Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial
Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial
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DOI：
10.1590/0074-02760160334
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发表时间：
2017-03-01
期刊：
影响因子：
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通讯作者：
Rassi, Anis
中科院分区：
文献类型：
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作者：
Rassi Jr, Anis;Marin Neto, José Antonio;Rassi, Anis
恰加斯心肌病是慢性恰加斯病最常见和最严重的表现，也是拉丁美洲发病和死亡的主要原因之一。尽管恰加斯心肌病的发病机制尚不完全清楚，但它可能涉及多种机制，包括寄生虫依赖性心肌损伤、免疫介导的心肌损伤（由寄生虫本身和自身抗原诱导）以及微血管和神经源性紊乱。在过去的三十年中，人们达成了共识，即寄生虫的持续存在对于恰加斯心肌病的发生和进展至关重要。在这种情况下，恰加斯病慢性期的抗寄生虫治疗可以预防与该疾病相关的并发症。然而，根据 BENEFIT 试验的结果，苯并硝唑似乎对阻止慢性恰加斯心肌病患者的疾病进展没有益处。在这篇综述中，我们对恰加斯病的主要致病机制进行了更新，并重新审视和讨论了 BENEFIT 试验的结果及其局限性和影响。
Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.