The impact of Schistosoma japonicum infection and treatment on ultrasound-detectable morbidity: a five-year cohort study in Southwest China.
The impact of Schistosoma japonicum infection and treatment on ultrasound-detectable morbidity: a five-year cohort study in Southwest China.
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DOI：
10.1371/journal.pntd.0000685
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发表时间：
2010-05-18
影响因子：
3.8
通讯作者：
Spear RC
中科院分区：
文献类型：
--
作者：
Carlton EJ;Hsiang M;Zhang Y;Johnson S;Hubbard A;Spear RC
超声检查允许非侵入性检查肝脏和脾脏，可以进一步了解血吸虫病的发病率。我们在中国西南部对578人进行了长达五年的跟踪调查。对参与者进行粪便日本血吸虫感染检测，并使用超声获得肝脏和脾脏的7个标准测量值，以评估血吸虫感染与超声可检测病理之间的关系，以及靶向治疗对发病率的影响。肝实质纤维化是S.日本血吸虫感染与超声检查时的感染（OR 1.40，95% CI：1.03-1.90）和感染强度（趋势检验，p = 0.002）相关，校正了年龄、性别和年份，与既往感染状态和强度相关性更强（校正OR 1.84，95% CI：1.30-2.60;趋势检验：p<0.001），尽管及时治疗了感染。 虽然随着时间的推移，实质纤维化的下降具有统计学显著性，但只有28%的严重实质纤维化（2级或3级）患者在入组时在5年内逆转为正常或1级。其他肝脏异常与S.日本血吸虫感染实质纤维化是S.日本血吸虫病的发病率，并可以证明减少疾病的控制努力。在感染水平相似的地区，其他超声测量方法的流行病学价值可能有限。由于严重的纤维化在治疗后可能不会迅速逆转，因此减少S。应结合治疗，预防血吸虫病发病。血吸虫病是一种水传播的寄生虫，感染了全世界约2亿人。日本血吸虫在亚洲发现，通过在肝脏中释放卵而致病，导致纤维化、贫血，在儿童中，还导致发育障碍。超声可以评估血吸虫病的肝脏病理;然而，需要更多的信息来评估标准超声测量的相关性。我们对578人进行了长达5年的随访，检测血吸虫病感染并进行超声检查，以评估感染与7种超声指标之间的关系，并评估抗血吸虫病化疗（吡喹酮）对发病率的影响。所有感染均得到及时治疗。肝实质纤维化，病理为S。日本血吸虫病，与血吸虫感染，并在高蠕虫负担的人是最先进的。治疗后肝纤维化显著下降，但严重肝纤维化逆转罕见。其他超声指标与血吸虫病感染或治疗并不一致。这些发现提示肝实质纤维化可用于衡量S.并评估疾病控制工作的影响。由于严重纤维化的逆转是有限的，疾病控制工作将是最有效的，如果他们不仅可以治疗现有的感染，而且还可以防止新的感染。
Ultrasonography allows for non-invasive examination of the liver and spleen and can further our understanding of schistosomiasis morbidity. We followed 578 people in Southwest China for up to five years. Participants were tested for Schistosoma japonicum infection in stool and seven standard measures of the liver and spleen were obtained using ultrasound to evaluate the relationship between schistosomiasis infection and ultrasound-detectable pathology, and the impact of targeted treatment on morbidity. Parenchymal fibrosis, a network pattern of the liver unique to S. japonicum, was associated with infection at the time of ultrasound (OR 1.40, 95% CI: 1.03–1.90) and infection intensity (test for trend, p = 0.002), adjusting for age, sex and year, and more strongly associated with prior infection status and intensity (adjusted OR 1.84, 95% CI: 1.30–2.60; test for trend: p<0.001 respectively), despite prompt treatment of infections. While declines in parenchymal fibrosis over time were statistically significant, only 28% of individuals with severe parenchymal fibrosis (grades 2 or 3) at enrollment reversed to normal or grade 1 within five years. Other liver abnormalities were less consistently associated with S. japonicum infection. Parenchymal fibrosis is an appropriate measure of S. japonicum morbidity and can document reductions in disease following control efforts. Other ultrasound measures may have limited epidemiological value in regions with similar infection levels. Because severe fibrosis may not reverse quickly following treatment, efforts to reduce exposure to S. japonicum should be considered in combination with treatment to prevent schistosomiasis morbidity. Schistosomiasis is a water-borne parasite that infects approximately 200 million people worldwide. Schistosoma japonicum, found in Asia, causes disease by releasing eggs in the liver, leading to fibrosis, anemia, and, in children, impaired growth. Ultrasound can assess liver pathology from schistosomiasis; however more information is needed to evaluate the relevance of standard ultrasound measures. We followed 578 people for up to five years, testing for schistosomiasis infection and conducting ultrasound examinations to assess the relationship between infection and seven ultrasound measures and to evaluate the impact of treatment with anti-schistosomiasis chemotherapy (praziquantel) on morbidity. All infections were promptly treated. Fibrosis of the liver parenchyma, pathology unique to S. japonicum, was associated with schistosomiasis infection, and was most advanced in people with high worm burdens. Liver fibrosis declined significantly following treatment, but reversal of severe liver fibrosis was rare. Other ultrasound measures were not consistently related to schistosomiasis infection or treatment. These findings suggest parenchymal fibrosis can be used to measure morbidity attributable to S. japonicum and evaluate the impact of disease control efforts. Because reversal of severe fibrosis was limited, disease control efforts will be most effective if they can not only treat existing infections but also prevent new infections.
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DOI：
10.1016/s0035-9203(03)90112-x
发表时间：
2003-03-01
影响因子：
2.2
作者：
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通讯作者：
McManus, DP
DOI：
10.4269/ajtmh.1989.41.63
发表时间：
1989-07-01
影响因子：
3.3
作者：
DOEHRINGSCHWERDTFEGER, E;MOHAMEDALI, G;EHRICH, JHH
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EHRICH, JHH
影响因子：
2.7
作者：
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DOI：
10.1016/s0035-9203(00)90274-8
发表时间：
2000-03-01
影响因子：
2.2
作者：
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McManus, DP
影响因子：
3.1
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