Viral Hepatitis Center, Gastroenterology Unit, Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Trans R Soc Trop Med Hyg. 2014 Mar;108(3):159-64. doi: 10.1093/trstmh/tru010.
Chronic hepatitis B (CHB) and schistosomiasis are prevalent in several countries, but the impact of this association is unknown. We aimed to investigate the prevalence and morbidity of this co-infection in Minas Gerais, an endemic area of schistosomiasis in Brazil.
In total, 406 adults with CHB (HBsAg positive >6 months) were included in a cross-sectional study. CHB was classified as replicative (HBV DNA ≥ 2.000 IU/ml), and low replicative or inactive hepatitis B carriers (HBV DNA <2.000 IU/ml). Schistosomiasis was confirmed by epidemiological and clinical records. Liver biopsies were scored by METAVIR. The risk of severe fibrosis was estimated by multivariate analysis.
Of the 406 patients, 64.8% (263) were male, and the median age was 45 years (IQR 35-54). In total, 57.9% (235) had replicative CHB, and 31.5% (128) had cirrhosis. Schistosoma mansoni was confirmed in 30.5% (124) patients, 81.5% (101) of which were male with a median age of 47 years (IQR 39.5-54). Of the co-infected patients, 61.3% (76) and 38.7% (48) had replicative and inactive CHB, respectively. Schistosomal portal fibrosis (PF) was detected in 69.4% (86/124) patients. Patients with replicative CHB and schistosomal PF had more advanced fibrosis and severe inflammation compared with patients without schistosomal PF (80.8% vs 43.6% for METAVIR F3-F4, p<0.01; 64.0% vs 39.8% for METAVIR A2-A3, p < 0.01). Age >50 years (OR = 1.10; 95% CI 1.06-1.14, p<0.001), male gender (OR = 2.61, 95% CI 1.12-6.09, p = 0.03), schistosomal PF (OR = 4.56, 95% CI 2.10-9.91, p<0.001) and alcoholism (OR = 2.46, 95% CI 1.16-5.19, p = 0.02) were independently associated with cirrhosis.
The association between replicative CHB and schistosomal PF can be a risk factor for more severe liver disease, which can result in deleterious outcomes for patients from endemic areas.
慢性乙型肝炎（CHB）和血吸虫病在多个国家流行，但这种关联的影响尚不清楚。我们旨在调查巴西血吸虫病流行地区米纳斯吉拉斯州这种合并感染的患病率和发病率。
共纳入 406 例慢性乙型肝炎（HBsAg 阳性 >6 个月）患者进行横断面研究。CHB 分为复制性（HBV DNA≥2.000 IU/ml）和低复制性或非活动性乙型肝炎携带者（HBV DNA<2.000 IU/ml）。通过流行病学和临床记录确认血吸虫病。肝活检由 METAVIR 评分。通过多变量分析估计严重纤维化的风险。
406 例患者中，64.8%（263 例）为男性，中位年龄为 45 岁（IQR 35-54）。共有 57.9%（235 例）存在复制性 CHB，31.5%（128 例）存在肝硬化。30.5%（124 例）患者证实存在曼氏血吸虫，其中 81.5%（101 例）为男性，中位年龄为 47 岁（IQR 39.5-54）。在合并感染的患者中，61.3%（76 例）和 38.7%（48 例）分别为复制性和非活动性 CHB。在 124 例血吸虫病患者中，69.4%（86 例）检测到血吸虫性门脉纤维化（PF）。与无血吸虫性 PF 的患者相比，存在复制性 CHB 和血吸虫性 PF 的患者纤维化和严重炎症更为严重（METAVIR F3-F4，80.8%对 43.6%，p<0.01；METAVIR A2-A3，64.0%对 39.8%，p < 0.01）。年龄>50 岁（OR=1.10；95%CI 1.06-1.14，p<0.001）、男性（OR=2.61，95%CI 1.12-6.09，p=0.03）、血吸虫性 PF（OR=4.56，95%CI 2.10-9.91，p<0.001）和酒精中毒（OR=2.46，95%CI 1.16-5.19，p=0.02）与肝硬化独立相关。
复制性 CHB 与血吸虫性 PF 的关联可能是更严重肝病的危险因素，这可能会对来自流行地区的患者产生不良后果。
