Haswell-Elkins M R, Mairiang E, Mairiang P, Chaiyakum J, Chamadol N, Loapaiboon V, Sithithaworn P, Elkins D B
Tropical Health Program, Queensland Institute of Medical Research, Brisbane, Australia.
Int J Cancer. 1994 Nov 15;59(4):505-9. doi: 10.1002/ijc.2910590412.
We describe an innovative strategy to quantify risk of cancer associated with varying levels of exposure to chronic parasitic infection through the identification of asymptomatic cases of cholangiocarcinoma within a population-based survey of Opisthorchis viverrini infection. Stool samples from 12,311 adults over age 24 years from 85 villages in northeast Thailand were examined for intensity of liver fluke infection. People from varying egg count categories were selected for ultrasound examination to identify hepatobiliary disease. Fifteen preclinical cases of cholangiocarcinoma were diagnosed from a total of 1,807 people based on ultrasonographic evidence with confirmation by endoscopy where possible. The prevalence odds of the diagnosis of cholangiocarcinoma increased gradually within the light and moderate intensity groups. In contrast, sharply elevated prevalence odds [age-, sex- and locality-adjusted prevalence odds ratio (POR) 14.1, p < 0.05] were observed within the most heavily liver fluke-infected group compared with the uninfected group. Males were more frequently affected than females (crude POR 4.5), but after controlling for intensity of infection, age and locality, the magnitude and significance of this measurement was reduced. Our data clearly demonstrate a significant relationship between intensity of liver fluke infection and cholangiocarcinoma and a strikingly high prevalence of the disease among heavily infected males.
我们描述了一种创新策略，通过在基于人群的华支睾吸虫感染调查中识别胆管癌无症状病例，来量化与不同程度慢性寄生虫感染相关的癌症风险。对泰国东北部85个村庄的12311名24岁以上成年人的粪便样本进行肝吸虫感染强度检测。从不同虫卵计数类别的人群中选取进行超声检查，以识别肝胆疾病。在总共1807人中，根据超声证据诊断出15例胆管癌临床前病例，并在可能的情况下通过内镜检查进行确诊。胆管癌诊断的患病率比值在轻度和中度感染组中逐渐增加。相比之下，与未感染组相比，在肝吸虫感染最严重的组中观察到患病率比值急剧升高（年龄、性别和地区调整后的患病率比值比（POR）为14.1，p<0.05）。男性比女性更易受影响（粗POR为4.5），但在控制感染强度、年龄和地区后，该测量值的幅度和显著性降低。我们的数据清楚地表明肝吸虫感染强度与胆管癌之间存在显著关系，且该疾病在重度感染男性中的患病率极高。
