The epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection: a population-based, cross-sectional study
The epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection: a population-based, cross-sectional study
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门静脉周围纤维化的流行病学和当前曼氏血吸虫感染的相关性：基于人群的横断面研究
DOI：
10.1101/2023.09.15.23295612
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Anjorin S
中科院分区：
文献类型：
--
作者：
Anjorin S
背景已知肠道血吸虫感染会导致门静脉周围纤维化（PPF）。然而，人们对 PPF 的流行病学仍知之甚少，特别是在曼氏血吸虫流行的地区。 方法 我们在血吸虫跟踪队列中随机抽取了来自乌干达马尤格、布利萨和帕克瓦奇地区 38 个村庄的 1442 个家庭，对 2834 名年龄在 5-90 岁的个体进行了检查。 PPF 是使用 Niamey Protocol.S 中的超声和图像模式 C-F 进行诊断的。通过 Kato-Katz 显微镜和护理点循环阴极抗原 (POC-CCA) 诊断曼氏菌感染状态/强度。将血吸虫感染、合并感染和合并症作为 PPF 暴露进行检查。使用按家庭聚类的标准误差进行逻辑回归。结果PPF 患病率为 12·10% (343/2834)，各地区的变化范围为 5·00-19·46%。 Kato-Katz 和 POC-CCA 迹线阴性和阳性的曼索尼患病率分别为 43·37% (1229/2834)、40·86% (1158/2834) 和 65·73% (1863/2834)。个体血吸虫感染状态/强度与 PPF 的可能性不相关。生活在成年人重度感染患病率低于 5%（每克粪便 400 个以上虫卵）的村庄中，PPF 发生率降低 30.2%。 PPF 的可能性随年龄从 5-25 岁线性增加，从 26-45 岁呈指数变化，从 45-60 岁保持不变，并在过去 60 岁稳步下降。肝脏疾病史、人类免疫缺陷病毒阳性 (HIV+) 和超声检测到的慢性肝炎/早期肝硬化样疾病与 PPF 可能性增加 2 倍以上相关。解释 目前单独的血吸虫感染对于 PPF 来说并不能提供任何信息。 HIV+病史和潜在的慢性肝炎/早期肝硬化样疾病是危险因素，可对其进行调查以进行 PPF 监测和管理。资金支持纳菲尔德人口健康泵启动基金、Wellcome Trust 机构战略支持基金 (204826/Z/16/Z)、John Fell 基金、Robertson 基金会奖学金和 UKRI EPSRC 奖 (EP/X021793/1).背景研究本研究之前的证据寄生虫感染引起的发病率是当前和过去接触的复杂相互作用。世界卫生组织 (WHO) 消除血吸虫病这一公共卫生问题的指南假定当前感染是流行发病率的可靠替代指标。指南中定义了社区感染阈值，如果满足，则假设不存在与血吸虫病相关的发病率。在常规大规模用药的重复治疗背景下，缺乏证据表明感染与普遍发病率之间存在关联。为了评估世界卫生组织的指南，需要在流行地区进行大规模的基于人群的横断面研究，将当前感染情况与同一时间点的当前发病率进行比较。横断面设计还可以调查多种危险因素，以评估当前血吸虫感染的相对重要性。门静脉周围纤维化是一种与血吸虫病相关的严重疾病，具有门静脉高压、上消化道出血和最终过早死亡等临床后果。然而，人们对这种疾病的分布知之甚少。目前还没有关于其最基本流行病学的信息，包括年龄和性别特定的可能性。它是血吸虫病特异性的或可归因于血吸虫病理学，与具有复杂病因的更微妙的病症（例如贫血）不同。因此，调查门静脉周围纤维化是保守的第一线……
BackgroundIntestinal schistosome infections are known to cause periportal fibrosis (PPF). Yet, the epidemiology of PPF remains poorly understood, especially in settings endemic withSchistosoma mansoni.MethodsWe randomly sampled 1442 households from 38 villages in Mayuge, Buliisa, and Pakwach Districts of Uganda within the SchistoTrack Cohort to examine 2834 individuals aged 5-90 years. PPF was diagnosed using ultrasound and image patterns C-F from the Niamey Protocol.S. mansoniinfection status/intensity was diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigens (POC-CCA). Schistosome infection, coinfections, and comorbidities were examined as exposures for PPF. Logistic regressions were run with standard errors clustered by household.FindingsPPF prevalence was 12·10% (343/2834), varying from 5·00-19·46% across districts.S. mansoniprevalence by Kato-Katz, and POC-CCA trace negative and positive was 43·37% (1229/2834), 40·86% (1158/2834), and 65·73% (1863/2834) respectively. Individual schistosome infection status/intensity was not correlated with the likelihood of PPF. Living in a village where adults had <5% prevalence of heavy intensity infections (400+ eggs per gram of stool) was associated with 30.2% decreased odds of PPF. The likelihood of PPF with age linearly increased from 5-25, exponentially changed from 26-45, remain unchanged from 45- 60, and steadily decreased past 60 years. History of liver diseases, human immunodeficiency virus positivity (HIV+), and ultrasound-detected chronic hepatitis/early cirrhosis-like disease were associated with >2-fold increased PPF likelihood.InterpretationCurrent individual schistosome infections alone are uninformative for PPF. History of HIV+ and underlying chronic hepatitis/early cirrhosis-like disease were risk factors and could be investigated for PPF surveillance and management.FundingNuffield Department of Population Health Pump Priming Fund, Wellcome Trust Institutional Strategic Support Fund (204826/Z/16/Z), John Fell Fund, Robertson Foundation Fellowship, and UKRI EPSRC Award (EP/X021793/1).Research in contextEvidence before this studyMorbidity due to parasitic infection is a complex interplay of current and past exposures. World Health Organization (WHO) guidelines for elimination of schistosomiasis as a public health problem assume current infection is a reliable proxy indicator of prevalent morbidity. Community infection thresholds are defined in guidelines and, when met, the assumption is there is no schistosomiasis-related morbidity. There is a lack of evidence for the association of infection with prevalent morbidity in the context of repeated treatment from routine mass drug administration. To evaluate WHO guidelines, there is a need for large-scale population- based, cross-sectional studies in endemic areas where current infection is compared with current morbidity at the same timepoint. A cross-sectional design also enables the investigation of a wide range of risk factors to assess the relative importance of current schistosome infection. Periportal fibrosis is a schistosomiasis-associated severe morbidity with clinical consequences such as portal hypertension, upper gastrointestinal tract bleeding, and ultimately premature death. Yet, little is known about the distribution of this disease; no information is available on its most basic epidemiology including age and gender-specific likelihoods. It is schistosomiasis-specific or attributable to schistosome pathology unlike more subtle conditions with complex aetiologies (e.g. anaemia). Hence, investigating periportal fibrosis serves as a first line, conservative …
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影响因子：
1
作者：
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DOI：
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发表时间：
2020
期刊：
Journal of Microbiology and Infectious Diseases
影响因子：
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25.7
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3.2
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