江苏省血吸虫病传播阻断地区新发展晚期血吸虫病调查

A survey on newly-developed advanced schistosomiasis patients in schistosomiasis transmission-interrupted areas of Jiangsu province

目的了解江苏省血吸虫病传播阻断地区新发展晚期血吸虫病病人分布特征,肝功能损伤和肝纤维化情况。方法2014-2015年,在江苏省2000年之前达到血吸虫病传播阻断标准的地区中,以2008年后新登记在册的晚血患者作为调查对象。采集调查对象血液样本,检测其肝功能及肝纤维化相关指标。此外,通过问卷调查收集调查对象人口社会学特征及首次确诊晚血时间。结果共调查江苏省新发展晚血患者共492例,其中男性237例,女性255例,平均年龄为(70.27±8.23)岁;病例主要分布在苏南地区(179例);各年确诊病例数以2013年最多(193例),2015年最少(9例)。291例(61.78%)病例至少有1项肝功能指标异常,苏南、苏中、苏北地区γ-谷氨酰转肽酶(GGT)异常率均较高,其中苏南地区最高(48.17%)。376例(78.83%)病例中至少有1项肝纤维化指标异常,苏南、苏中、苏北地区透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽(PⅢP)异常率差异均有统计学意义(χ^(2)=65.682、28.816、36.862、16.151,P均<0.05);苏南地区PⅢP、CⅣ异常率均最高,苏北地区HA、LN异常率最高。苏州地区153例新发展晚血病例中,免疫球蛋白(Ig)G异常率最高,IgA次之,IgM异常率最低。相关性分析显示,HA与IgG,LN、CⅣ与IgA、IgG,PⅢP与IgA均存在正相关关系(P均<0.05)。结论江苏省新发展晚血患者慢性肝功能损伤和肝纤维化较普遍,其病情进展可能与体内免疫失衡相关,免疫球蛋白水平可在一定程度上反映病情进展。

Objective To understand the distribution characteristics and the status of liver function injury and liver fibrosis of newly-developed advanced schistosomiasis patients in schistosomiasis transmission-interrupted areas of Jiangsu province.Methods From 2014 to 2015,Among the areas that met the standards of transmission interruption before 2000 in Jiangsu province,the newly registered patients with advanced schistosomiasis after 2008 were selected.Blood samples were collected and liver function and fibrosis related indexes were detected.In addition,the demographic and sociological characteristics and the time of first diagnosis of advanced schistosomiasis were collected through questionnaire survey.Results There were 492 patients including 237 males and 255 females with average age of(70.27±8.23)years old.The cases were mainly distributed in South Jiangsu(179 cases).Maximum number of confirmed cases was in 2013(193 cases)and the least was in 2015(9 cases).291 patients(61.78%)had at least one abnormal liver function index and the abnormal rates ofγ-glutamyl transpeptidase(GGT)were the highest in South Jiangsu,Middle Jiangsu and North Jiangsu,especially in South Jiangsu(48.17%).376 cases(78.83%)had at least one abnormal hepatic fibrosis index.The difference of positive rates of hyaluronic acid(HA),laminin(LN),collagen type Ⅳ(CⅣ)and type Ⅲ porocollagen peptide(PⅢP)in south,middle and north Jiangsu were statistically significant(χ^(2)=65.682,28.816,36.862,16.151,all P<0.05).The abnormal rates of PⅢP and CⅣ were the highest in South Jiangsu,and the abnormal rate of HA,LN were the highest in North Jiangsu.Among the 153 cases in Suzhou,the abnormal rate of immunoglobulin(Ig)G was the highest,followed by IgA and IgM.Correlation analysis showed that HA was correlated with IgG;LN and CⅣwere correlated with IgA and IgG;PⅢP was correlated with IgA(all P<0.05).Conclusions Chronic liver function injury and liver fibrosis were common among newly-developed advanced schistosomiasis patients.The progression of the disease might be closely related to immune imbalance in the body and the level of immunoglobulin could reflect the progression of the disease to a certain extent.