传播阻断地区新发展晚期血吸虫病病人情况调查

Survey on newly-developed advanced schistosomiasis patients in schistosomiasis transmission-interrupted areas

目的了解传播阻断地区新发展晚期血吸虫病(晚血)病人的情况。方法根据调查标准,2008-2011年间新确诊的晚血病人经县、省2级确认后,详细了解病人的流行病学史及现病史,并进行相关的医学检查。结果 75例病人中,男性22例,女性53例,平均年龄为(70.0±7.0)岁,均曾感染过血吸虫,并经平均1.85次抗虫治疗,1976-1985年间连续进行了平均26.24次粪检,结果均为阴性;患者居住地末次发现钉螺的时间多数在1976年,最晚的在1983年;期间多次检查未达到晚血诊断标准的患者在2008-2011年间确诊为晚血病人。本次调查显示,病人的肝脏均呈纤维化改变,达Ⅲ级改变者占82.7%,脾脏肿大者占90.7%,有腹水者占20.0%,门静脉增宽者占22.7%;肝功能酶指标ALT、AST和γGT均值分别为31.81、53.19 U/L和89.28 U/L,阳性率分别为21.3%、49.3%及57.3%;纤维化指标中HA、LN、CⅥ及PⅢP异常的阳性率分别为73.3%、13.3%、17.3%及9.3%,HA均值是正常高值的3倍。结论血吸虫病传播阻断地区存在着历史感染病人经抗虫治疗后,虽无再次感染可能,但病情持续进展,最终成为晚血病人的现象,但新病人的产生与现阶段的疫情无关;新发展晚血病人目前存在着较为严重的肝功能损伤及活跃的纤维增生,抗纤维化治疗是必要的。

Objective To understand the status of newly-developed advanced schistosomiasis patients in schistosome trans- mission-interrupted areas. Methods The newly diagnosed advanced schistosomiasis patients confirmed by professionals at prov- ince and county levels according to the available standards were investigated. Their detailed epidemiology history and present signs/ symptoms were surveyed, and the relevant medical examinations were performed. Results There were 75 patients including 22 males and 53 females. The average age was （70.0＋7.0） years and they were all infected with schistosome previously. They received anti-schistosome therapy （mean 1.85 times） and stool examinations （mean 26.24 times） continuously from 1976 to 1985, and the results of stool examination were all negative. In majority of the patients＇ resident areas, the last time that Oncomelania hupensis snails were found was 1976, and the latest was 1983. During this period, no patients were up to the diagnostic criteria of advanced schistosomiasis after multiple examinations, and they were diagnosed as advanced cases between 2008 and 2011. The survey indi- cated that liver fibrosis was found in all the patients with 82.7% showing grad HI pathological change, 90.7% of them had spleno- megaly, 20.0% had ascites, and 22.7% had portal vein broadening. The mean value of enzyme indexes of liver function was 31.81 U/L （ALT）, 53.19 U/L （AST） and 89.28 U/L （＂/-GT）, and the positive rate was 21.3%, 49.3% and 57.3%, respectively. As for the fibrosis indexes, the positive rate of HA, LN, C WI and P m P was 73.3%, 13.3%, 17.3% and 9.3%, respectively, and the mean value of HA was 3 times higher than that of the upper limit of normal standard. Conclusions Newly-developed advanced schistosomiasis patients are those who were dignosed and cured parasitologically but progressed pathologically without any chance of re-infection. Anti-fibrosis therapy is necessary as the patients show considerable progressive liver fibrosis.