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Jiang H, Zhou J, Cai X, Hu B, Wang H, Fu C, Xu N, Gong Y, Tong Y, Yin J, Huang J, Wang J, Jiang Q, Liang S, Zhou Y. Impact of historical disease conditions on mortality and life expectancy in patients with advanced schistosomiasis in Hunan Province, China. Trans R Soc Trop Med Hyg 2024:trae052. [PMID: 39143751 DOI: 10.1093/trstmh/trae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 08/12/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Although the prognosis of advanced schistosomiasis patients has significantly improved, the impact of historical disease conditions on life expectancy remains unclear. METHODS Utilizing data from an advanced schistosomiasis cohort (n=10 362) from 2008 to 2019 in Hunan, China, we examined five historical disease conditions: times of praziquantel treatment, the history of ascites, splenectomy, upper gastrointestinal bleeding (UGIB) and hepatic coma. Using latent class analysis, participants were categorized into three groups: Group 1 (characterized by no risk conditions), Group 2 (had ≤3 times of praziquantel treatment without UGIB history) and Group 3 (had UGIB history). Life expectancies were calculated using the life table method. RESULTS At the age of 45 y, patients with ≤3 times of praziquantel treatment, a history of ascites, UGIB, hepatic coma and those without splenectomy exhibited lower life expectancies. Groups 1, 2 and 3 had estimated life expectancies of 32.32, 26.76 and 25.38 y, respectively. Compared with Group 1, women in Group 3 experienced greater life expectancy loss than those in Group 2, with the difference narrowing with age. CONCLUSIONS Based on the consideration of overall physical conditions, tailored treatment and healthcare, along with public health interventions targeting diverse populations, could mitigate the prevalence of poor disease conditions and premature deaths.
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Affiliation(s)
- Honglin Jiang
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Jie Zhou
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Xinting Cai
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Benjiao Hu
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Huilan Wang
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Chen Fu
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Ning Xu
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Yanfeng Gong
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Yixin Tong
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Jiangfan Yin
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Junhui Huang
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Jiamin Wang
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Qingwu Jiang
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
| | - Songyue Liang
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Jin'e Middle Road, Yueyang, Hunan 414021, China
| | - Yibiao Zhou
- Department of Epidemiology, Fudan University School of Public Health, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Shanghai 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Shanghai 200032, China
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Hu F, Xie SY, Yuan M, Li YF, Li ZJ, Gao ZL, Lan WM, Liu YM, Xu J, Lin DD. The Dynamics of Hepatic Fibrosis Related to Schistosomiasis and Its Risk Factors in a Cohort of China. Pathogens 2021; 10:1532. [PMID: 34959487 PMCID: PMC8703886 DOI: 10.3390/pathogens10121532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
China has had a long history against schistosomiasis japonica. The most serious prognosis of chronic schistosome infection is hepatic fibrosis, which develops into advanced schistosomiasis if the process is not effectively controlled. After a more than seven decades endeavor, China has gained remarkable achievements in schistosomiasis control and achieved transmission control nationwide (infection rate of schistosomes in residents and domestic animals both less than 1%) by 2015. However, new advanced schistosomiasis cases emerge annually in China, even in areas where the transmission of schistosomiasis had been interrupted. In the present study, the residents (>5 years old) in a schistosomiasis endemic village were examined for schistosomiasis every year during 1995-2019 by the modified Kato-Katz thick smear method and/or miracidium hatching technique. Residents who were identified to have an active infection method were treated with praziquantel at a dose of 40 mg/kg body weight. Ultrasonography was carried out to assess the liver morbidity related to schistosomiasis in 1995 and 2019, respectively. The prevalence of schistosomiasis among residents presented a downward trend annually, from 17.89% (175/978) in 1995 to 0 (0/475) in 2019. Among 292 residents who received ultrasound scan both in 1995 and 2019, 141 (48.29%) presented stable liver damage, while liver fibrosis was developed severely in 86 (29.45%) and reversed in 65 (22.26%) residents. Univariate and multivariate analysis showed that anti-fibrosis treatment was the protective factor against schistosomiasis hepatic fibrosis. Males, residents aged 38 and above, fishermen, and people who did not receive anti-fibrosis treatment were groups with higher risk of liver fibrosis development. Our results revealed that although the infection rate of schistosome dropped significantly in endemic areas, liver fibrosis was still developing among some residents, even though they had received deworming treatment. Liver protection/anti-fibrosis treatment should be administered in endemic regions and regions with historically uncontrolled transmission to slow down the deterioration of hepatic fibrosis among patients in schistosomiasis endemic areas.
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Affiliation(s)
- Fei Hu
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Shu-Ying Xie
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Min Yuan
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Yi-Feng Li
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Zhao-Jun Li
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Zhu-Lu Gao
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Wei-Ming Lan
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Yue-Ming Liu
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
| | - Jing Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, Chinese Center for Tropical Disease Research, Shanghai 200025, China
| | - Dan-Dan Lin
- Jiangxi Provincial Institute of Parasitic Diseases, Jiangxi Province Key Laboratory of Schistosomiasis Prevention and Control, Nanchang 330096, China; (F.H.); (S.-Y.X.); (M.Y.); (Y.-F.L.); (Z.-J.L.); (Z.-L.G.); (W.-M.L.); (Y.-M.L.)
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Fang H, Yu L, You D, Peng N, Guo W, Wang J, Zhang X. In vivo Therapeutic Effects and Mechanisms of Hydroxyasiaticoside Combined With Praziquantel in the Treatment of Schistosomiasis Induced Hepatic Fibrosis. Front Bioeng Biotechnol 2021; 8:613784. [PMID: 33553120 PMCID: PMC7862569 DOI: 10.3389/fbioe.2020.613784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022] Open
Abstract
Schistosomiasis has been a fatal obstinate disease that threatens global human health, resulting in the granulomatous inflammation and liver fibrosis. Objective:The aim of this study was to evaluate the therapeutic effects and mechanisms of hydroxyasiaticoside combined with praziquantel in the treatment of schistosomiasis-induced liver fibrosis. Methods:Mice were randomly distributed into four experimental groups: normal control group, model group, praziquantel group, praziquantel + hydroxyasiaticoside group. Except for the normal control group, they were infected with Schistosomia cercariae through the abdominal skin to induce liver fibrosis. In the intervention group, mice were administered with the respective drugs by gavage after 8 weeks of infection. At the end of the treatment, mice were sacrificed to collect blood for the determination of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels. Moreover, the liver was excised, weighed, and liver indices were calculated. Histopathological examination was performed to assess liver morphology. Besides, the expression of collagen type I and III in liver was determined; the mRNA expression levels of IL-6 and TNF-α in liver tissues were measured using Real-time PCR while ELISA and western blotting were performed on liver tissue homogenate to determine the protein expression of IL-6 and TNF-α. Results:The combination of praziquantel and hydroxyasiaticoside lowered the pathological scores of schistosomiasis-induced hepatic fibrosis, the liver indice, serum AST and ALT levels, improved liver morphology, downregulated the expression levels of hepatic type I and III collagen, inhibited the mRNA expression levels of pro-inflammatory factors (IL-6 and TNF-α) in the liver of mice relative to the praziquantel alone. Conclusion:The combination of hydroxyasiaticoside and praziquantel is a potential therapeutic option for schistosomiasis-induced hepatic fibrosis. Notably, this combination noticeably suppresses the protein and mRNA expression levels of pro-inflammatory factors (TNF-α and IL-6) in the liver.
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Affiliation(s)
- Huilong Fang
- Department of Pharmacology, Xiangnan University, Chenzhou, China
| | - Ling Yu
- Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Da You
- Department of Pharmacology, Xiangnan University, Chenzhou, China
| | - Nan Peng
- Department of Pharmacology, Xiangnan University, Chenzhou, China
| | - Wanbei Guo
- Department of Pharmacology, Xiangnan University, Chenzhou, China
| | - Junjie Wang
- Department of Pharmacology, Xiangnan University, Chenzhou, China
| | - Xing Zhang
- Department of Trauma and Reconstructive Surgery, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
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Jiang S, Huang X, Ni L, Xia R, Nakayama K, Chen S. Positive consequences of splenectomy for patients with schistosomiasis-induced variceal bleeding. Surg Endosc 2020; 35:2339-2346. [PMID: 32440930 DOI: 10.1007/s00464-020-07648-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with hepatic schistosomiasis are at high risk of gastroesophageal variceal bleeding, which is highly torrential and life threatening. This study aimed to assess the effects of splenectomy on patients with schistosomiasis-induced variceal bleeding, especially those influences related to overall survival (OS) rate. METHODS From January 2005 to December 2018, 112 patients with schistosomiasis-induced varices were enrolled. In that period, all the patients with hepatic schistosomiasis who received endoscopic treatment for primary and secondary prophylaxis of gastroesophageal variceal bleeding were found eligible. The patients were divided into splenectomized group (n = 44, 39.3%) and control group (n = 68, 60.7%). RESULTS Multivariate regression analysis of OS showed that splenectomy, hepatic carcinoma, and times of endoscopic treatment were independent prognostic factors for OS. Kaplan-Meier analysis revealed that the 5-year OS rate was 82.7% in splenectomized group versus 53.2% in control group (P = 0.037). The rate of no recurrence of variceal bleeding during 5-year (56.8% vs. 47.7%, P = 0.449) indicated that there was no significant difference between the two groups. Patients who received splenectomy had increased risk of portal vein thrombosis (52.3% vs. 29.4%, P = 0.012) and decreased proportion of severe ascites (20.5% vs 50.0%, P = 0.002). CONCLUSION Splenectomy prior to endoscopic treatment provides a superior long-term survival for patients with schistosomiasis-induced variceal bleeding.
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Affiliation(s)
- Siyu Jiang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Liyuan Ni
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ruiqi Xia
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Kiyoko Nakayama
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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Li G, Lian L, Huang S, Miao J, Cao H, Zuo C, Liu X, Zhu Z. Nomograms to predict 2-year overall survival and advanced schistosomiasis-specific survival after discharge: a competing risk analysis. J Transl Med 2020; 18:187. [PMID: 32375846 PMCID: PMC7201698 DOI: 10.1186/s12967-020-02353-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background The prognosis of patients with advanced schistosomiasis is poor. Pre-existing prognosis studies did not differentiate the causes of the deaths. The objectives were to evaluate the 2-year overall survival (OS) and advanced schistosomiasis-specific survival (ASS) in patients with advanced schistosomiasis after discharge through competing risk analysis and to build predictive nomograms. Methods Data was extracted from a previously constructed database from Hubei province. Patients were enrolled from September 2014 to January 2015, with follow up to January 2017. OS and ASS were primary outcome measures. Nomograms for estimating 2-year OS and ASS rates after discharge were established based on univariate and multivariate Cox regression model and Fine and Gray’s model. Their predictive performances were evaluated using C-index and validated in both internal and external validation cohorts. Results The training cohort included 1487 patients with advanced schistosomiasis. Two-year mortality rate of the training cohort was 8.27% (123/1487). Competing events accounted for 26.83% (33/123). Older age, splemomegaly clinical classification, abnormal serum DBil, AST, ALP and positive HBsAg were significantly associated with 2-year OS. Older age, splemomegaly clinical classification, abnormal serum AST, ALP and positive HBsAg were significantly associated with 2-year ASS. The established nomograms were well calibrated, and had good discriminative ability, with a C-index of 0.813 (95% CI 0.803–0.823) for 2-year OS prediction and 0.834 (95% CI 0.824–0.844) for 2-year ASS prediction. Their predictive performances were well validated in both internal and external validation cohorts. Conclusion The effective predictors of 2-year OS and ASS were discovered through competing risk analysis. The nomograms could be used as convenient predictive tools in clinical practice to guide follow-up and aid accurate prognostic assessment.
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Affiliation(s)
- Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Lifei Lian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Huan Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Chengchao Zuo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Xiaoyan Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
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