Sithithaworn P, Haswell-Elkins M R, Mairiang P, Satarug S, Mairiang E, Vatanasapt V, Elkins D B
Department of Parasitology, Faculty of Medicine, Khon Kaen University, Thailand.
Int J Parasitol. 1994 Sep;24(6):833-43. doi: 10.1016/0020-7519(94)90009-4.
Infection with the liver fluke, Opisthorchis viverrini, remains a major public health problem in Northeast Thailand, where approximately one-third of the population is infected. The northeast region is largely populated by Laos-descendent Thais who enjoy eating raw fish, which harbour the infective stage of the fluke. The parasite has maintained its presence in the population despite the widespread use of praziquantel and dissemination of health education material throughout the region by vigorous government-sponsored programs in recent years. The most severe consequence of liver fluke infection is cholangiocarcinoma, i.e. cancer of the bile duct epithelium. Although mortality due to the parasites alone appears to be uncommon, cholangiocarcinoma arising as a result of infection is one of the leading causes of death in the region. This paper reviews the pathogenesis of infection and the geographic, hospital-based and community studies which demonstrate the close relationship between infection and cancer. In addition, data from the Cancer Registry of Khon Kaen, Northeast Thailand and population-based studies using ultrasonography to visualize early tumours which illuminate the very high frequency of the cancer among heavily infected individuals and communities are discussed. Finally, the paper will close with a brief commentary on the prospects for control of the parasite and its likely impact on the frequency of cancer given the current epidemiological situation of liver fluke infection.
感染肝吸虫——泰国后睾吸虫，仍是泰国东北部的一个主要公共卫生问题，该地区约三分之一的人口受到感染。东北地区主要居住着有老挝血统的泰国人，他们喜欢吃生鱼，而生鱼体内带有吸虫的感染阶段。尽管近年来政府大力资助的项目在该地区广泛使用了吡喹酮并分发了健康教育材料，但这种寄生虫在人群中仍然存在。肝吸虫感染最严重的后果是胆管癌，即胆管上皮癌。虽然仅由寄生虫导致的死亡似乎并不常见，但因感染引发的胆管癌是该地区主要的死亡原因之一。本文回顾了感染的发病机制以及地理、医院和社区研究，这些研究表明了感染与癌症之间的密切关系。此外，还讨论了泰国东北部孔敬癌症登记处的数据以及使用超声检查来可视化早期肿瘤的基于人群的研究，这些研究揭示了在重度感染的个体和社区中癌症的高发病率。最后，鉴于目前肝吸虫感染的流行病学情况，本文将对控制该寄生虫的前景及其对癌症发病率可能产生的影响作简要评论。
