Li Y S, Sleigh A C, Ross A G, Li Y, Williams G M, Tanner M, McManus D P
Australian Centre for International and Tropical Health and Nutrition, Queensland Institute of Medical Research, Herston, Brisbane, Australia.
Trans R Soc Trop Med Hyg. 2000 Mar-Apr;94(2):191-7. doi: 10.1016/s0035-9203(00)90274-8.
We studied a community cohort of 193 individuals exposed to endemic Schistosoma japonicum infection in the Dongting Lake region of China to assess subclinical morbidity and the 2-year benefit of curative therapy (praziquantel) administered in 1996. Prevalence and intensity of S. japonicum infection before treatment were 28% and 192 eggs per gram faeces (epg), respectively. Two years after cure, 22% of the cohort were re-infected, but with a lighter intensity (67 epg). Sixty-four subjects (37%) showed significant improvement in ultrasound parenchyma images after treatment and 51 subjects (54%) showed significant improvement of periportal fibrosis. Left-lobe enlargement also reversed (P < 0.05) and splenomegaly reversed in 6 of 8 cases and developed in only 1. Two years post-treatment a dilated portal vein became less frequent, but the decline was not significant (16% vs 11%, P < 0.05). The serum levels of laminin and collagen IV associated with re-infection and intensity and hyaluronic acid levels correlated with ultrasound findings (P < 0.01). Overall, treatment induced a marked decrease in subclinical hepatosplenic morbidity attributable to S. japonicum although low-intensity re-infection after treatment remained relatively frequent. Stratified analysis and logistic models evaluated potential confounding factors for assessment of treatment effects on hepatic fibrosis. S. japonicum infection and moderate-heavy alcohol intake interacted: improvement in parenchymal morbidity was impeded among drinkers (P < 0.05). Chemotherapy focused on at-risk residents controls prevalent subclinical hepatic fibrosis but re-infection indicates the need for complementary control strategies.
我们研究了中国洞庭湖地区193名暴露于日本血吸虫地方流行感染的社区队列，以评估亚临床发病率以及1996年给予的治愈性治疗（吡喹酮）的两年疗效。治疗前日本血吸虫感染的患病率和感染强度分别为28%和每克粪便192个虫卵（epg）。治愈两年后，队列中有22%再次感染，但感染强度较轻（67 epg）。64名受试者（37%）治疗后超声实质图像有显著改善，51名受试者（54%）门周纤维化有显著改善。左叶肿大也得到逆转（P<0.05），8例中有6例脾肿大得到逆转，仅1例出现脾肿大。治疗后两年，门静脉扩张的情况变得不那么频繁，但下降不显著（16%对11%，P<0.05）。与再次感染和感染强度相关的层粘连蛋白和IV型胶原血清水平以及与超声检查结果相关的透明质酸水平（P<0.01）。总体而言，治疗使日本血吸虫所致的亚临床肝脾发病率显著降低，尽管治疗后低强度再次感染仍然相对频繁。分层分析和逻辑模型评估了评估治疗对肝纤维化影响的潜在混杂因素。日本血吸虫感染与中度至重度饮酒存在相互作用：饮酒者实质发病率的改善受到阻碍（P<0.05）。针对高危居民的化疗可控制普遍存在的亚临床肝纤维化，但再次感染表明需要补充控制策略。
