Yin An-hua, Hua Hai-yong, Sun Guo-xiang, Xu Min-gao, Zhou Wei-en, Zhu Wei-cheng, Feng Jun-yuan, You Lu, Tang Feng, Liang You-sheng
Changshu City Center for Disease Control and Prevention, China, Changshu 215500, China.
Jiangsu Institute of Parasitic Diseases, China.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi. 2013 Oct;25(5):477-80, 484.
To understand the status of newly-developed advanced schistosomiasis patients in schistosome transmission-interrupted areas.
The newly diagnosed advanced schistosomiasis patients confirmed by professionals at province and county levels according to the available standards were investigated. Their detailed epidemiology history and present signs/ symptoms were surveyed, and the relevant medical examinations were performed.
There were 75 patients including 22 males and 53 females. The average age was (70.0 +/- 7.0) years and they were all infected with schistosome previously. They received anti-schistosome therapy (mean 1.85 times) and stool examinations (mean 26.24 times) continuously from 1976 to 1985, and the results of stool examination were all negative. In majority of the patients' resident areas, the last time that Oncomelania hupensis snails were found was 1976, and the latest was 1983. During this period, no patients were up to the diagnostic criteria of advanced schistosomiasis after multiple examinations, and they were diagnosed as advanced cases between 2008 and 2011. The survey indicated that liver fibrosis was found in all the patients with 82.7% showing grad III pathological change, 90.7% of them had splenomegaly, 20.0% had ascites, and 22.7% had portal vein broadening. The mean value of enzyme indexes of liver function was 31.81 U/L (ALT), 53.19 U/L (AST) and 89.28 U/L (gamma-GT), and the positive rate was 21.3%, 49.3% and 57.3%, respectively. As for the fibrosis indexes, the positive rate of HA, LN, C VI and P III P was 73.3%, 13.3%, 17.3% and 9.3%, respectively, and the mean value of HA was 3 times higher than that of the upper limit of normal standard. Conclusions Newly-developed advanced schistosomiasis patients are those who were dignosed and cured parasitologically but progressed pathologically without any chance of re-infection. Anti-fibrosis therapy is necessary as the patients show considerable progressive liver fibrosis.
了解血吸虫病传播阻断地区新发现的晚期血吸虫病患者的状况。
对经省、县级专业人员依据现有标准确诊的新发现晚期血吸虫病患者进行调查。调查其详细的流行病学史及当前体征/症状，并进行相关医学检查。
共75例患者，其中男性22例，女性53例。平均年龄为（70.0±7.0）岁，既往均感染过血吸虫。1976年至1985年期间，他们持续接受抗血吸虫治疗（平均1.85次）及粪便检查（平均26.24次），粪便检查结果均为阴性。大多数患者居住地区最后一次发现钉螺的时间为1976年，最晚为1983年。在此期间，多次检查均无患者达到晚期血吸虫病诊断标准，他们于2008年至2011年期间被诊断为晚期病例。调查显示，所有患者均有肝纤维化，82.7%表现为Ⅲ级病理改变，90.7%有脾肿大，20.0%有腹水，22.7%有门静脉增宽。肝功能酶学指标平均值分别为谷丙转氨酶（ALT）31.81 U/L、谷草转氨酶（AST）53.19 U/L、γ-谷氨酰转肽酶（γ-GT）89.28 U/L，阳性率分别为21.3%、49.3%和57.3%。纤维化指标方面，透明质酸（HA）、层粘连蛋白（LN）、Ⅳ型胶原（C VI）和Ⅲ型前胶原肽（P III P）的阳性率分别为73.3%、13.3%、17.3%和9.3%，HA平均值高于正常标准上限3倍。结论新发现的晚期血吸虫病患者是那些曾接受病原学诊断并治愈，但病理上仍有进展且无再次感染机会的患者。鉴于患者存在明显进展性肝纤维化，抗纤维化治疗很有必要。
