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Objective To investigate the cell composition and the transcriptional characteristics in microenvironments of hepatic tissues in mice at late stage of Echinococcus multilocularis infection at a single-cell level. Methods Peri-lesion and paired distal hepatic specimens were collected from two BALB/c mice (6 to 8 weeks old) infected with E. multilocularis for single-cell RNA sequencing. The Seurat package in the R software was employed for quality control of data, multi-sample integration and correction of batch effects, and uniform manifold approximation and projection (UMAP) algorithm was used for cell clustering. Cell types were annotated using classical marker genes. Differentially expressed genes were screened in each cell type through differential gene expression analysis, and the biological roles of cells were predicted using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Results A total of 43 710 cells from peri-lesion and distal hepatic tissues of E. multilocularis-infected mice were analyzed, and were classified into 11 cell types, including neutrophils, T cells, macrophages, granulocyte-monocyte progenitor cells, B cells, plasma cells, basophils, hepatic stellate cells, endothelial cells, hepatocytes, and platelets. T cells were the largest population of immune cells in the microenvironment of hepatic tissues, including five CD4+ T cell subsets, two CD8+ T cell subsets and phosphoantigen-reactive γδT cells. The proportions of CD4+ helper T cells and cytotoxic CD4+ T cells decreased and the proportion of T helper 2 (Th2) cells increased in peri-lesion tissues relative to distal hepatic tissues. In addition, the differentially expressed genes in Th2 cells were associated with negative regulation of the immune system, and the highly expressed genes in cytotoxic CD4+ T cells correlated with activation of the immune system. Conclusions Single-cell RNA sequencing deciphers the cell composition and distribution in microenvironments of hepatic tissues from mice infected with E. multilocularis, and the increased proportion of Th2 cells in peri-lesion hepatic tissues may be associated with formation of immunosuppressive microenvironments.
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Alveolar echinococcosis, caused by Echinococcus multilocularis infection, is a highly deadly zoonotic parasitic disease. As a benzimidazole compound, albendazole has a strong and broad-spectrum anti-parasitic action. For alveolar echinococcosis patients that are unwilling to receive surgical treatment, lose the timing for surgery, or are intolerant to surgery due to poor physical status, administration of albendazole may delay disease progression. Recently, a large number of advances have been achieved in experimental studies on alveolar echinococcosis. In order to increase the understanding of the therapeutic efficacy of albendazole for alveolar echinococcosis, this review summarizes the advances in albendazole treatment for alveolar echinococcosis, so as to provide insights into the clinical treatment of alveolar echinococcosis with albendazole.
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Objective To identify the differentially expressed proteins in different liver tissues in the mouse model of alveolar echinococcosis using high-resolution mass spectrometry with data independent acquisition (DIA), and to identify the key proteins contributing to the pathogenesis of alveolar echinococcosis. Methods Protoscoleces were isolated from Microtus fuscus with alveolar echinococcosis and the experimental model of alveolar echinococcosis was established in female Kunming mice aged 6 to 8 weeks by infection with Echinococcus multilocularis protoscoleces. Mice were divided into the experimental and control groups, and animals in the experimental group was injected with approximately 3 000 protoscoleces, while mice in the control group were injected with the same volume of physiological saline. Mouse liver specimens were sampled from both groups one year post-infection and subjected to pathological examinations. In addition, the lesions (the lesion group) and peri-lesion specimens (the peri-lesion group) were sampled from the liver of mice in the experimental group and the normal liver specimens (the normal group) were sampled from mice in the control group for DIA proteomics analysis, and the differentially expressed proteins were subjected to bioinformatics analysis. Results A total of 1 020 differentially expressed proteins were identified between the lesion group and the normal group, including 671 up-regulated proteins and 349 down-regulated proteins, and 495 differentially expressed proteins were identified between the peri-lesion group and the normal group, including 327 up-regulated proteins and 168 down-regulated proteins. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed that these differentially expressed proteins were involved in peroxisome, peroxisome proliferator-activated receptor (PPAR) and fatty acid degradation pathways, and the peroxisome and PPAR signaling pathways were found to correlate with liver injury. Several differentially expressed proteins that may contribute to the pathogenesis of alveolar echinococcosis were identified in these two pathways, including fatty acid binding protein 1 (Fabp1), Acyl-CoA synthetase long chain family member 1 (Acsl1), Acyl-CoA oxidase 1 (Acox1), Enoyl-CoA hydratase and 3-hydroxyacyl CoA dehydrogenase (Ehhadh) and Acetyl-Coenzyme A acyltransferase 1B (Acaa1b), which were down-regulated in mice in the experimental group. Conclusion A large number of differentially expressed proteins are identified in the liver of the mouse model of alveolar echinococcosis, and Fabp1, Acsl1, Acox1, Ehhadh and Acaa1b may contribute to the pathogenesis of alveolar echinococcosis.
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Objective:To evaluate the clinical efficacy and safety of ex vivo liver resection and autotransplantation (ELRA) by using a Bayesian single-arm Meta-analysis.Methods:Databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang were searched from January 1, 1990 to December 30, 2021 on ELRA studies. The Bayesian one-arm Meta-analysis was performed by using the statistical software of R (V4.1.2) and the Markov chain-Monte Carlo method was used to simulate the posterior distribution. The mortality rate within 30 days after operation, 1-year survival rate, major postoperative complications, R 0 resection rate and other related indexes were analyzed. Results:A total of 20 studies with 436 patients were included. Bayesian single-arm Meta-analysis showed that the 1-year survival rate after ELRA was 83.24% [95% highest posterior density ( HPD): 72.40%-92.05%]. The 1-year survival rates after surgery were 88.66% (95% HPD: 81.52%-94.50%) for patients with hepatic alveolar echinococcosis and 61.29% (95% HPD: 38.53%-93.68%) for patients with hepatic malignancies, respectively. The mortality rate within 30 d after surgery, the incidence of significant postoperative complications, and the R 0 resection rate were 6.96% (95% HPD: 4.47%-10.15%), 27.91% (95% HPD: 19.00%-38.30%), and 99.84% (95% HPD: 37.61%-100.00%), respectively. Renal failure was the most frequent cause of death after ELRA. Conclusion:ELRA is indicated for hepatic malignancies and hepatic alveolar echinococcosis when intrahepatic resection cannot be accomplished in vivo. The greatest benefit is observed in patients with hepatic alveolar echinococcosis, while only some patients with hepatic malignancies can benefit. The indications for ELRA for hepatic malignancies need to be further studied to define the subgroup of patients who can benefit from this operation.
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RESUMEN: El diagnóstico y tratamiento de las equinococosis requiere de la participación de especialistas multidisciplinarios,por lo que, estandarizar la terminología utilizada es fundamental. Para armonizar la terminología sobre bases científicas y lingüísticas sólidas, la Asociación Mundial de Equinococosis generó un proceso de consenso formal. Los principales logros de este proceso fueron: realizar una actualización de la nomenclatura actual de Echinococcus spp.; generar un acuerdo sobre nombres de enfermedades causadas por Echinococcus spp.: equinococosis quística (EQ), equinococosis alveolar (EA) y equinococosis neotropical (NE), y la exclusión de los demás nombres; ejecutar un acuerdo sobre el uso restringido del adjetivo "hidatido" para referirse al quiste y al líquido debido a E. granulosus sensu lato; y un acuerdo sobre una descripción estandarizada de las intervenciones quirúrgicas para EQ, de acuerdo con el marco de "Acceso, Apertura, Resección e Integridad del quiste" (AARI). Además, se enumeraron 95 términos "aprobados" y 60 "rechazados". Las recomendaciones proporcionadas serán aplicables a publicaciones científicas y comunicación con profesionales. El objetivo de este manuscrito fue generar un documento de estudio referente al uso de terminología actualizada en echinococcosis desde la biología a la terapéutica.
SUMMARY: The diagnosis and treatment of echinococcosis requires the participation of different multidisciplinary specialists Therefore, standardizing the terminology used is essential. To harmonize terminology on a sound scientific and linguistic basis, the World Echinococcosis Association generated a formal consensus process. The main achievements of this process were to update the current nomenclature of Echinococcus spp .; to generate an agreement on names of diseases caused by Echinococcus spp .: cystic echinococcosis (CE), alveolar echinococcosis (EA) and neotropical echinococcosis (NE), and the exclusion of other names; execute an agreement on the restricted use of the adjective "hydatid" to refer to the cyst and the fluid due to E. granulosus sensu lato; and an agreement on a standardized description of surgical interventions for CE, according to the framework of "Cyst Access, Opening, Resection and Integrity" (AARI). In addition, 95 "approved" and 60 "rejected" terms were listed. The recommendations provided will be applicable to scientific publications and communication with professionals. The aim of this manuscript was to generate a study document referring to echinococcosis from biology to therapy.
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Humans , Animals , Echinococcosis , Echinococcus , Terminology as TopicABSTRACT
The clinical data of a case of adrenal alveolar echinococcosis treated and misdiagnosed in our hospital were reported retrospectively. The pre-operative CT examination of this patient showed that the liver S7 segment-the right adrenal gland area showed irregular masses of mixed density lesions, the boundary was unclear, consider the possibility of liver hydatid. During the operation, hydatid was found to only invade the liver capsule, and the primary lesion was the adrenal gland. The right adrenal gland and lesion were resected by urological surgeons. The pathological diagnosis was adrenal alveolar echinococcosis. When the imaging examination considers hepatic alveolar echinococcosis, and the lesion is mainly in the right adrenal gland area, it should be considered that the primary lesion could be in the adrenal gland.
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BACKGROUND: The biological characteristics of hepatic alveolar echinococcosis are similar to cancer lesions. Its biological characteristics of invasive growth and metastasis increase the difficulty of surgery. The fibrosis of the outer capsule wall can inhibit the growth of echinococcus multilocularis and keep the disease in the quiescent stage. The role of mesenchymal stem cells in the fibrosis of the outer capsule wall of echinococcosis remains unclear. OBJECTIVE: To investigate the effect of alveolar echinococcosis protoscolices on the differentiation of mesenchymal stem cells into fibroblasts. METHODS: Bone marrow mesenchymal stem cells were isolated from femur bone marrow of 4-week-old C57BL/6 mice, and cultured by adherent method. Alveolar echinococcosis protoscolices were extracted from gerbils infected with alveolar echinococcus. The experiment was divided into three groups. The alveolar echinococcosis group was co-cultured with the third generation of bone marrow mesenchymal stem cells and the protocephalus of alveolar echinococcosis protoscolices. The Echinococcus granulosus group was co-cultured with the third generation of bone marrow mesenchymal stem cells and the protocephalus of Echinococcus granulosus protoscolices. The simple control group was cultured with the third generation of bone marrow mesenchymal stem cells. At 1, 3, 5, and 7 days of cultivation, the real-time fluorescent quantitative PCR was used to detect collagen type I, collagen type III, transforming growth factor-beta 1 and Smad7 gene expression. Western blot assay was utilized to determine collagen type I, collagen type III, Smad7 and phosphorylated Smad2/3 protein expression. ELISA was applied to measure supernatant collagen type I and collagen type III contents. RESULTS AND CONCLUSION: (1) Real-time fluorescent quantitative PCR detection displayed that transforming growth factor-beta 1, collagen type I, collagen type III mRNA relative expression levels were significantly lower in the alveolar echinococcosis group than in the Echinococcus granulosus group and simple control group (P < 0.05). Smad7 mRNA relative expression was significantly higher in the alveolar echinococcosis group than in the Echinococcus granulosus group and simple control group (P < 0.05). (2) Western blot assay showed that collagen type I, collagen type III and phosphorylated Smad2/3 protein relative expression levels were significantly lower in the alveolar echinococcosis group than in the Echinococcus granulosus group and simple control group (P < 0.05). Smad7 protein relative expression was significantly higher in the alveolar echinococcosis group than in the Echinococcus granulosus group and simple control group (P < 0.05). (3) ELISA exhibited that supernatant collagen type I and collagen type III contents were significantly lower in the alveolar echinococcosis group than in the Echinococcus granulosus group and simple control group (P < 0.05). (4) Alveolar echinococcosis protoscolices may promote bone marrow mesenchymal stem cells to secrete Smad7, inhibit the collagen type I, collagen type III and transforming growth factor-beta 1 through the transforming growth factor-beta/Smad signaling pathway, thereby inhibiting the fibrosis of bone marrow mesenchymal stem cells.
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The diagnosis and treatment of a local case with alveolar echinococcosis was presented. Based on clinical data and epidemiological surveys, this is a rare, local case with alveolar echinococcosis in Nanzhang County, suggesting the possibility of local transmission of echinococcosis. The prevention, control and surveillance of echinococcosis requires to be reinforced in nonendemic areas.
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Imaging and serological approaches play an important role in the diagnosis and treatment of alveolar echinococcosis; however, they also suffer from some problems during their applications in clinical practices, which urges the identification of potential diagnostic markers. Novel serological, genomics and proteomics diagnostic markers alone or in combination may increase the sensitivity and specificity in early diagnosis of alveolar echinococcosis, which play vital roles in monitoring of disease courses and prognostic evaluation. This review mainly presents the advances in the studies on novel diagnostic markers for alveolar echinococcosis.
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Objective To detect the expression of transforming growth factor-β1 (TGF-β1), p38MAPK and bone morphogenetic protein-7 (BMP-7) protein in the liver specimens of patients with hepatic alveolar echinococcosis, and to investigate the potential role of TGF-β1, p38MAPK and BMP-7 protein in hepatic fibrosis caused by hepatic alveolar echinococcosis. Methods A total of 20 patients with hepatic alveolar echinococcosis were enrolled as study subjects, and hepatic specimens were sampled from the sites within 0.5 cm (Group A) and 0.5 to 1.5 cm from hepatic alveolar echinococcosis lesions (Group B), while normal liver specimens sampled from the sites 2 cm and greater from hepatic alveolar echinococcosis lesions served as controls (Group C). The fibrosis of liver specimens was pathological examined using HE and Masson staining, and the expression of TGF-β1, p38MAPK and BMP-7 protein was quantified in liver tissues using Western blotting. The associations of TGF-β1, p38MAPK and BMP-7 protein expression with hepatic fibrosis were assessed. Results HE staining showed the malaligned structure of hepatocytes and destruction of the structure of hepatic lobules at various degrees in liver specimens in groups A and B, with hepatocyte degeneration, atrophy and necrosis, hyperplasia of fibrous tissues and eosinophilic granulocyte infiltration seen, while no abnormal pathological alterations of liver tissues, normal hepatocyte structure and morphology and uniform size, no malaligned structure of hepatocytes, clear structure of hepatic lobules, no or mild hepatocyte degeneration or necrosis, and no eosinophilic granulocyte infiltration were seen in Group C. Masson staining showed that there was hyperplasia of multiple fibrous connective tissues in the liver portal areas in groups A and B, with fibrosis seen in hepatic lobules, while no obvious pathological changes were seen in Group C. There were significant differences seen in TGF-β1 (P < 0.001), p38MAPK (P < 0.01) and BMP-7 protein (P < 0.05) expression in liver tissues in groups A, B and C, and higher TGF-β1, p38MAPK and BMP-7 protein expression was quantified in groups A and B than in Group C (all P values < 0.05), while greater TGF-β1, p38MAPK and BMP-7 protein expression was detected in Group B than in Group C (all P values < 0.05). The expression of TGF-β1, p38MAPK and BMP-7 protein correlated positively with the severity of hepatic fibrosis (r = 0.866, 0.702 and 0.801, all P values < 0.05), and there were significant differences in TGF-β1 (F = 72.580, P < 0.01), p38MAPK (χ2 = 31.705, P < 0.01) and BMP-7 protein expression (χ2 = 48.388, P < 0.01) among liver tissues with different degrees of fibrosis. The TGF-β1 protein expression correlated positively with p38MAPK and BMP-7 protein expression (r = 0.607 and 0.702, both P values < 0.001), and the BMP-7 protein expression also correlated positively with p38MAPK protein expression (r = 0.456, P < 0.001). Conclusion The interaction among TGF-β1, p38MAPK and BMP-7 jointly participates in the development of hepatic fibrosis induced hepatic alveolar echinococcosis.
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The patients with hepatic alveolar echinococcosis have unapparent early symptoms due to invasive and slow growth, and the disease is usually at an advanced stage upon diagnosis, which has a poor prognosis. Early diagnosis of hepatic alveolar echinococcosis is therefore of great importance. The advances in the ultrasound techniques continues to improve the accuracy for the diagnosis of hepatic alveolar echinococcosis, and ultrasound plays a critical role in the treatment and assessment of therapeutic efficacy for hepatic alveolar echinococcosis. This paper mainly reviews the application of ultrasound in the diagnosis and treatment of hepatic alveolar echinococcosis.
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This paper reports a case with alveolar echinococcosis metastatic to the brain. This case underwent 10-year antiechinococcosis treatment and operations of the liver, right kidney and brain. Following multiple operations and oral administration of albendazole, the case still had recurrence and distant metastasis of hepatic echinococcosis. It is suggested that early prevention, early diagnosis, early regular treatment and surgical radical treatment are critical to the treatment of alveolar echinococcosis.
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Objective@#To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis(HAE).@*Methods@#The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed. Among them, there were 7 males and 5 females, the age ranged from 16~58 years(median 42 years). The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A, 3 class B and 7 class C, and the median model for end-stage liver disease(MELD)score was 19.5(8~23).@*Results@#The mean time of OLT procedure and anhepatic phase in 12 patients were 456.25(456.25±44.98)min and 79.17(79.17±10.01)min respectively. The median intraoperative blood loss and hospital stay times were 1000 ml(600~4000 ml), and 29.5(15±58)days respectively. All the patients were followed-up for 0 months to 207 months. Among the 12 patients who underwent OLT, 2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT, and multiple organ failure on day 32 post-OLT, respectively. One case developed lung metastasis 2 years after operation, and brain metastasis was found in the same patient after 4 years. The recurrence occurred 3 years after OLT in another patient, no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients.@*Conclusions@#OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy.
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Objective To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis (HAE) .Methods The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed .Among them ,there were 7 males and 5 females ,the age ranged from 16～58 years(median 42 years) .The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A ,3 class B and 7 class C ,and the median model for end-stage liver disease(MELD)score was 19 .5(8～23) .Results The mean time of OLT procedure and anhepatic phase in 12 patients were 456 .25(456 .25 ± 44 .98)min and 79 .17(79 .17 ± 10 .01)min respectively .The median intraoperative blood loss and hospital stay times were 1000 ml(600～4000 ml) ,and 29 .5(15 ± 58)days respectively . All the patients were followed-up for 0 months to 207 months .Among the 12 patients who underwent OLT ,2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT ,and multiple organ failure on day 32 post-OLT ,respectively .One case developed lung metastasis 2 years after operation ,and brain metastasis was found in the same patient after 4 years .The recurrence occurred 3 years after OLT in another patient ,no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients .Conclusions OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy .
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Echinococcosis is a disease caused by the Echinococcus species that parasitizes in humans. Alveolar echinococcosis (AE) which is caused by Echinococcus multilocularis is harmful to humans. AE mainly occurs in the liver and can be transferred to retroperitoneal lymph nodes, lung, brain, bone, spleen and other organs through lymphatic and blood vessels. Cholangiocarcinoma can occur in the intrahepatic and extrahepatic bile ducts and is more common in the hilar. We reported a case of hilar bile duct alveolar echinococcosis which was originally misdiagnosed an cholangiocarcinoma.
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Humans , Bile Ducts , Bile Ducts, Extrahepatic , Bile , Blood Vessels , Brain , Cholangiocarcinoma , Echinococcosis , Echinococcus , Echinococcus multilocularis , Liver , Lung , Lymph Nodes , SpleenABSTRACT
Objective To assess the value of MRI combined with serum ferritin analysis in measurement of hepatic iron deposition among patients with hepatic alveolar echinococcosis. Methods A total of 96 patients with definitive diagnosis of hepatic alveolar echinococcosis and 30 healthy volunteers were enrolled and underwent routine 1.5T MR scanning, and all laboratory examination data were captured. The liver-to-muscle signal intensity ratio, serum ferritin level and liver functions were analyzed. Results The liver-to-muscle signal intensity ratio was (1.95 ± 0.57) in patients with hepatic alveolar echinococcosis and (2.22 ± 0.28) in healthy volunteers (t = 2.022, P < 0.05), and the liver-to-muscle signal intensity ratio was negatively associated the serum ferritin level in patients with hepatic alveolar echinococcosis (rs = –0.446, P < 0.01). Conclusions Abnormal iron deposition is detected in the liver of patients with hepatic alveolar echinococcosis, and serum ferritin level may be helpful for the identification of abnormal iron deposition in the liver of patients with hepatic alveolar echinococcosis. The liver-to-muscle signal intensity ratio measured by MRI may be a non-invasive approached used to assess the hepatic iron deposition in patients with hepatic alveolar echinococcosis.
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Objective To investigate the biologic viability and boundary range of hepatic alveolar echinococcosis (HAE) by the contrast-enhanced ultrasonography (CEUS) and acoustic radiation force impulse elastography (ARFI). Methods Totally 27 HAE patients confirmed by pathology underwent CEUS and ARFI examinations. Results Gray scale sonography of HAE showed unclear boundary, inhomogeneous, and middle hyperechoic nodules, and the maximum area was (6.08 ± 4.47) cm2 in 27 lesions. CEUS of HAE showed non-enhancement in three phases and black hole sign. Circumferential enhancement on the pe riphery of the lesion was synchronized with the liver parenchyma and showed “fast in and slow out”. The maximum area was (8.87 ± 4.83) cm2. The area of ECUS was larger than gray scale sonography in HAE (t = 2.20, P = 0.03). The mean shear wave velocities (SWVs) of the interior, the boundary range, and the surrounding liver tissues of HAE were statistically different by ARFI (F = 84.538, P < 0.001), and the interior had the highest values. Conclusions CEUS and ARFI examinations can detect the biologic viability and boundary range of migrating zone around HAE, which is valuable for guiding treatment, judging curative effect, and predicting prognosis.
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Alveolar echinococcosis is a parasitic zoonosis that severely damages human health. Currently, radical surgical resection is the first choice for hepatic alveolar echinococcosis. For the advanced hepatic echinococcosis patients with refractory radical resection, the palliative surgery combined with chemotherapy, liver transplantation, drug therapy, and radiofrequency microwave ablation may provide comprehensive tools. This article reviews the current situation and progress of comprehensive treatments for hepatic alveolar echinococcosis.
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Objective To investigate the clinical characteristics of patients with advanced hepatic alveolar echinococcosis, so as to provide more evidence for the diagnosis and treatment of advanced hepatic alveolar echinococcosis. Methods The clinical records of 175 cases with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from 2012 to 2017 were retrospectively reviewed. Results Among the 175 cases with hepatic alveolar echinococcosis, the male to female ratio was 1∶1.6, and the mean age was (38.6 ± 12.9) years (range, 11 to 69 years). 93.7% of the patients (164 cases) were Tibetan, and 79.4% (139 cases) were from Guoluo Prefecture. 73.7% (129 cases) were herdsmen, and 58.3% (102 cases) were illiterate. The major clinical symptoms included upper abdominal pain, yellowing of skin and mucosa, and scleral icterus. 69.1% of the lesions were located in bilateral livers, and 63.4% of the cases have 2 and more lesions. 53.7% of the cases have their inferior vena cava involved by the lesions. In addition, the most affected neighboring organ was diaphragmatic muscle (21.7%), and lung was the most affected distant metastatic site (40.6%). Conclusions Advanced hepatic alveolar echinococcosis is highly prevalent in Guoluo Prefecture, Qinghai Province. Screening of this disease is required in this region and rational treatment scheme should be developed.
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Objective To investigate the clinical characteristics of patients with advanced hepatic alveolar echinococcosis, so as to provide more evidence for the diagnosis and treatment of advanced hepatic alveolar echinococcosis. Methods The clinical records of 175 cases with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from 2012 to 2017 were retrospectively reviewed. Results Among the 175 cases with hepatic alveolar echinococcosis, the male to female ratio was 1∶1.6, and the mean age was (38.6 ± 12.9) years (range, 11 to 69 years). 93.7% of the patients (164 cases) were Tibetan, and 79.4% (139 cases) were from Guoluo Prefecture. 73.7% (129 cases) were herdsmen, and 58.3% (102 cases) were illiterate. The major clinical symptoms included upper abdominal pain, yellowing of skin and mucosa, and scleral icterus. 69.1% of the lesions were located in bilateral livers, and 63.4% of the cases have 2 and more lesions. 53.7% of the cases have their inferior vena cava involved by the lesions. In addition, the most affected neighboring organ was diaphragmatic muscle (21.7%), and lung was the most affected distant metastatic site (40.6%). Conclusions Advanced hepatic alveolar echinococcosis is highly prevalent in Guoluo Prefecture, Qinghai Province. Screening of this disease is required in this region and rational treatment scheme should be developed.