Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a "watch-and-wait" approach.
Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a "watch-and-wait" approach.
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DOI：
10.1371/journal.pntd.0003057
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发表时间：
2014-08
影响因子：
3.8
通讯作者：
Brunetti E
中科院分区：
文献类型：
--
作者：
Piccoli L;Tamarozzi F;Cattaneo F;Mariconti M;Filice C;Bruno A;Brunetti E
人类囊型包虫病是一种慢性、复杂和被忽视的感染。它的临床管理已经发展了几十年，没有充分的疗效评价。最近的专家意见建议，不复杂的非活动性肝囊肿应不予治疗，并随时间推移进行单独监测（“观察和等待”方法）。然而，支持这种方法的临床数据仍然很少，并且大多以会议论文集的形式发表。在这项研究中，我们报告我们的经验，长期超声和血清学随访的非活动性肝囊肿。从1994年3月至2013年10月，38例患者47个肝囊肿，诊断为非活动性，没有任何既往治疗史，在我们的门诊诊所进行了至少24个月（中位随访51.95个月）的超声和血清学随访，间隔6-12个月。在97.4%的患者中，囊肿随着时间的推移保持不活动，仅在1例病例中检测到囊肿重新激活。监测期间未发生并发症。在随访期间，74.1%的病例在诊断时CE血清学检测为阴性或变为阴性，25.9%的病例为阳性或变为阳性。对超声显示无活动性囊肿但血清学试验阳性的患者也进行了CT扫描（胸部和腹部），以排除肝外囊肿定位。这项研究证实了一个阶段的具体方法的囊型包虫病的管理的重要性，并支持使用一个监测的方法，只有不活跃的，简单的肝囊肿。它还证实，与超声和其他成像技术相比，血清学在这些患者的临床管理中仅起辅助作用。这些研究结果的临床管理和囊状棘球蚴病的自然史的影响进行了讨论。人类囊型棘球蚴病（CE）是一种慢性、复杂和被忽视的寄生虫感染，主要表现为肝囊肿，超声分期。最近的专家意见建议，不复杂的非活动性囊肿应不予治疗，并使用所谓的“观察和等待”方法进行长期监测。目前，没有可靠的生物标记的囊肿活动。即使在囊肿切除后，阳性抗体滴度也可能持续数年;因此需要长期随访以评估囊肿生物活性随时间的演变。在转诊中心的选定病例中，越来越多地使用非活动性肝CE囊肿的观察和等待方法;然而，尚未发表有关其安全性和有效性的数据。我们回顾性研究了47例诊断时无并发症的非活动性囊肿，采用观察和等待方法进行治疗，中位随访时间为51.95个月。我们观察到这些囊肿在几乎所有病例中随时间推移保持不活动，没有任何并发症。这些结果支持了对这些囊肿的观察和等待方法。此外，我们证实，与超声和其他成像技术相比，血清学在这些患者的临床管理中仅发挥辅助作用。
Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time (“watch-and-wait” approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6–12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed. Human cystic echinococcosis (CE) is a chronic, complex and neglected parasitic infection presenting mostly as hepatic cysts, which are staged by ultrasound. Recent expert opinion recommends that uncomplicated inactive cysts should be left untreated and solely monitored over time, using the so-called “watch-and-wait” approach. Currently, no reliable biological marker of cyst activity is available. Positive antibody titers may persist for years even after removal of a cyst; therefore a long-term follow-up is required to assess the evolution of the cyst's biological activity over time. The watch-and-wait approach to inactive hepatic CE cysts is increasingly used in selected cases in referral centers; however, no data on its safety and effectiveness has yet been published. We retrospectively studied 47 inactive uncomplicated cysts at diagnosis, managed by a watch-and-wait approach, with a median follow-up of 51.95 months. We observed that these cysts remained inactive over time in almost all cases, without any complications. These results support the watch-and-wait approach to these cysts. Furthermore, we confirmed that serology only plays an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques.
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