Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis.
Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pntd.0005372
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发表时间：
2017-02
影响因子：
3.8
通讯作者：
King CH
中科院分区：
文献类型：
--
作者：
Andrade G;Bertsch DJ;Gazzinelli A;King CH
自 1984 年以来，世界卫生组织已认可通过药物治疗来减少血吸虫感染及其发病率。横断面研究表明治疗前感染强度与血吸虫相关病理风险之间存在相关性。然而，有证据还表明，治疗后强度的降低可能无法逆转发病率，因为有些发病率发生在所有感染水平，有些发病率反映了永久性组织损伤。该项目的目的是系统地审查基于药物控制血吸虫病的证据，并对治疗后感染强度降低对感染相关发病率的影响进行定量估计。该评论一开始就在 PROSPERO 上注册 (CRD42015026080)。通过在线搜索和私人档案搜索确定了评估治疗前后发病率的研究。计算每个结果的治疗后优势比或标准化平均差，并通过荟萃回归将这些与治疗相关的卵数减少率（ERR）相关。 ERR 越高，大多数发病率的降低幅度越大。使用随机效应荟萃分析得出总结估计：曼氏血吸虫和日本血吸虫治疗后，左侧肝肿大减少了 54%，右侧肝肿大减少了 47%，脾肿大减少了 37%，门静脉周围纤维化减少了 52%，腹泻减少了 53%，便血减少了 75%。对于埃及沙门氏菌，血尿减少 92%，蛋白尿减少 90%，膀胱病变减少 86%，上尿路病变减少 72%。门脉扩张或血红蛋白水平没有一致的变化。在亚组分析中，年龄、感染状况、地区、寄生虫种类和随访间隔与结果的有意义的差异相关。虽然实施血吸虫病治疗存在挑战，并且吡喹酮疗法不能完全治愈，但产蛋量的减少与发病率的降低显着相关，并且在考虑采取更积极的策略以最大程度地减少感染强度时，可以用来预测疾病负担的减轻。血吸虫病是由血吸虫寄生吸虫感染引起的疾病。根据感染种类的不同，慢性血吸虫感染可引起多种病变，包括肝脏和脾脏肿大、肝门静脉纤维化和高血压，或膀胱溃疡和畸形以及肾脏阻塞。感染还会引起贫血、腹泻、腹痛、体能下降等。在我们的研究中，我们量化了血吸虫感染人群中感染相关发病率的降低，这是通过给予一种或多种药物治疗实现的。我们系统地回顾了 71 份关于血吸虫相关发病率降低的现有报告，并根据对主要数据的荟萃分析确定，当治疗后寄生虫负荷进一步减少时，持续发病率会逐渐降低，正如标准诊断测试中虫卵计数减少所反映的那样。这表明重复或更有效的抗寄生虫药物治疗将成为更大程度减少受影响地区血吸虫相关患者发病率的宝贵工具。
Since 1984, WHO has endorsed drug treatment to reduce Schistosoma infection and its consequent morbidity. Cross-sectional studies suggest pre-treatment correlation between infection intensity and risk for Schistosoma-related pathology. However, evidence also suggests that post-treatment reduction in intensity may not reverse morbidity because some morbidities occur at all levels of infection, and some reflect permanent tissue damage. The aim of this project was to systematically review evidence on drug-based control of schistosomiasis and to develop a quantitative estimate of the impact of post-treatment reductions in infection intensity on prevalence of infection-associated morbidity. This review was registered at inception with PROSPERO (CRD42015026080). Studies that evaluated morbidity before and after treatment were identified by online searches and searches of private archives. Post-treatment odds ratios or standardized mean differences were calculated for each outcome, and these were correlated to treatment-related egg count reduction ratios (ERRs) by meta-regression. A greater ERR correlated with greater reduction in odds of most morbidities. Random effects meta-analysis was used to derive summary estimates: after treatment of S. mansoni and S. japonicum, left-sided hepatomegaly was reduced by 54%, right-sided hepatomegaly by 47%, splenomegaly by 37%, periportal fibrosis by 52%, diarrhea by 53%, and blood in stools by 75%. For S. haematobium, hematuria was reduced by 92%, proteinuria by 90%, bladder lesions by 86%, and upper urinary tract lesions by 72%. There were no consistent changes in portal dilation or hemoglobin levels. In sub-group analysis, age, infection status, region, parasite species, and interval to follow-up were associated with meaningful differences in outcome. While there are challenges to implementing therapy for schistosomiasis, and praziquantel therapy is not fully curative, reductions in egg output are significantly correlated with decreased morbidity and can be used to project diminution in disease burden when contemplating more aggressive strategies to minimize infection intensity. Schistosomiasis is the disease caused by infection with Schistosoma parasitic flukes. Depending on the infecting species, chronic Schistosoma infection can cause a variety of pathologies including liver and spleen enlargement, fibrosis and hypertension of the portal vein of the liver, or bladder ulceration and deformities and kidney blockage. Infection can also cause anemia, diarrhea, abdominal pain, and decreased physical fitness. In our study, we quantified the reductions in prevalence of infection-related morbidities among populations with Schistosoma infection, as achieved by giving one or more drug treatments. We systematically reviewed 71 available reports of Schistosoma-related morbidity reduction and determined, based on a meta-analysis of the primary data, that the odds of persisting morbidity progressively decrease when greater post-treatment reductions in parasite burden are achieved, as reflected by reduced egg counts in standard diagnostic testing. This suggests that repeated or more effective anti-parasite drug treatment will be a valuable tool for greater reduction of Schistosoma-related patient morbidities in affected areas.