目的 了解湖沼型血吸虫病流行区既往血吸虫感染者的基本特征和肝纤维化发生情况，为晚期血吸虫病的早预防、早发现、早干预提供依据。方法 以湖北省江陵县2008—2012年登记在册的既往血吸虫感染者为研究对象，采用整群抽样方法，开展结构化问卷调查收集其基本信息，使用彩色多普勒B超评估肝纤维化程度，采用化学发光法检测肝纤维化四项指标，采用全自动生化检测仪检测肝功能生化指标，采用间接红细胞凝集试验（IHA）检测抗血吸虫抗体。使用R 4.0.0软件进行统计学分析，分类变量比较采用卡方检验，连续性变量比较采用方差分析。结果 共调查既往血吸虫感染者514例，男女比为1.28∶1，平均年龄为（61.63 ± 9.63）岁。B超检测显示，肝实质正常者占28.21%（145/514），轻度肝纤维化者占36.19%（186/514），中重度肝纤维化者占35.60%（183/514）。不同性别、年龄人群的肝纤维化程度差异均存在统计学意义（χ² = 14.48、39.34，均P < 0.01）。肝实质正常、轻度肝纤维化、中重度肝纤维化者的肝脏形态异常率分别为13.97%（20/145）、28.49%（53/186）、34.97%（64/183）（χ² = 19.07，P < 0.01）；脾脏平均厚度分别为（29.72 ± 4.62）、（30.37 ± 5.00）、（31.34 ± 4.88）mm（F = 4.58，P < 0.05），门静脉平均内径分别为（10.47 ± 0.80）、（10.32 ± 0.76）、（10.58 ± 0.87）mm（F = 9.59，P < 0.01）。肝实质正常、轻度肝纤维化、中重度肝纤维化者的透明质酸酶（HA）异常率分别为18.62%（27/145）、28.50%（53/186）和39.34%（72/183），差异有统计学意义（χ² = 16.84，P < 0.01）；其他肝纤维化指标（Ⅲ型前胶原、层粘连蛋白、Ⅳ型胶原）、肝功能生化指标（总胆红素、总蛋白、白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶等）的组间差异均无统计学差异（均P > 0.05）。IHA结果显示，抗血吸虫抗体阳性者有94例，总抗体阳性率为18.29%（94/514）；肝实质正常、轻度肝纤维化、中重度肝纤维化者的抗体阳性率分别为15.17%（22/145）、20.97%（39/186）、18.03%（33/183），差异无统计学意义（χ² = 1.84，P > 0.05）。所有调查对象的病原学结果均为阴性。结论 湖沼型流行区既往血吸虫感染者中肝纤维化发生水平较高，且与肝脏形态异常、脾厚、门静脉内径及HA水平升高密切相关。应进一步加强对既往感染者的管理，监测肝纤维化发生发展情况及其风险因素，对重点风险人群加强早期干预和健康管理，降低晚期血吸虫病的发生风险。

Objective To investigate the demographic characteristics and prevalence of liver fibrosis among individuals with a history of schistosomiasis in lake-marsh type endemic area, providing evidence for the early prevention, detection, and intervention of advanced schistosomiasis. Methdos Individuals registered as previously infected with Schistosoma japonicum in Jiangling County, Hubei Province between 2008 and 2012 were selected through cluster sampling. A structured questionnaire was used to collect demographic data. Liver fibrosis was assessed by Doppler ultrasound. The four liver fibrosis indicators were detected using chemiluminescence assay, and the liver function biochemical indicators were measured with the automated biochemical analyzer. The anti-schistosome antibodies were detected using the indirect hemagglutination assay (IHA). Statistical analyses were performed using R software version 4.0.0. Chi-square tests were applied to categorical variables, and one-way ANOVA was used for continuous variables. Results A total of 514 individuals with a history of schistosome infection were included, the ratio of male/female was 1.28∶1, with a mean age of (61.63 ± 9.63) years. Ultrasound results indicated that 28.21% (145/514) individuals had normal liver parenchyma, 36.19% (186/514) had mild liver fibrosis, and 35.60% (183/514) had moderate to severe liver fibrosis. Statistically differences in liver fibrosis severity were observed across different sex and age groups (χ² = 14.48, 39.34; both P < 0.01). The proportions of abnormal liver morphology were 13.97% (20/145), 28.49% (53/186), and 34.97% (64/183) in individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis, respectively (χ² = 19.07, P < 0.01). Mean spleen thickness of individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were (29.72 ± 4.62), (30.37 ± 5.00), and (31.34 ± 4.88) mm, respectively (F = 4.58, P < 0.05); and the portal vein diameters were (10.47 ± 0.80), (10.32 ± 0.76), and (10.58 ± 0.87) mm, respectively (F = 9.59, P < 0.01). The abnormal rates of hyaluronidase (HA) among the individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were 18.62% (27/145), 28.50% (53/186), and 39.34% (72/183), with a statistically difference (χ² = 16.84, P < 0.01). There were no statistically differences observed in other liver fibrosis indicators (procollagen Ⅲ, laminin, or collagen type Ⅳ) or liver function biochemical indicators (total bilirubin, total protein, albumin, alanine aminotransferase, or aspartate aminotransferase). IHA results indicated that 94 individuals tested positive for anti-schistosome antibodies, corresponding to an overall antibody positivity rate of 18.29%; the antibody positivity rate among the individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were 15.17% (22/145), 20.97% (39/186), and 18.03% (33/183), respectively (χ² = 1.84, P > 0.05). No cases were found to be positive on parasitological examination. Conclusion Individuals with a history of schistosomiasis in marshland-endemic regions exhibit a high prevalence of liver fibrosis and antibody positivity. The severity of fibrosis correlates with abnormal liver morphology, increased spleen thickness, portal vein dilation, and elevated HA levels. Enhanced monitoring, targeted management, and early intervention in this population are essential to reduce the burden of advanced schistosomiasis.