人类眼部弓形虫病的治疗策略：抗生素为何失效
Treatment Strategy in Human Ocular Toxoplasmosis: Why Antibiotics Have Failed.
作者信息
Garweg Justus G, Pleyer Uwe
机构信息
Swiss Eye Institute, Rotkreuz, and Uveitis Clinic, Berner Augenklinik am Lindenhofspital, 3012 Bern, Switzerland.
Department of Ophthalmology, Inselspital, University of Bern, 3012 Bern, Switzerland.
出版信息
J Clin Med. 2021 Mar 5;10(5):1090. doi: 10.3390/jcm10051090.
BACKGROUND
There is currently no clear evidence of the effectiveness of antibiotic therapy in acute ocular toxoplasmosis (OT), but its effect as a secondary prophylaxis is undisputed. The majority of uveitis specialists advocate treatment. This meta-analytic review aims to critically analyze determinants of treatment success and to update current treatment strategies for OT in order to explain this discrepancy.
METHODS
A systematic literature search was performed in NCBI/PubMed, Clinical Trials, Google Scholar and ScienceDirect to retrieve pro- and retrospective studies using the key terms "ocular toxoplasmosis" or "retinochoroiditis" and "immunocompetent" and "treatment" or "therapy" and "human." Of these, larger case series and prospective clinical studies and cross references identified from meta-analyses were selected by a manual search, and primary and secondary outcome parameters were extracted.
RESULTS
Ten case series and clinical trials reported success parameters for treatment outcomes, and four additional for recurrence prophylaxis. Five treatment studies were randomized clinical trials, three comparative and two noncomparative case series. Though several outcome parameters were reported, five of them defined time to healing, four visual gain and one lesion size as primary and secondary outcome parameters, recurrence rate as a secondary outcome parameter was reported once. No conclusive evidence was found for an antibiotic treatment effect. Four prophylaxis studies addressed the prevention of recurrences after treatment. The primary outcome in all studies was the effect of treatment and prophylaxis on recurrences, and all four found a significant effect on the risk of and time to recurrences.
CONCLUSIONS
Antibiotic treatment of OT aims at controlling parasite proliferation. The absence of an effect on visual acuity and time to healing is thus not surprising. The fact that time to and number of recurrences respond to recurrence of prophylaxis proves the antibiotic effect on parasite activity.
背景
目前尚无明确证据表明抗生素治疗对急性眼部弓形虫病（OT）有效，但其作为二级预防的效果是无可争议的。大多数葡萄膜炎专家主张进行治疗。本荟萃分析旨在批判性地分析治疗成功的决定因素，并更新当前OT的治疗策略，以解释这种差异。
方法
在NCBI/ PubMed、临床试验、谷歌学术和科学Direct中进行系统的文献检索，以检索使用关键词“眼部弓形虫病”或“视网膜脉络膜炎”以及“免疫功能正常”和“治疗”或“疗法”以及“人类”的前瞻性和回顾性研究。其中，通过人工检索选择了从荟萃分析中确定的较大病例系列、前瞻性临床研究和交叉参考文献，并提取了主要和次要结局参数。
结果
10个病例系列和临床试验报告了治疗结局的成功参数，另有4个报告了预防复发的参数。5项治疗研究为随机临床试验，3项为比较性研究，2项为非比较性病例系列。尽管报告了几个结局参数，但其中5个将愈合时间、4个视力提高和1个病变大小定义为主要和次要结局参数，复发率作为次要结局参数仅报告了一次。未发现抗生素治疗效果的确凿证据。4项预防研究涉及治疗后复发的预防。所有研究的主要结局是治疗和预防对复发的影响，所有4项研究均发现对复发风险和复发时间有显著影响。
结论
OT的抗生素治疗旨在控制寄生虫增殖。因此，对视力和愈合时间没有影响并不奇怪。复发时间和复发次数对预防复发有反应这一事实证明了抗生素对寄生虫活性的作用。
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