西昌邛海周边地区超声检测日本血吸虫所致肝纤维化结果分析

目的 了解日本血吸虫对西昌邛海周边地区人群肝脏损害的情况。方法 随机选择该地区4个乡20个村民小组5－60岁村民1060例进行腹部超声检查。结果 经超声检查肝纤维化异常率为26．89％，日本血吸虫感染率与肝纤维化异常率存在正相关（P＜0．002），虫卵负荷量与肝脏的损害有直接的关系（P＜0．001）；不同性别感染血吸虫者Ⅱ级以上肝损害与未感染者差异有显著性（P＜0．025）；肝纤维化随年龄增长明显呈上升趋势；有血吸虫病诊断依据者肝纤维化异常率明显高于无依据者（P＜0．005）；未接受治疗的患者肝纤维化异常率与接受治疗者差异有显著性（P＜0．025）。结论 人群肝纤维化与血吸虫病流行地区的感染率、感染率、接触疫水及治疗等因素有关，超声检测能直接评价人群血吸虫病病情。     

安徽省枞阳县凤仪村居民血吸虫病状况调查

目的了解凤仪村居民血吸虫感染及血吸虫病对居民肝、脾损害情况。方法对5～65岁居民进行查病，确定感染情况，同时对受检者用B超进行肝、脾检查。结果人群血吸虫感染率4．81％，各年龄组均有患者，男、女人群肝、脾肿大率差异无统计学意义（P〉0．05），肝纤维化异常率男性高于女性（P〈0．01），随着年龄的增长肝纤维化异常率增高，有病史人群与无病史人群、粪检阳性人群与粪检阴性人群肝、脾肿大率差异有统计学意义（P〈0．01）。结论凤仪村人群血吸虫病病情仍较严重，肝、脾损害明显，同时提示超声检测能评价人群血吸虫病病情。     

日本血吸虫实验感染的病理学

人体日本血吸虫感染的病理学不如曼氏血吸虫感染的那么明确。对日本血吸虫病的描述常假借曼氏血吸虫病的研究结果。急性毒血症性日本血吸虫病(片山热)在流行区出生的人中很少见,但常见于外来人口首次感染者。慢性重度感染的主要损害为肝脏的门脉周围纤维化伴脾肿大与门脉高压。在一些肝纤维化病例可见肺动脉炎与肺原性心脏病。如同曼氏血吸虫感染,在流行地区的人群中大多为无明显病理变化的轻型患者。     

乙肝病毒感染对血吸虫病肝纤维化影响的超声图分析

我国南方血吸虫病流行严重，同时又是乙肝病毒的高感染区。血吸虫和乙肝病毒均可引起肝脏不同程度的损害，血吸虫和乙肝病毒感染关系的调查较多，但结果不一，有报道乙肝病毒感染是加速慢性血吸虫病发展成肝癌的重要原因之一［‘］。有关乙肝病毒感染对血吸虫病肝纤维化，特别是肝超声日改变的报道甚少。为此，我们对四川一血吸虫病重流行区的一千余人进行了血吸虫、乙肝两对半和肝脏B超等三项检查，并分析了乙肝病毒感染对血吸虫病肝纤维化的影响。1对欧和方法1．且对我选自眉山县正山口乡白塔、与管两个村6－60岁村民。1．2血吸由田诊所…     

血吸虫病的异位损害及异位血吸虫病

血吸虫病是由于血吸虫(日本血吸虫)感染人体所致的一种严重的感染性疾病。人体皮肤接触含尾蚴的疫水而感染。血吸虫主要寄生在门静脉系统而引起相应病理损害，主要为虫卵沉积于肝脏和结肠引起虫卵肉芽肿及继发肝肠纤维化。临床主要有急性、慢性及晚期血吸病。血吸虫虫卵肉芽肿也可引起肝、肠以外的器官或组织损害，统称为异位损害或异位血吸虫病。常见的异位血吸虫病有肺血吸虫病、脑血吸虫病及胃血吸虫病等。     

日本血吸虫病肝纤维化的危险因素探讨

[目的 ]探讨日本血吸虫病患者肝纤维化的影响因素。 [方法 ]日本血吸虫病 2级和 3级肝纤维化患者 81例 ,1级肝纤维化患者 6 1例和无肝纤维化的血吸虫感染者 5 0例 ,就可能影响肝脏损伤的因素进行研究 ,对所有因素用有序回归模型分析。 [结果 ]可能与日本血吸虫病肝纤维化有关的危险因素有 :血吸虫病治疗次数(OR =1 75 ) ,血吸虫感染间期 (OR =1 40 ) ) ,经常饮酒 (每天多于 1次 ,5年以上 ) (OR =1 95 )和晚期血吸虫病 (巨脾型和腹水型 )家族史 (OR =2 11)。 [结论 ]血吸虫反复感染、感染间期越长、经常饮酒和有晚期血吸虫病家族史的血吸虫病患者肝组织发生纤维化的危险性也越大。     

重组日本血吸虫副肌球蛋白诱导水牛保护性免疫的研究

为观察重组日本血吸虫副肌球蛋白(rSj97)对水牛的保护效果。20头水牛随机分为佐剂(QuilA)对照组和抗原(rSj97)免疫组。对照组仅注射QuilA,而免疫组注射QuilA加rSj97,在第0、2、15周肌肉注射。第3次免疫后两周经腹部贴片攻击感染1000条日本血吸虫尾蚴,感染后第49d剖杀冲虫,计数虫数和肝卵数。结果显示,与对照组相比,rSj97免疫组的减虫率为49.9%(P<0.05),肝脏减卵率57.3%(P<0.01)。提示rSj97可诱导水牛产生一定程度的抗血吸虫攻击感染的保护性免疫力,并具有一定程度的抗病作用,进一步证实了副肌球蛋白可作为抗血吸虫病的候选疫苗分子。     

日本血吸虫病重疫区人群B超流行病学调查

按照世界卫生组织1990年开罗会议制定的”超声诊断在血吸虫病应用中的试行标准化方法”，在日本血吸虫所致肝脏病理损害超声图上可显示明确特征性的基础上，作者于1992年在血吸虫病重疫区的两个自然村，整群抽样1004例村民进行腹部B超检查。结果显示肝实质有不同程度改变者639人（63．6％），其中肝实质改变为I级者454人（45．2％）、Ⅱ级131人（13．0％）、Ⅲ级54人（5．4％）。肝实质超声图显示异常者中粪检、免疫学检查、直检阳性者与各项检测阴性者进行比较，两组超声异常率分别为74．1％及9．8％（P＜0．01），而非流行村200例配对对照组未发现1例超声异常。另通过对成人和儿童肝、脾、门静脉内径的超声测量结果表明，判断异常的标准值尚有待进一步探讨。本研究再次证实了B超在现场应用中，对人群血吸虫病患病率的评估和防治效果的判断具有实用价值，可作为该病流行病学调查的一种较好的方法。     

消退素RvE1对日本血吸虫病肝纤维化小鼠外周血肝纤维化指标和细胞因子的影响

目的：通过检测模型小鼠外周血肝纤维化有关指标和细胞因子水平研究消退素RvE1对小鼠日本血吸虫病肝纤维化的影响及其机制,从而探讨合理的防治策略。方法：用日本血吸虫尾蚴皮肤敷贴法感染小鼠,构建日本血吸虫病肝纤维化模型。感染5wk后,将造模组小鼠随机分为2组：模型对照组(血吸虫感染+NS.)、治疗组（血吸虫感染+RvE1）,以正常小鼠为正常对照组。感染10wk后取血标本,采用放射免疫法检测血清肝纤维化指标,包括Ⅳ型胶原（Ⅳ-C）、Ⅲ型前胶原（PCⅢ）、透明质酸（HA）及层粘连蛋白（LN）;采用ELISA 法测定RvE1对日本血吸虫病肝纤维化小鼠血清中TNF-α和IFN-γ水平的影响。结果：感染10wk后,各组小鼠未见自然死亡,各组小鼠体重无明显变化,统计学分析无差异;感染10wk后,RvE1治疗组小鼠血清肝纤维化各项指标,包括Ⅳ型胶原、Ⅲ型前胶原、透明质酸及层粘连蛋白水平,与模型对照组比较均有明显降低,有显著性差异（P<0.05）;感染10wk后,RvE1治疗组小鼠血清中促炎介质TNF-α水平较模型对照组有明显降低,有显著性差异（P<0.05）,而血清中抑炎介质IFN-γ水平较模型对照组有明显升高,有显著性差异（P<0.05）。结论：我们认为给予外源性RvE1可以通过抗炎及促进肝脏炎症消退,发挥抗日本血吸虫病肝纤维化的作用。     

晚期血吸虫病合并HBV感染患者临床表现与肝脏病理关系的探讨

本文对88例肝内乙肝抗原阳性的晚期血吸虫病手术患者进行肝脏病理和临床分析,发现晚期血吸虫病合并HBV感染患者有四种肝脏病理类型:单纯血吸虫病性肝纤维化(13.6％);肝纤维化合并慢性肝炎(18.2％);肝纤维化合并静止性肝硬化(29.6％)和肝纤维化合并活动性肝硬化(38.6％).88例患者中,43例(48.9％)无肝功能损害的临床指征,患者的临床表现可以与肝脏病理变化程度不一致.     

Serological evaluation of ultrasound examination for chronic schistosomiasis japonica in a previously endemic area--the Chikugo River Basin, Japan

Ultrasound diagnosis of chronic schistosomiasis japonica was assessed by comparison with the results of serological tests using enzyme-linked immunosorbent assay (ELISA) with egg and adult worm antigen, and the circumoval precipitation test. The subjects were persons resident in the Chikugo River Basin in Kyushu, southwest Japan, where schistosomiasis used to be highly prevalent. Of 93 individuals with a past history of infection, 37 (39.8%) presented the characteristic echo pattern of the disease (network, sieve, mottled or mixed pattern). In the serological tests, the ultrasound (US)-positive subjects showed a significantly higher IgG antibody-positive rate in ELISA (81.1% for egg-ELISA), than the US-negative subjects (37.5% for egg-ELISA). Individuals bearing dead Schistosoma japonicum eggs proven by tissue biopsy showed a similar antibody-positive rate (76.5% for egg-ELISA) to that of the US-positive subjects. Sera of a group which had no schistosomiasis characteristic echo pattern, but had liver fibrosis, hepatomegaly or liver cirrhosis as shown by US, were also highly positive (71.4% for egg-ELISA). The present serological studies thus confirmed the usefulness of ultrasound diagnosis for chronic schistosomiasis japonica. Furthermore, we were able to determine certain indications of liver abnormality currently undefined in the normally utilized US classifications.     

Liver ultrasound findings in a low prevalence area of S. japonicum in China: comparison with history, physical examination, parasitological and serological results.

The paper describes a study carried out in a community in Dongdian township, Anhui Province, People's Republic of China. Medical history and the results of a physical examination, ultrasound investigation, parasitological and serological tests for Schistosoma japonicum infection were compared in 661 persons of 169 households. A lack of correlation between parasitological and serological indicators of infection and morbidity was observed in this area of low (6.4%) prevalence and intensity of infection. The prevalence of abnormal ultrasound findings in the liver in this population was high (56%), and was significantly higher than the prevalence of S. japonicum infection. The abnormal ultrasound findings correlated with a history of schistosomiasis, and the correlation increased significantly according to the number of times treated and the time since the last treatment, which suggested that past parenteral treatment has a role in the high rate of abnormal liver ultrasound findings. The significant correlation between the qualitative and quantitative serological results and abnormal ultrasound parenchymal patterns suggests that cross-reactivity between the etiology of the parenchymal disease and these tests is occurring. The presence of HBsAg correlated with the composite presence of ultrasound abnormalities of the liver parenchyma: increased echogenicity, periportal fibrosis and/or nodules and irregular fibrosis, whereas a normal ultrasound pattern was associated with the absence of HBV antigenemia.     

晚期血吸虫病脾被膜厚度与脾小梁宽度的变化

目的 探讨脾被膜厚度与脾小梁宽度在晚期血吸虫病肝、脾纤维化患者中的变化及其意义。方法 39例晚期血吸虫病患者的肝活检标本和脾切除标本行常规病理检查，进行肝、脾纤维化程度分期，光镜下测脾被膜厚度与脾小梁宽度，以5例正常肝、脾标本作对照。结果 晚期血吸虫病患者脾被膜厚度与脾小梁宽度明显高于对照组(P＜0．05，P＜0．01)，并随肝纤维化程度的升高有一定程度的增厚增宽，脾被膜厚度和脾小梁宽度都与肝纤维化程度有一定的相关性，r分别为0．58和0．73(P均＜0．01)。与脾纤维化程度也有一定的相关性，r分别为0．59和0．41(P均＜0．01)。结论 脾被膜厚度与脾小梁宽度都可作为评价晚期血吸虫病肝、脾纤维化程度的指标。     

晚期日本血吸虫病患者肝组织基质金属蛋白酶2和9的表达

目的研究基质金属蛋白酶2(MMP-2)、基质金属蛋白酶9(MMP-9)在晚期日本血吸虫病患者肝组织中的表达及意义。方法26例晚期日本血吸虫病患者肝活检标本和5例正常人肝标本行常规病理检查,用MMP-2、MMP-9和Ⅳ型胶原(G-Ⅳ)单克隆抗体进行免疫组织化学染色进行定量和定位研究。结果MMP-2主要表达在肝细胞浆、肝细胞膜和肝窦,肌成纤维细胞和血管内皮细胞也有表达。MMP-9主要表达在肝星状细胞、肝窦和肌成纤维细胞,偶见肝细胞浆和胆管上皮细胞表达。晚期日本血吸虫病患者肝组织MMP-2、MMP-9和G-Ⅳ的表达明显高于正常人(P<0.05),随着汇管区炎症活动度和肝纤维化程度的升高,MMP-2的表达也明显增强(P<0.01),MMP-9的表达无明显改变(P>0.05),C-Ⅳ表达与MMP-2呈同步关系。结论MMP-2与日本血吸虫病肝纤维化的发生、发展有关,MMP-9表达与日本血吸虫病肝纤维化的发生有关。     

西昌邛海周边地区地理环境与血吸虫病流行的关系

目的本文通过调查四川省西昌市邛海湖盆地区4个乡196个村民组中的20个组的居民血吸虫病的感染情况,了解当地地理环境、生产条件对血吸虫病流行的影响. 方法用Kato -Katz法进行粪检,得出感染率;对20个组进行地理环境分类、种植作物分类及生产条件和外围环境因素的调查. 结果该地区的地势是由平地、阶地向梯地过渡,相对应的居民血吸虫病感染率也随梯(阶)地面积比例的增大而增高,两者呈正相关(rs=0.739, P< 0.001).环境复杂的汇水区及环山堰的多少也与感染率呈正相关(rs=0.793, P <0.001及rs=0.758, P<0.001).水稻种植比例的大小与血吸虫病感染率呈负相关(rs=-0.726 ,P<0.001),而经济作物如蔬菜、烤烟等的种植比例大小与血吸虫病感染率呈正相关 (rs =0.781,P<0.001).结论平坝种植水稻区已不再是严重的血吸虫病流行区,而环境复杂的梯阶地区、汇水区血吸虫病流行严重.     

Diagnostic value of connective tissue metabolites in Schistosoma mansoni related liver disease.

Reliable non-invasive markers of hepatosplenic involvement in schistosomiasis are needed for determination of morbidity levels in endemic populations and for diagnosis and follow-up of affected individuals. Serum levels of connective tissue metabolites have been investigated as fibrosis markers in various hepatic disorders, but their accuracy in the detection of hepatosplenic schistosomiasis under endemic conditions has not been fully elucidated. 206 adult inhabitants of a Tanzanian village highly endemic for schistosomiasis mansoni (prevalence 88%) underwent clinical, parasitological and sonographic work-up; sera were tested for aminoterminal procollagen III-peptide (PIIIP), carboxyterminal procollagen IV peptide (NC1) and laminin. Connective tissue marker levels did not correlate with the presence or intensity of infection. NC1 levels were significantly correlated with periportal liver fibrosis (P < 0.001), splenomegaly (P < 0.002), portal vein dilatation (P < 0.004) and the presence of portosystemic collaterals (P < 0.001); for PIIIP and laminin, none of the respective relationships was significant. Due to wide overlap of NC1 levels between individuals with normal sonography findings and those with advanced periportal fibrosis and portal hypertension, the sensitivity and positive predictive value of this markers to detect these individuals were low (< 40%), although specificity and overall accuracy in the given setting were good (80-90%). It is concluded that PIIIP and laminin are not useful as diagnostic serum markers of hepatosplenic schistosomiasis at the community level; NC1 was significantly related to various indices of hepatosplenic involvement, but its low sensitivity precludes its use as a screening tool under endemic conditions.     

Validation of ultrasonography for hepatic schistosomiasis using a porcine Schistosoma japonicum model

Ultrasonography is increasingly used to record hepatosplenic involvement in schistosomiasis. However, questions remain unsolved regarding diagnostic accuracy in mild hepatic disease and under influence of confounders like co-infections. We report on a study to evaluate the suitability of a pig model of schistosomiasis japonica to investigate such problems. Nine pigs (12 weeks of age) were infected with 1000 Schistosoma japonicum cercariae. Together with 10 uninfected controls, they underwent B-mode and Doppler ultrasonography 12 weeks after infection, followed by parasitological and gross pathological examination and quantification of hepatic collagen. At this time, all infected pigs had patent infection, hepatic displacement of ova and various grades of portal and septal liver fibrosis. Sonographically, echogenic portal thickening (ePT), increased hepatic echogenicity (EG), increased hepatic dimensions and dilatation of the portal vein were found to correlate with other parameters of morbidity. Algorithms from human medicine were appropriate to grade ePT in the pig model. It is concluded that the porcine model of schistosomiasis japonica can be instrumental in approaching problems which for any reasons cannot be studied in human beings.     

Effects of pentoxifylline on the hepatic content of TGF-β1 and collagen in Schistosomiasis japonica mice with liver fibrosis

To study the effects of pentoxif-ylline (PTX) on the content of hepatic TGF-β, type Ⅰand type Ⅲ collagen in schistosomiasis japonica mice with liver fibrosis and its mechanism of anti-fibrosis.     

血吸虫病流行区居民腹部超声显像指标典型相关及冗余度分析

目的　探讨日本血吸虫病肝、脾B超指标间以及与感染次数、感染时间和每克粪便平均虫卵数 (EPG )的相关性。　方法　采用典型相关方法分析肝、脾B超指标间及其与感染次数、感染时间和EPG的相关性 ,用冗余度分析方法分析肝、脾变异中有多少比例互为相关。　结果　男、女无既往感染组和既往感染组的第 1典型相关系数分别为0.7842、0.5483和 0.5800、0. 4220 (P值均 <0.01) ;男、女粪检阴性组和阳性组的第 1典型相关系数分别为 0.6063、0.5215和 0.6595、0.3849(P值均 <0. 01) ;男、女无既往感染组肝B超指标变异分别有 43.5 %和 17.5 %与脾B超指标变异有关 ,而既往感染组分别为 22.1%和 11.4%。而在男、女粪检阴性组分别为 26.8%和 16.8% ,粪检阳性组分别为 2 7.6%和 10.7% ;既往感染组 ,感染次数、调查时距首次感染时间和粪检阳性者的EPG与肝、脾B超指标的典型变量均无相关性 (P >0.05 )。　结论　日本血吸虫病肝、脾B超指标间具有典型相关关系 ,且男性的相关性大于女性 ;在既往感染者中感染次数、调查时距首次感染时间和粪检阳性者EPG与肝、脾B超指标的典型变量间均未发现相关性。     

晚期血吸虫病患者肝脾Ⅰ、Ⅲ型胶原含量的变化

目的　研究晚期血吸虫病(晚血)患者肝、脾组织Ⅰ型胶原(CⅠ)和Ⅲ型胶原(CⅢ)的含量变化。　方法　对55例晚血患者肝活检标本和脾切除标本进行常规病理检查,肝、脾纤维化程度分期,经天狼猩红染色后,于偏光显微镜观察CⅠ、CⅢ分布情况。用图像分析仪计算CⅠ、CⅢ含量。5例正常肝、脾标本作对照。　结果　患者肝组织CⅠ、CⅢ含量明显增加(P<0.01),肝窦中也明显增加(P<0.01),CⅠ/CⅢ比值明显降低(P<0.01)。随着肝纤维化程度的升高,肝窦CⅠ、CⅢ含量呈下降趋势,CⅠ/CⅢ比值则呈上升趋势。脾索CⅠ、CⅢ含量明显增加,CⅠ/CⅢ比值降低(P值均<0.01)。随着脾纤维化程度的升高,CⅠ、CⅢ含量呈上升趋势,CⅠ/CⅢ比值则呈下降趋势。　结论　晚血患者肝、脾组织CⅠ、CⅢ含量增加,以CⅢ增幅较大