Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China:: re-infection, subclinical disease and fibrosis marker measurements
Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China:: re-infection, subclinical disease and fibrosis marker measurements
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DOI：
10.1016/s0035-9203(00)90274-8
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发表时间：
2000-03-01
影响因子：
2.2
通讯作者：
McManus, DP
中科院分区：
文献类型：
--
作者：
Li, YS;Sleigh, AC;McManus, DP
我们研究了一个社区队列的193个人暴露于地方性日本血吸虫感染在中国洞庭湖地区，以评估亚临床发病率和2年的治疗性治疗（吡喹酮）在1996年管理的好处。S.日本血吸虫感染率分别为28%和192粒/克粪便（EPG）。治愈两年后，22%的队列再次感染，但强度较轻（67 epg）。治疗后，64例受试者（37%）显示超声实质图像显著改善，51例受试者（54%）显示门静脉周围纤维化显著改善。左叶肿大也逆转（P <0.05），8例中6例脾肿大逆转，仅1例发展为脾肿大。治疗后2年，门静脉扩张的发生率降低，但下降不显著（16%比11%，P> 0.05）。血清层粘连蛋白、Ⅳ型胶原水平与再感染程度及程度相关，血清透明质酸水平与超声检查结果相关（P <0.01）。总体而言，治疗诱导了亚临床肝脾发病率显著降低归因于S。日本血吸虫虽然低强度治疗后再感染仍然相对频繁。分层分析和logistic模型评价了评估肝纤维化治疗效果的潜在混杂因素。S.日本血吸虫感染和中度-重度酒精摄入之间存在交互作用：饮酒者脑实质发病率的改善受到阻碍（P <0.05）。化疗集中在高危居民控制流行的亚临床肝纤维化，但再感染表明需要补充控制策略。
We studied a community cohort of 193 individuals exposed to endemic Schistosoma japonicum infection in the Dongting Lake region of China to assess subclinical morbidity and the 2-year benefit of curative therapy (praziquantel) administered in 1996. Prevalence and intensity of S. japonicum infection before treatment were 28% and 192 eggs per gram faeces (epg), respectively. Two years after cure, 22% of the cohort were reinfected, but with a lighter intensity (67 epg). Sixty-four subjects (37%) showed significant improvement in ultrasound parenchyma images after treatment and 51 subjects (54%) showed significant improvement of periportal fibrosis. Left-lobe enlargement also reversed (P < 0.05) and splenomegaly reversed in 6 of 8 cases and developed in only 1. Two years post-treatment a dilated portal vein became less frequent, but the decline was not significant (16% vs 11%, P > 0.05). The serum levels of laminin and collagen IV associated with reinfection and intensity and hyaluronic acid levels correlated with ultrasound findings (P < 0.01). Overall, treatment induced a marked decrease in subclinical hepatosplenic morbidity attributable to S. japonicum although low-intensity re-infection after treatment remained relatively frequent. Stratified analysis and logistic models evaluated potential confounding factors for assessment of treatment effects on hepatic fibrosis. S. japonicum infection and moderate-heavy alcohol intake interacted: improvement in parenchymal morbidity was impeded among drinkers (P < 0.05). Chemotherapy focused on at-risk residents controls prevalent subclinical hepatic fibrosis but re-infection indicates the need for complementary control strategies.