A longitudinal analysis of albendazole treatment effect on neurocysticercosis cyst evolution using multistate models.
A longitudinal analysis of albendazole treatment effect on neurocysticercosis cyst evolution using multistate models.
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使用多状态模型纵向分析阿苯达唑治疗对神经囊尾蚴病囊肿进化的影响。
DOI：
10.1093/trstmh/trz073
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发表时间：
2019
影响因子：
2.2
通讯作者：
Zhang,Hongbin
中科院分区：
文献类型：
--
作者：
Montgomery,MichelleA;Ramos,Marcel;Kelvin,ElizabethA;Carpio,Arturo;Jaramillo,Alexander;Hauser,WAllen;Zhang,Hongbin
在神经囊虫病中，猪带绦虫的幼虫形式在消失之前似乎经历了三个阶段的进化-活跃，退行性和有时钙化。抗虫药物阿苯达唑已被证明能加速神经囊虫病活动性囊肿的消退。无论治疗与否，人们对囊肿在每个阶段进展所需的时间知之甚少。在一项阿苯达唑随机临床试验中，我们将117例患者的脑成像数据从患者水平重新配置为囊肿水平，在基线、1、6、12和24个月时拍摄图像。应用多状态模型，我们模拟了囊肿在下一次成像前发展到后续囊肿阶段的风险（vs无变化）。我们检查了阿苯达唑治疗的总体影响，以及患者和囊肿特征对危害的影响。结果sal苯达唑加速了从活跃期到退行期（HR=2.7, 95% CI 1.3 ~ 6.5）和从退行期到消失期（HR=1.9, 95% CI 1.1 ~ 3.9）的进化。阿苯达唑对男性患者的影响更大，基线时没有钙化囊肿，并且在不同部位有多个囊肿。结论本研究对阿苯达唑在囊肿轨迹的哪个部位影响最大提供了更好的理解。
BackgroundIn neurocysticercosis, the larval form of the pork tapewormTaenia soliumappears to evolve through three phases—active, degenerative and sometimes calcification—before disappearance. The antihelmintic drug, albendazole, has been shown to hasten the resolution of active cysts in neurocysticercosis. Little is known about the time cysts take to progress through each phase, with or without treatment.MethodsWe reconfigured brain imaging data from patient level to cyst level for 117 patients in a randomized clinical trial of albendazole in which images were taken at baseline, 1, 6, 12 and 24 mo. Applying a multistate model, we modelled the hazard of a cyst evolving to subsequent cyst phases before the next imaging (vs no change). We examined the impact of albendazole treatment overall and by patient and cyst characteristics on the hazard.ResultsAlbendazole accelerated the evolution from the active to degenerative phase (HR=2.7, 95% CI 1.3 to 6.5) and from the degenerative phase to disappearance (HR=1.9, 95% CI 1.1 to 3.9). Albendazole’s impact was stronger for patients who were male, did not have calcified cysts at baseline and who had multiple cysts in different locations.ConclusionsThis research provides a better understanding of where in the cyst trajectory albendazole has the greatest impact.