【摘要】 目的 建立前瞻性队列研究，探索新发展晚期血吸虫病成因及相关危险因素，为新发展晚期血吸虫病的诊断、治疗和预后判断提供研究平台和数据资源。方法 在江苏省不同地区采用分层整群抽样选择经规范治疗且目前未达到晚期血吸虫病诊断标准的血吸虫既往感染者，排除严重自身免疫病后作为入列人员进行问卷调查、体格检查、腹部超声检查及血常规、肝功能、空腹血糖、血脂、纤维化等指标的实验室检查。2017年8月至2019年7月为队列基线数据调查年，2019年8月为随访起始点，每24个自然月为随访周期。结果 入列人员共6 843人，平均年龄62.1岁，51～70岁者占96%,农民占59.9%,有病毒性肝炎史者为6.4%。初次感染血吸虫年龄为16.8岁，初次治疗与诊断间隔时间平均为0.2年。血常规，血糖，血脂、肝功能及纤维化指标的均值都在正常值范围；除血糖外，其余各指标阳性率在男女之间差异均有统计学意义，其中血脂4项及蛋白3项指标为女性高于男性，肝酶3项及透明质酸为男性高于女性。70.1%入列人员的肝实质出现了以I级改变为主的变化，肝脏左叶增厚者为37.8%,脾脏长、厚径异常率分别为17.4%、12.5%;男女性别间异常率差异除门静脉主干内径及腹水外，余均有统计学意义，其中肝左叶厚径及最大斜径异常率男性大于女性，肝实质改变女性(73.3%)高于男性(67.7%),但病变程度以女性(I级56.0%)较男性(I级48.0%)为轻。结论 新发展晚期血吸虫病成因前瞻性队列采取多种方式收集暴露因素数据以及齐全的生物样本，为探索新发展晚期血吸虫病的成因提供了丰富的研究资源和队列基础。更多还原

【Abstract】 Objective A prospective cohort study was established to explore the causes and related risk factors of newly developed advanced schistosomiasis, and to provide a research platform and data resources for the diagnosis, treatment and prognosis of newly developed advanced schistosomiasis. Methods Stratified cluster sampling was used to select the previously Schistosoma japonicum infected patients who had received standardized treatment without meeting the diagnostic criteria of advanced schistosomiasis in Jiangsu Province. After excluding serious autoimmune diseases, they were included in the cohort for questionnaire survey, physical examination, abdominal ultrasonography and laboratory examination of blood routine, liver function, fasting blood glucose, blood lipid, fibrosis and other indicators. August 2017 to July 2019 was the baseline data survey year for the cohort. The follow-up started in August 2019,and the follow-up period was two years. Results A total of 6 843 people were enrolled(4 774 from South Jiangsu, 1 041 from Middle Jiangsu and 1 028 from North Jiangsu),the average age was 62.1 years old, 96% were 51-70 years old, 59.9% were farmers and 6.4% had a history of viral hepatitis. The age of initial infection with Schistosoma japonicum was 16.8 years. The mean interval between initial treatment and diagnosis was 0.2 years, and the mean interval between the last anti-insect treatment and initial treatment was 1.6 years. The mean values of blood routine, blood glucose, blood lipid and liver function indexes are within the normal range. Except for blood glucose, men and women showed statistically significant differences of other indicators. Among them, the four indicators of blood lipid(TC,TG,LDL-C and HDL-C) and three indicators of protein(TP,ALB,GLO) were higher in female than in those male. Three indicators of liver enzymes(ALT,AST,GGT) and hyaluronic acid(HA) were higher in male than those in female. 70.1% of the liver parenchyma showed grade I changes. 37.8% of the patients had thickened left lobe of the liver, 0.5% had widened inner diameter of main portal vein, and the abnormal rates of long and thick diameter of spleen and ascites were 17.4% and 12.5%,respectively. 0.4% patients had ascites; There was no statistically significant difference in the abnormal rate of the inner diameter of the main portal vein and ascites between male and female. The abnormal rate of the thick diameter and the maximum oblique diameter of the left lobe of the liver in male was greater than that in female. The abnormal rate of the liver parenchyma changes in female(73.3%) was higher than that in male(67.7%). However, the lesion severity in female(grade I 56.0%) was milder than that in male(grade I 48.0%). Conclusion This cohort collected exposure factor data and complete biological samples by various means, which provided research resources and cohort platform for exploring the causes of newly developed advanced schistosomiasis.更多还原