Jia Tie-Wu, Zhou Xiao-Nong, Wang Xian-Hong, Utzinger Jürg, Steinmann Peter, Wu Xiao-Hua
Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, China.
Bull World Health Organ. 2007 Jun;85(6):458-65. doi: 10.2471/blt.06.033035.
To estimate the age-specific disability weight of chronic schistosomiasis japonica in China.
Between October 2004 and January 2005, residents from two schistosome-endemic counties were screened for Schistosoma japonicum infection using an enzyme-linked immunosorbent assay. Disability and morbidity were assessed in seropositive individuals using the European quality of life questionnaire with an additional cognitive dimension (known as the "EQ-5D plus") and ultrasonography. The age-specific disability weight of chronic schistosomiasis was estimated based on participants self-rated health scores on the visual analogue scale of the questionnaire; the relationships between health status, morbidity and disability weight were explored using multilevel regression models.
Of 2843 seropositive individuals, 1419 (49.9%) were classified as having chronic schistosomiasis. Hepatomegaly was found in 76.3% (1082/1419); hepatic fibrosis was found in 73.3% (1040/1419); and splenomegaly was found in 18.6% (264/1419). Diarrhoea was the most common self-reported symptom (46.0%; 653/1419), followed by abdominal pain (32.6%; 463/1419), impaired capacity to work or study (30.7%; 436/1419), and blood in the stool (11.1%; 157/1419). More than half of the respondents reported impairments in at least one dimension of the EQ-5D plus questionnaire, particularly pain or discomfort (47.9%; 675/1410) and anxiety or depression (39.4%; 555/1410). The overall disability weight was 0.191, and age-specific weights ranged from 0.095 among those aged 5-14 years to 0.246 among those aged > 60 years. Multilevel regression models indicated that the disability weight was significantly associated with the participants sex, grade of hepatic fibrosis, the presence of hepatomegaly, abdominal pain, blood in the stool, impaired capacity to work or study, and cognition.
The disability weight attributable to chronic schistosomiasis japonica is high and increases with age. Our findings call for a reappraisal of the disability weights due to chronic schistosomiasis mansoni and schistosomiasis haematobia as well as a re-estimation of the global burden of schistosomiasis.
估算中国日本血吸虫病的年龄特异性残疾权重。
在2004年10月至2005年1月期间，使用酶联免疫吸附试验对来自两个血吸虫病流行县的居民进行日本血吸虫感染筛查。采用带有额外认知维度的欧洲生活质量问卷（即“EQ-5D加”）和超声检查对血清学阳性个体的残疾和发病情况进行评估。根据参与者在问卷视觉模拟量表上的自评健康得分估算慢性血吸虫病的年龄特异性残疾权重；使用多水平回归模型探讨健康状况、发病情况与残疾权重之间的关系。
在2843名血清学阳性个体中，1419人（49.9%）被归类为患有慢性血吸虫病。76.3%（1082/1419）的人有肝肿大；73.3%（1040/1419）的人有肝纤维化；18.6%（264/1419）的人有脾肿大。腹泻是最常见的自我报告症状（46.0%；653/1419），其次是腹痛（32.6%；463/1419）、工作或学习能力受损（30.7%；436/1419）和便血（11.1%；157/1419）。超过一半的受访者报告在EQ-5D加问卷的至少一个维度存在损伤，尤其是疼痛或不适（47.9%；675/1410）和焦虑或抑郁（39.4%；555/1410）。总体残疾权重为0.191，年龄特异性权重范围从5至14岁人群中的0.095到60岁以上人群中的0.246。多水平回归模型表明，残疾权重与参与者的性别、肝纤维化程度、肝肿大的存在、腹痛、便血、工作或学习能力受损以及认知显著相关。
日本血吸虫病所致的残疾权重较高且随年龄增加。我们的研究结果呼吁重新评估曼氏血吸虫病和埃及血吸虫病所致的残疾权重，并重新估算血吸虫病的全球负担。
