Hepatic echinococcosis: Clinical and therapeutic aspects
Hepatic echinococcosis: Clinical and therapeutic aspects
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DOI：
10.3748/wjg.v18.i13.1448
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发表时间：
2012-04-07
影响因子：
4.3
通讯作者：
Cacopardo, Bruno
中科院分区：
文献类型：
--
作者：
Nunnari, Giuseppe;Pinzone, Marilia R.;Cacopardo, Bruno
棘球绦虫病或包虫病（HD）是一种由绦虫属绦虫幼虫期引起的人畜共患病。肝棘球蚴病是一种危及生命的疾病，主要分化为肺泡型和囊状型，分别与多房棘球蚴（E. multilocularis）和细粒棘球蚴（E. granulosus）感染相关。囊性棘球蚴病（CE）在世界范围内分布，而肝肺泡棘球蚴病（AE）在北半球流行，包括北美和一些亚洲和欧洲国家，如法国、德国和奥地利。芽孢杆菌幼囊是球形的单囊泡，由内部生发层和外部脱细胞层组成。囊肿的扩张与宿主的免疫反应和随后的纤维层的形成有关，称为包囊；老年性囊肿通常表现为内部分隔和子囊肿。多房性大肠杆菌具有肿瘤样浸润性行为；导致组织破坏，最终导致肝功能衰竭。肝是HD累及的主要部位，无论是肺泡性和囊性包虫病。HD通常在很长一段时间内无症状，因为囊肿生长通常缓慢；最常见的症状是疲劳和腹痛。由于囊肿渗漏或破裂，患者也可能出现黄疸、肝肿大或过敏反应。HD的诊断通常通过超声检查和免疫诊断相结合来完成；此外，手术技术的改进，微创治疗方法（如穿刺、抽吸、注射、再抽吸（PAIR））的引入，以及更有效的药物（如苯并咪唑）的出现，深刻地改变了HD患者的预期寿命和生活质量。本文旨在提供肝包虫病的生物学、诊断、临床和治疗方面的最新综述。(C) 2012年白石登。版权所有。
Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echiococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E multilocularis has a tumor-like, infiltrative behavior; which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis. (C) 2012 Baishideng. All rights reserved.