曼氏血吸虫病：超声评估的肝纤维化及血清透明质酸浓度
Schistosomiasis mansoni: ultrasound-evaluated hepatic fibrosis and serum concentrations of hyaluronic acid.
作者信息
Silva C C, Domingues A L, Lopes E P, Morais C N, Santos R B, Luna C F, Nader H B, Martins J R
机构信息
Universidade Federal de Pernambuco, Rua Irmã Maria Davi 154, Recife, PE, Brazil.
出版信息
Ann Trop Med Parasitol. 2011 Apr;105(3):233-9. doi: 10.1179/136485911X12987676649629.
Schistosomiasis mansoni is a fibrogenic liver disease that constitutes a major health problem in north-eastern Brazil. Although one common manifestation of the disease, periportal fibrosis (PPF), can be assessed by ultrasonography by well-trained physicians, the necessary equipment and personnel are not always readily available. Serum markers, including hyaluronic acid (HA), have been used as alternative means of measuring fibrosis. Recently serum concentrations of HA have been evaluated in 77 Brazilians (61 cases of schistosomiasis mansoni and 16 healthy controls) and compared against the ultrasound-evaluated PPF in the same subjects. The HA was measured using a non-competitive fluorescence-based assay, while the PPF was explored using a portable ultrasound scanner (SSD-500; Aloka, Tokyo) and graded, as patterns A-F, according to the World Health Organization's 'Niamey protocol'. In general, the serum concentrations of HA were found to be positively correlated with the severity of the PPF. The mean concentration of HA in the sera of the 16 controls was significantly lower than that recorded in the schistosomiasis cases who showed PPF of patterns D or E (P<0·001 for each). The cases who showed pattern-C PPF also had significantly less HA in their sera than the cases with PPF of patterns D or E (P<0·001 for each), and the cases with pattern-D fibrosis had significantly lower HA concentrations in their sera than the cases with PPF of pattern E (P<0·001). In an analysis based on a receiver-operating-characteristic (ROC) curve, an HA concentration of 20·2 μg/litre of serum was identified as a threshold that could be used to distinguish moderate cases of PPF (i.e. patterns C or D) from the more advanced cases (i.e. patterns E or F), with a sensitivity of 60% and specificity of 65%. In conclusion, it appears that serum concentrations of hyaluronic acid could be used as markers for periportal fibrosis in patients with schistosomiasis mansoni.
曼氏血吸虫病是一种致纤维化的肝脏疾病，在巴西东北部构成了一个重大的健康问题。尽管该疾病的一种常见表现——门周纤维化（PPF），可以由训练有素的医生通过超声检查进行评估，但必要的设备和人员并非总是随时可用。血清标志物，包括透明质酸（HA），已被用作测量纤维化的替代手段。最近，对77名巴西人（61例曼氏血吸虫病患者和16名健康对照）的血清HA浓度进行了评估，并与同一受试者经超声评估的PPF进行了比较。HA采用基于非竞争性荧光的检测方法进行测量，而PPF则使用便携式超声扫描仪（SSD - 500；Aloka，东京）进行检测，并根据世界卫生组织的“尼亚美方案”分为A - F型。总体而言，发现血清HA浓度与PPF的严重程度呈正相关。16名对照者血清中的HA平均浓度显著低于表现为D型或E型PPF的血吸虫病患者（每种情况P<0·001）。表现为C型PPF的患者血清中的HA也明显少于表现为D型或E型PPF的患者（每种情况P<0·001），而表现为D型纤维化的患者血清中的HA浓度明显低于表现为E型PPF的患者（P<0·001）。在基于受试者工作特征（ROC）曲线的分析中，血清HA浓度为20·2μg/升被确定为一个阈值，可用于区分中度PPF病例（即C型或D型）与更严重的病例（即E型或F型），灵敏度为60%，特异性为65%。总之，透明质酸的血清浓度似乎可以用作曼氏血吸虫病患者门周纤维化的标志物。
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