关键词: 晚期血吸虫病, 新报告病例, 江西省, 流行病学, 临床特征

Abstract:

Objective To analyze the epidemiological and clinical characteristics of newly reported advanced schistosomiasis (AS) cases in Jiangxi Province from 2019 to 2022, so as to provide insights into optimization of the AS control strategy. Methods The epidemiological and clinical characteristics of newly reported AS patients in Jiangxi Province from 2019 to 2022 were collected by means of a retrospective review, medical record inquiry, and questionnaire surveys, including demographics, history of case diagnosis and treatment, comorbidities and complications, laboratory tests (routine blood tests, blood biochemical tests, coagulation functions, and hepatic fibrosis markers) and ultrasound examinations. All data were input into Microsoft Excel 2016, and all statistical analyses were performed with SPSS 25.0. The χ² test was used for comparisons between groups. Results A total of 518 newly reported AS cases were recorded in Jiangxi Province from 2019 to 2022, and 488 cases were included in this analysis. These AS cases were predominantly found in Shangrao City (45.2%, 234/518), Jiujiang City (31.1%, 161/518), Nanchang City (14.1%, 73/518) and Yichun City (9.6%, 50/518), and the majority of these cases were male (62.5%, 305/488). The subjects had a mean age of (66.61 ± 9.84) years, including 82.2% (401/488) at ages of 60 years and older, 88.5% (432/488) with an educational level of primary school and below, and 77.1% (376/488) with an occupation of farmer. Ascites subtype was the predominant clinical subtype (75.4%, 368/488), and 23.6% (115/488) of the subjects were comorbid with other diseases, with hypertension as the most common comorbidity (41 cases), followed by diabetes mellitus (14 cases). Of all cases, 13.1% (64/488) had complications, with upper gastrointestinal bleeding as the predominant complication (53 cases), and the proportions of etiological treatment and antifibrotic therapy were 91.4% (446/488) and 82.6% (403/488). Laboratory tests showed the highest incidence of abnormal platelet counts in blood cell analysis (59.1%, 117/198), and there was a significant difference in the incidence of abnormal platelet counts among subjects with different clinical subtypes of AS (χ² = 12.398, P < 0.05). Regarding liver function parameters, the highest incidence of abnormal albumin was detected (70.7%, 140/198), and regarding hepatic fibrosis markers, the highest incidence of abnormal procollagen typeⅢ (PCⅢ) was recorded (56.6%, 112/198), with a 58.9% (96/163) incidence of abnormal PCⅢ seen among ascites-subtype cases. Regarding coagulation function indicators, thrombin time prolongation was the most common coagulation disorder (52.5%, 104/198), and the proportion of abnormal activated partial thromboplastin time varied in clinical subtypes (χ² = 13.696, P < 0.05). Ultrasound examinations showed grade Ⅲ hepatic parenchymal fibrosis among 89.2% (415/465) of subjects, 69.9% (325/465) among subjects with ascites, and 62.2% (289/465) among subjects with the inner diameter of main portal vein of > 13 mm. Conclusion Elderly men are predominant among newly reported AS cases in Jiangxi Province, and ascites subtype is the predominant clinical subtype, with hypertension and diabetes mellitus as common comorbidities. Despite multiple etiological and antifibrotic treatments given among selected patients, AS remained to progress to advanced stage, suggesting the need to strengthen early monitoring and interventions among patients with comorbid metabolic diseases to slow down disease progression.

Key words: Newly reported cases, Advanced schistosomiasis, Jiangxi Province, Epidemiology, Clinical characteristics