Hepatic schistosomiasis as a determining factor in the development of hepatic granulomas and liver fibrosis: a review of the current literature

Hepatic schistosomiasis is a neglected parasitosis that affects millions of people each year worldwide and leads to high healthcare costs and increased morbidity and mortality in infected humans. It is a disease that has been widely studied in terms of its pathophysiology; therefore, the signaling pathways that lead to liver damage, with the consequent development of liver fibrosis, are now better understood. Research has elucidated the role of soluble egg antigen in the development of hepatic granulomas and liver fibrosis, the signal transducer and activator of transcription 3 and its participation in liver damage, the role of heat shock protein 47 and its involvement in liver fibrosis, the anti-inflammatory effects caused by interleukin-37, and the role of natural killer and natural killer T cells in the development of the disease. Hepatic schistosomiasis can range from simple hepatomegaly to the development of portal hypertension combined with hepatic fibrosis. For diagnostic purposes, a microscopic examination of excreta remains the gold standard; however, abdominal ultrasound has recently taken on an important role in the assessment of liver lesions produced by the parasite. Praziquantel is considered the management drug of choice, and has been associated with a potential preventive antifibrotic effect.

肝血吸虫病（Hepatic schistosomiasis）是一种被忽视的寄生虫病，每年影响全球数百万人，导致高昂的医疗成本，并增加感染者的发病率和死亡率。其病理生理学（pathophysiology）已得到广泛研究，因此，导致肝损伤并继而发展为肝纤维化（liver fibrosis）的信号通路（signaling pathways）目前已被更好地理解。研究已阐明可溶性虫卵抗原（soluble egg antigen）在肝肉芽肿（hepatic granulomas）和肝纤维化形成中的作用、信号转导和转录激活因子3（signal transducer and activator of transcription 3）及其在肝损伤中的参与、热休克蛋白47（heat shock protein 47）及其在肝纤维化中的作用、白细胞介素-37（interleukin-37）的抗炎效应，以及自然杀伤细胞（natural killer cells）和自然杀伤T细胞（natural killer T cells）在疾病发展中的作用。肝血吸虫病的表现可从单纯肝肿大（hepatomegaly）到合并肝纤维化的门静脉高压症（portal hypertension）不等。在诊断方面，排泄物显微镜检查（microscopic examination of excreta）仍是金标准；然而，腹部超声（abdominal ultrasound）近年来在评估寄生虫引起的肝脏病变（liver lesions）中已发挥重要作用。吡喹酮（Praziquantel）被视为首选治疗药物，并被证实具有潜在的预防性抗纤维化作用（preventive antifibrotic effect）。