埃及亚历山大省的慢性肝病：血吸虫病和肝炎病毒感染的影响

Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections.

作者信息

Angelico M, Renganathan E, Gandin C, Fathy M, Profili M C, Refai W, De Santis A, Nagi A, Amin G, Capocaccia L, Callea F, Rapicetta M, Badr G, Rocchi G

机构信息

Department of Public Health, Tor Vergata University, Rome.

出版信息

J Hepatol. 1997 Feb;26(2):236-43. doi: 10.1016/s0168-8278(97)80036-0.

DOI:10.1016/s0168-8278(97)80036-0

PMID:9059941

Abstract

BACKGROUND/AIMS: In Egypt chronic liver disease is customarily attributed to Schistosoma mansoni infection. Anti-HCV antibodies are highly prevalent among Egyptian blood donors, yet little is known about the risk factors, pathogenicity and virological features of HCV and its association with schistosomiasis. We studied 135 adult patients with chronic liver disease living in the Alexandria governorate, mostly in rural areas of the Nile Delta.

METHODS

Evaluation included abdominal ultrasonography; detection of anti-HCV antibodies and markers of HBV and HDV infection; HCV-RNA assay by 5' untranslated region nested polymerase-chain-reaction and HCV genotyping by a line probe assay; serologic (anti-soluble egg antigen, anti-SEA) and parasitological examinations for Schistosoma mansoni infection; and liver biopsy, if not contraindicated.

RESULTS

Ninety-one (67%) patients had anti-HCV and 107 (85%) anti-SEA, 32 (30%) of whom excreted schistosomal eggs in stools. In addition, 21 (16%) patients had HBsAg, 86 (64%) anti-HBc and four (3%) anti-delta. Thus, many patients had evidence of multiple infections, double in 66% (anti-HCV and anti-SEA), triple in 33% (anti-HCV HBsAg and anti-SEA). Based on our diagnostic criteria, 25 (19%) patients had schistosomal portal fibrosis (anti-HCV positive in eight), 24 (18%) chronic hepatitis (anti-HCV positive in 19), 76 (56%) cirrhosis (anti-HCV positive in 58) and 10 hepatic tumors (anti-HCV positive in six). At multivariate analysis, the presence of anti-HCV was independently associated with previous parenteral anti-schistosomal therapy, a history of hematemesis and seropositivity for anti-HBc. Fifty (55%) of 91 anti-HCV positive sera had HCV-RNA, in 41 cases classified as genotype 4a. Detection of HCV-RNA was associated with a more severe liver disease and occurred less frequently in patients with a history of schistosomiasis.

CONCLUSIONS

HCV infection with genotype 4a is the main cause of severe chronic liver disease in Egypt, where it is highly associated with schistosomiasis.

摘要

背景/目的：在埃及，慢性肝病通常被认为是由曼氏血吸虫感染所致。抗丙型肝炎病毒（HCV）抗体在埃及献血者中高度流行，但关于HCV的危险因素、致病性、病毒学特征及其与血吸虫病的关联却知之甚少。我们研究了135例居住在亚历山大省的成年慢性肝病患者，他们大多来自尼罗河三角洲的农村地区。

方法

评估包括腹部超声检查；检测抗HCV抗体以及乙肝病毒（HBV）和丁型肝炎病毒（HDV）感染标志物；通过5'非翻译区巢式聚合酶链反应进行HCV-RNA检测，并通过线性探针分析法进行HCV基因分型；进行曼氏血吸虫感染的血清学（抗可溶性虫卵抗原，抗SEA）和寄生虫学检查；若未 contraindicated则进行肝活检。

结果

91例（67%）患者抗HCV阳性，107例（85%）抗SEA阳性，其中32例（30%）粪便中排出血吸虫卵。此外，21例（16%）患者乙肝表面抗原（HBsAg）阳性，86例（64%）抗HBc阳性，4例（3%）抗HD阳性。因此，许多患者有多种感染的证据，66%为双重感染（抗HCV和抗SEA），33%为三重感染（抗HCV、HBsAg和抗SEA）。根据我们的诊断标准，25例（19%）患者有血吸虫性门静脉纤维化（8例抗HCV阳性），24例（18%）为慢性肝炎（19例抗HCV阳性），76例（56%）为肝硬化（58例抗HCV阳性），10例为肝肿瘤（6例抗HCV阳性）。多因素分析显示，抗HCV的存在与既往肠道外抗血吸虫治疗、呕血史和抗HBc血清阳性独立相关。91例抗HCV阳性血清中有50例（55%）检测到HCV-RNA，41例为4a基因型。HCV-RNA的检测与更严重的肝病相关，在有血吸虫病病史的患者中出现频率较低。