Epidemiological characteristics on liver fibrosis among individuals with a history of schistosome infection in lake-marsh type endemic area

doi:10.12140/j.issn.1000-7423.2025.06.007

Abstract

Abstract:

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.

Key words: Schistosomiasis japonica, Previously infected individuals, Liver fibrosis, Ultrasound examination, Serological marker

CLC Number:

R532.21

PAN Youwen, LI Shizhen, HUANG Song, LIU Xiong, LI Zhu, YANG Meikai, LI Guocui, ZHU Hong, YUAN Yi, ZHANG Lijuan, ZHANG Xia. Epidemiological characteristics on liver fibrosis among individuals with a history of schistosome infection in lake-marsh type endemic area[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2025, 43(6): 793-799.

Figures/Tables 3

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References 22

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基本特征 Baseline characteristics		不同肝纤维化程度的个体数（构成比/%） No. individuals at different stages of liver fibrosis (Proportion/%)						χ²值 χ² value		P值 P value
基本特征 Baseline characteristics		正常 Normal		轻度 Mild		中重度 Moderate to severe	合计 Total	χ²值 χ² value		P值 P value
性别 Sex
男 Male		67（23.18）		100（34.60）		122（42.22）	289（100）	14.48		< 0.01
女 Female		78（34.67）		86（38.22）		61（27.11）	225（100）
年龄组/岁 Age group/year
< 50		15（27.78）		28（51.85）		11（20.37）	54（100）	39.34		< 0.01
50~59		48（34.04）		55（39.01）		38（26.95）	141（100）
60~69		67（33.33）		66（32.84）		68（33.83）	201（100）
≥ 70		15（12.71）		37（31.36）		66（55.93）	118（100）
职业 Occupation
农民 Farmer		138（28.75）		168（35.00）		174（36.25）	480（100）	4.43		> 0.05
其他 Other		7（20.59）		18（52.94）		9（26.47）	34（100）
文化程度 Education Level
文盲 Illiterate	32（21.62）		63（42.57）		53（35.81）		148（100）		6.85	> 0.05
小学 Primary	58（28.86）		67（33.33）		76（37.81）		201（100）
初中及以上 Junior high and above	55（33.33）		56（33.94）		54（32.73）		165（100）
合计 Total	145（28.21）		186（36.19）		183（35.60）		514（100）

指标 Indicator		总异常率/% Overall abnormal rate		不同肝纤维化程度的异常率/% Abnormal rate at different stages of liver fibrosis/%					检验值 Test value		P值 P value
指标 Indicator		总异常率/% Overall abnormal rate		正常 Normal		轻度 Mild	中重度 Moderate to severe		检验值 Test value		P值 P value
肝纤维化指标 Liver fibrosis indicators
层粘连蛋白 LN	0（0/514）		0（0/145）		0（0/183）			0（0/186）		-^a		-^a
Ⅲ型前胶原 PCⅢ	0（0/514）		0（0/145）		0（0/183）			0（0/186）		-^a		-^a
Ⅳ型胶原 Ⅳ-C	2.33（12/514）		1.38（2/145）		1.61（3/183）			3.83（7/186）		-^b		> 0.05
透明质酸酶 HA	29.57（152/514）		18.62（27/145）		28.49（53/183）			39.34（72/186）		16.84^c		< 0.01
肝功能生化指标 Liver function biochemical indicators
总胆红素 T-Bil	11.50（59/514）		8.97（13/145）		11.83（22/183）			13.11（24/186）		1.41^c		> 0.05
丙氨酸转氨酶 ALT	6.03（31/514）		5.52（8/145）		8.60（16/183）			3.83（7/186）		3.81^c		> 0.05
天冬氨酸转氨酶 AST	12.06（62/514）		6.90（10/145）		12.90（24/183）			15.30（28/186）		5.58^c		> 0.05
白蛋白 ALB	1.95（10/514）		0.69（1/145）		1.08（2/183）			3.83（7/186）		-^b		> 0.05
总蛋白 TP	3.89（20/514）		2.76（4/145）		3.76（7/183）			4.92（9/186）		-^b		> 0.05