Keang H, Odermatt P, Odermatt-Biays S, Cheam S, Degrémont A, Hatz C
Provincial Hospital of Kratie, Kratie, Cambodia.
Trans R Soc Trop Med Hyg. 2007 Aug;101(8):759-65. doi: 10.1016/j.trstmh.2007.04.007. Epub 2007 Jun 12.
Severe liver disease due to Schistosoma mekongi was frequent in northern Cambodia. Between 1995 and 2002, seven rounds of mass chemotherapy (praziquantel) reduced infection from 50% to below 3%. In 2002, we assessed hepatosplenic morbidity by historical, clinical and ultrasonographic investigations in adults (older than 14 years) from endemic (n=342) and non-endemic (n=103) areas (Kratie province). Clinical hepatomegaly (25 vs. 0%), splenomegaly (55 vs. 0%), reported blood in stool (41 vs. 20%) and abdominal pain (78 vs. 57%) were significantly higher in the endemic area. In this area, significantly more subjects reported a family history of death due to schistosomiasis (12 vs. 0%); 63% (vs. 0%) reported having at least three treatments of praziquantel in previous years; and only 11% (vs. 99%) had normal liver ultrasonographic examination. Periportal fibrosis with portal hypertension was diagnosed in 46% (vs. 0%) of people in this area; 18% (vs. 0%) and 5% (vs. 0%) of portal hypertension was classified as moderate and severe, respectively. People aged between 24 and 35 years were mostly affected. There was no gender difference. The pathology in the endemic district is most probably residual morbidity of S. mekongi infections. Contributions of co-infections (hepatitis) cannot be excluded. Careful monitoring of the affected communities is required.
湄公血吸虫病导致的严重肝病在柬埔寨北部很常见。1995年至2002年期间，七轮大规模化疗（吡喹酮）使感染率从50%降至3%以下。2002年，我们通过历史、临床和超声检查，对来自流行区（n=342）和非流行区（n=103）（桔井省）的14岁以上成年人的肝脾发病率进行了评估。流行区临床肝肿大（25%对0%）、脾肿大（55%对0%）、便血报告率（41%对20%）和腹痛报告率（78%对57%）显著更高。在该地区，更多受试者报告有血吸虫病死亡家族史（12%对0%）；63%（对0%）报告前几年至少接受过三次吡喹酮治疗；只有11%（对99%）的肝脏超声检查正常。该地区46%（对0%）的人被诊断为伴有门静脉高压的门静脉周围纤维化；门静脉高压的18%（对0%）和5%（对0%）分别被归类为中度和重度。24至35岁的人受影响最大。没有性别差异。流行区的病理情况很可能是湄公血吸虫感染的残留发病率。不能排除合并感染（肝炎）的影响。需要对受影响社区进行仔细监测。
