Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection
Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection
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DOI：
10.4269/ajtmh.2000.63.133
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发表时间：
2000-09-01
影响因子：
3.3
通讯作者：
King, CH
中科院分区：
文献类型：
--
作者：
Hodder, SL;Mahmoud, AAF;King, CH
虽然有强有力的流行病学证据表明埃及血吸虫感染与膀胱癌有关，但细胞学筛查对尿路癌的实用性尚未在S.血吸虫地方性种群。目前的横断面研究检查了1,014名居民（年龄1至91岁）的尿细胞学结果。肯尼亚海岸省的姆桑布韦尼地区。在705个可评估的细胞学标本中，炎症（39%）、角化过度（30%）、化生（33%）和明显的肥大（0.4%）的患病率明显高于先前研究的非流行性人群。总体而言，S.埃及血吸虫感染与细胞学异常的风险增加密切相关（化生或角化过度的相对风险> 2.8倍; P < 0.001）。组间分析证实化生和S。在生命早期（男孩和女孩从1岁到15岁）感染嗜血杆菌。然而，在20岁以上，尽管感染率和感染强度下降，化生的患病率仍保持在33-45%。晚期（中度或重度）化生的患病率显示出两个与年龄相关的高峰：第一个在10-14岁（感染高峰期），第二个在大于或等于60岁的受试者中。在研究人群中，无论是细胞学检查还是随访超声检查均未检测到癌症。这些数据表明，年龄依赖性进展的细胞异常的泌尿上皮细胞，这是与慢性S。随着受试者年龄的增长，其变得与并发感染强度无关。癌症筛查的影响进行了讨论。
Although there is strong epidemiologic evidence linking Schistosoma haematobium infection with carcinoma of the bladder, the utility of cytologic screening for urinary tract cancer has not been critically evaluated in S. haematobium-endemic populations. The present cross-sectional study examined urine cytology findings among 1,014 residents (ages 1 to 91) of the S. haematobium-endemic Msambweni area of Coast Province, Kenya. Among 705 evaluable cytology specimens, prevalence of inflammation (39%), hyperkeratosis (30%), metaplasia (33%), and frank atypia (0.4%) was notably higher than in previously studied, non-endemic populations. Overall, S. haematobium infection was strongly associated with increased risk for cytologic abnormality (> 2.8-fold relative risk of metaplasia or hyperkeratosis; P < 0.001). Age-group analysis confirmed parallel increases in metaplasia and S. haematobium infection prevalence early in life (from age 1 to 15 for both boys and girls). However, above age 20, metaplasia prevalence persisted at 33-45% prevalence despite a decline in infection prevalence and intensity. Prevalence of advanced (moderate or severe) metaplasia showed two age-related peaks: the first at 10-14 years of age (at the time of peak infection), and the second among subjects greater than or equal to 60 years old. No cancers were detected in the study population either on cytology or on follow-up ultrasound examination. These data suggest an age-dependent progression of cellular abnormalities in the urinary epithelium that is associated with chronic S. haematobium infection, which becomes independent of concurrent infection intensity as subjects grow older. Implications for cancer screening are discussed.