日本血吸虫病肝纤维化的临床特点  

Clinical characteristics of schistosomiasis japonica liver fibrosis and its prophylaxis and treatment countermeasures

作　　者：乌文琳[1] 黄育英[1] 陈家林[1] 徐晓菲[1] 邵平阳[1] 丁韧烨[1] 杨易平[1] 

机构地区：[1]浙江省嘉兴市第一医院,嘉兴314000

出　　处：《中国血吸虫病防治杂志》2006年第6期422-426,共5页Chinese Journal of Schistosomiasis Control

基　　金：浙江省嘉兴市科技计划重点项目(20021056)

摘　　要：目的通过检测有关细胞因子及病理学对肝组织标本从细胞、分子水平、组织超微结构等研究日本血吸虫病肝纤维化的发生、发展特点,并探讨合理的防治对策。方法晚期血吸虫病(晚血)包括切脾后、未达晚血标准的脾肿大者及晚血夹杂肝炎者分为A、B、C3组,除进行肝纤维化指标、生化检测和超声显像检测外,另对部分患者作淋巴细胞亚群、细胞膜CD35表达免疫学检测。部分患者作肝组织病理学的免疫组化检查。结果1212例中有94.06%的患者曾接受不同药物的病原治疗。血吸虫间接血凝试验、酶联免疫吸附试验1项或2项均为阳性者3组差异有显著性。肝纤维化4项指标测定中,层黏蛋白、透明质酸3组差异亦有显著性。超声显像肝实质分级3组差异亦有显著性。肝纤维化病理特征研究中,炎症与纤维化呈正相关。晚血肝纤维化时C-I、C-型胶原在肝汇管区、中央静脉、肝窦等部位含量均明显增加,肝窦本身出现扩张与狭窄两种病理改变。结论血吸虫病的病理不仅属窦前性改变,肝窦本身病变在肝纤维化的发生中起着重要作用。彻底杀虫治疗或切脾后,肝纤维化仍可继续发展,今后尚需加强随访与防治,减少晚血的发生与发展。Objective To explore the occurrence and development of schistosomiasis japonica hepatic fibrosis, and the treatment countermeasure. Methods Three groups of patients,including advanced schistosomiasis （splenectomy involved）, non-advanced schistosomiasis splenomegaly and advanced schistosomiasis with hepatitis, were followed up. Biochemical tests including hepatic fibrosis indexes, liver ultrasonography,lymphocyte subcluster, and membrane CD35 were examined. Immunohistochemical tests of liver cells were performed in some patients. Results A total of 94.06% of 1 212 patients took various anti-schistosome treatments. The difference was significant for positive antigen and antibody to schistosome, LN and HA ,and the ultrasonic indexes of liver fibrosis among the three groups. The degree of liver substance pathohistological examinations showed inflammation had a positive correlation with hepatic fibrosis. The contents of C- Ⅰ , C- Ⅱ in portal regions, central vein and hepatic sinusoid were increased in advanced schistosomiasis hepatic fibrosis. In hepatic fibrosis, hepatic sinusoid showed two pathological changes of dilation and stricture. Conclusions In schistosomiasis japonica, hepatic sinusoid changes playa great role in hepatic fibrosis. Hepatic fibrosis would still develop even after the thorough anti schistosome therapy. So, anti-fibrosis therapy is necessary.

关 键 词：日本血吸虫病 肝纤维化 临床特点 

分 类 号：R532.21[医药卫生—内科学]