai County Blang Mountain Township Health Center, Xishuangbanna 666213, Yunnan, China

Received:2023-11-03 Revised:2024-01-27 Online:2024-04-30 Published:2024-04-24
Contact: * E-mail: yanghenglin2014@126.com

摘要/Abstract

摘要：

目的观察单次和双次阿苯达唑治疗人体土源性线虫感染的疗效。方法 2015年10月—2016年1月，选择云南省西双版纳州勐海县布朗山乡5所小学2~6年级的小学生进行基线调查，连续2 d收集粪样，每人每天1份，每份粪样采用Kato-Katz法制作3张加藤片镜检，结果为阳性（蛔虫、钩虫、鞭虫单一或混合感染）的学生接受阿苯达唑治疗（一次口服400 mg）。服药后3 d连续2 d收集粪样并镜检。4周后同一批学生再次服用阿苯达唑片剂400 mg，3 d后连续2 d收集粪样并镜检。2次服药后均同时开展问卷调查，统计不良反应情况。经2次服药后仍然阳性的学生再服用阿苯达唑片剂治疗1次。将5所小学按行政村归纳，统计不同行政村鞭虫感染治疗疗效。率的比较采用卡方检验。结果 5所学校共调查438人，土源性线虫感染率82.19%（360/438）。男生感染率为79.19%（175/221），女生为85.25%（185/217），差异无统计学意义（χ² = 2.754，P > 0.05）；布朗族、拉祜族、哈尼族、其他民族学生土源性线虫感染率分别为89.79%（299/333）、90.57%（48/53)、21.43%（9/42）、4/10（χ² = 133.781，P < 0.05）；2~6年级学生土源性线虫感染率分别为73.97%（54/73）、90.38%（94/104）、73.56%（64/87）、87.50%（28/32）、84.51%（120/142）（χ² = 13.700，P < 0.05）。蛔虫、钩虫、鞭虫感染率分别为52.51%（230/438）、35.39%（155/438）、73.29%（321/438），其中第1次服药后蛔虫、钩虫、鞭虫感染治愈率分别为94.24%（180/191）、63.64%（77/121）、2.64%（7/265），第2次服药后蛔虫、钩虫、鞭虫感染治愈率分别为98.77%（161/163）、91%（91/100）、6.33%（14/221）。蛔虫、钩虫、鞭虫感染者服用1、2次阿苯达唑治愈率差异均有统计学意义（χ² = 5.107、22.487、3.976，P < 0.05）。蛔虫、钩虫、鞭虫轻、中、重度感染者两次服药后治愈率差异均无统计学意义（第一次服药χ² = 3.218、3.930、4.050，P > 0.05；第二次服药χ² = 1.745、1.902、0.329，P > 0.05）。第1次服药后觉得吞药片困难、头晕、恶心、腹泻、呕吐等不良反应的发生率依次为11.47%（39/340）、10.88%（37/340）、16.76%（57/340）、7.65%（26/340）、1.47%（5/340）。第2次服药不良反应发生率接近第1次，两次服药各项不良反应发生率差异均无统计学意义。按照学校所在行政村分析，第2次服药后吉良小学感染鞭虫的学生治愈率为12.68%（9/71），高于曼囡小学（3.60%，4/111）（χ² = 5.374，P < 0.05）。结论阿苯达唑单次疗法对蛔虫感染有较好疗效；双次疗法对蛔虫和钩虫的驱虫效果均更好，且不增加不良反应的发生率。用阿苯达唑治疗中、重度的蛔虫、钩虫感染者无需增加剂量。阿苯达唑对鞭虫治疗效果较差，不宜单独使用阿苯达唑治疗鞭虫感染者。

关键词: 阿苯达唑, 土源性线虫, 疗效观察, 不良反应, 耐药性

Abstract:

Objective To evaluate the efficacy of once and twice doses of albendazole in treating human soil-transmitted helminth infections. Methods From October 2015 to January 2016, school students of grades 2-6 in 5 primary schools were selected to participate baseline survey (in Blang Mountain Township, Menghai County, Xishuangbanna Prefecture, Yunnan Province. Fecal samples were collected for two consecutive days (one sample per day), each of which was used to prepare three slides and examined using Kato-Katz method by microscopy. Students with fecal egg-positive finding (Ascaris, hookworm, Trichuris single or mixed infections) are treated with albendazole (400 mg single dose). Three days after treatment, fecal samples were collected in consecutive 2 days. After 4 weeks, the same group of students received additional single dose of 400 mg albendazole and their fecal samples were collected 3 days after dosing and examined. A questionnaire survey was conducted at the same time of two medications to assess the adverse reactions. Students who were still egg-positive after twice dosing were treated with albendazole once more. The examinees of the five primary schools were summarized according to administrative villages to evaluste the therapeutic effect on Trichuris infection in different villages. The comparison of rates is conducted using χ² test. Results A total of 438 people from 5 schools were investigated, and the infection rate of soil-derived nematodes was 82.19% (360/438). The infection rate was 79.19% (175/221) in boys and 85.25% (185/217) in girls, with no significant difference (χ² = 2.754, P > 0.05). The infection rates of soil-transmitted helminth were 89.79% (299/333), 90.57% (48/53), 21.43% (9/42), 4/10 (χ² = 133.781, P < 0.05) among the Blang, Lahu, Hani and other ethnological populations, respectively. The infection rates were 73.97% (54/73), 90.38% (94/104), 73.56% (64/87), 87.50% (28/32), 84.51% (120/142), respectively (χ² = 13.700, P < 0.05). The infection rates of Ascaris, hookworm and Trichuris were 52.51% (230/438), 35.39% (155/438) and 73.29% (321/438), respectively. The cure rates of Ascaris, hookworm and Trichuris infection after the first dose were 94.24% (180/191), 63.64% (77/121) and 2.64% (7/265), respectively. The cure rates of Ascaris, hookworm and Trichuris infection after the second dose were 98.77% (161/163), 91% (91/100) and 6.33% (14/221), respectively. There was a significant difference in the cure rates of patients with Ascaris, hookworm and Trichuris who took albendazole once and twice (χ² = 5.107, 22.487, 3.976, P < 0.05). There was no significant difference in the cure rates of mild, moderate and severe patients with Ascaris, hookworm and Trichuris after two doses (the first treatment χ² = 3.218, 3.930, 4.050, P > 0.05; the second treatment χ² = 1.745, 1.902, 0.329, P > 0.05). The incidence of adverse reactions such as difficulty swallowing pills, dizziness, nausea, diarrhea and vomiting after the first dose was 11.47% (39/340), 10.88% (37/340), 16.76% (57/340), 7.65% (26/340) and 1.47% (5/340), respectively. The incidence of adverse reactions in the second dose was close to that in the first dose, and there was no statistical significance in the incidence of adverse reactions between the two doses. According to the analysis of the village where the school was located, the cure rate of the students infected with Trichuris was 12.68% (9/71) in Kira Primary School after the second dose, which was higher than that in Mannian Primary School (3.60%, 4/111) (χ² = 5.374, P < 0.05). Conclusion Albendazole single therapy showed good effect on Ascaris infection, while double therapy presented a better deworming effect on Ascaris and hookworm infection without increasing the frequency of adverse reactions. It is unnecessary to increase the dosage of albendazole for treating moderate and severe Ascaris and hookworm infections. Albendazole is not effective for treating Trichuris, thus it is not advisable to use albendazole alone for treatment of Trichuris infection.

Key words: Albendazole, Soil-transmitted helminth, Efficacy observation, Adverse reaction, Drug resistance

中图分类号:

R532.1

严信留, 杜尊伟, 杨亚明, 汪丽波, 吴方伟, 李奔福, 李鸿斌, 陈然, 字金荣, 彭佳, 蔡璇, 保雪莹, 唐小英, 杨恒林. 单次和双次阿苯达唑治疗土源性线虫感染的疗效观察[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(2): 204-210.

YAN Xinliu, DU Zunwei, YANG Yaming, WANG Libo, WU Fangwei, LI Benfu, LI Hongbin, CHEN Ran, ZI Jinrong, PENG Jia, CAI Xuan, BAO Xueying, TANG Xiaoying, YANG Henglin. Therapeutic effect of once and twice doses of albendazole for soil-transmitted helminth infection[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2024, 42(2): 204-210.

图/表 2

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参考文献 32

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不良反应类型 Type of adverse reaction	不良反应发生人数（发生率/%） No. adverse reaction (incidence rate/%)		χ²值 χ² value	P值 P value
不良反应类型 Type of adverse reaction	第1次服药后 After the first dose	第2次服药后 After the second dose	χ²值 χ² value	P值 P value
吞药片困难 Difficulty swallowing pills
是 Yes	39（11.47）	29（10.47）	1.094	> 0.05
否 No	260（76.47）	221（79.78）
不知道 Unknown	41（12.06）	27（9.75）
头晕 Dizziness
是 Yes	37（10.88）	43（15.52）	2.914	> 0.05
否 No	303（89.12）	234（84.48）
恶心 Feel sick
是 Yes	57（16.76）	45（16.25）	0.03	> 0.05
否 No	283（83.24）	232（83.75）
腹泻 Diarrhea
是 Yes	26（7.65）	24（8.66）	0.212	> 0.05
否 No	314（92.35）	253（91.34）
呕吐 Emesis
是 Yes	5（1.47）	9（3.25）	2.177	> 0.05
否 No	335（98.53）	268（96.75）

学校名称 School name	行政村 Administrative Village	第1次服药 The first dose			第2次服药 The second dose			χ²值 χ²value	P值 P value
学校名称 School name	行政村 Administrative Village	检查人数 No. inspected	治愈人数No. cured	治愈率/% Cure rate/%	检查人数 No. inspected	治愈人数 No. cured	治愈率/% Cure rate/%	χ²值 χ²value	P值 P value
吉良小学 Jiliang Elementary School	吉良 Jiliang	77	4	5.19	71	9	12.68	5.374^a	0.02
曼囡小学 Mannan Elementary School	曼囡 Mannan	148	3	2.03	111	4	3.60	2.011^b	0.156
章家小学（3个校点） Zhangjia Elementary School (3 campuses)	章家 Zhangjia	40	0	0	39	1	2.56	0.000^c	1
合计 Total		265	7	2.64	221	14	6.33

单次和双次阿苯达唑治疗土源性线虫感染的疗效观察

Therapeutic effect of once and twice doses of albendazole for soil-transmitted helminth infection

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