肝吸虫病不典型临床特征初探  

Preliminary exploration on the clinic features of atypical Clonorchis sinensis

作　　者：邹洋[1] 王非[1] 王磊[1] 李小丽[1] 齐志群[1] 栗绍刚[1] 冯曼玲[1] 

机构地区：[1]首都医科大学附属北京友谊医院北京热带医学研究所,热带病防治研究北京市重点实验室,北京市100050

出　　处：《热带病与寄生虫学》2014年第1期18-20,23,共4页Journal of Tropical Diseases and Parasitology

基　　金：北京市科委首都临床特色应用研究专项资助项目(Z20130309020037);首都医科大学附属北京友谊医院院启动课题(yyqdkt2011-29);国家临床重点专科建设项目资助

摘　　要：目的分析不典型肝吸虫病的临床、影像和实验室特征,以减少肝吸虫病的误诊和漏诊。方法通过对4例小典型肝吸虫病的流行病学史、临床表现和实验室检查,肝吸虫血清学和病原学检测情况的详细报道和分析及治疗效果的评价,归纳总结不典型肝吸虫病的临床和实验室特点。结果非疫区临床患者,血嗜酸性粒细胞增高和(或)血IgE水平增高者,在临床上要考虑寄生虫感染的可能;如影像上早期有以肝细胞坏死为主要病理损伤的临床表现,体现为肝脏呈片状低密度占位性改变,要排除外肝吸虫感染的可能,完善肝吸虫相关血清学和病原学诊断,必要时可试验性驱虫治疗。结论在非肝吸虫病流行区患者,如有不明原因的血嗜酸性粒细胞增高,影像上为肝脏呈片状低密度占位性改变,要加强肝吸虫病的鉴别诊断意识,即使在试验性杀虫治疗过程中,也不能忽视粪便中继续寻找病原学依据的必要。减少肝吸虫病的临床误诊和漏诊。Objective To analyze the clinical, imaging and laboratory features for the atypical Clonorchis sinensis, and reduce misdiagnosis and missed diagnosis of Clonorchis sinensis. Methods Four atypical Clonorchis sinensis cases were analyzed on the epidemiological history, clinical manifestations and laboratory examination, serological and pathogenic detection, and the effect of treatment was evaluated. The clinical and laboratory features for the atypical Clonorchis sinensis were summarized. Results Patients from non- endemic regions with higher level of eosinophilia and lgE should be considered the possibility of parasitic infection. The clinical manifestations reflected in imaging as patchy low density occupying changes in the early stage, which indicated the pathological injury of hepatocyte necrosis, should be excluded the possibility of Clonorchis sinensis infection. The serological and pathogenic diagnosis of Clonorchis sinensis should be perfected, and it could be necessary for the patients with trial anthelmintic treatment. Conclusion The differential diagnosis of Clonorchis sinensis should be strengthened for the patients from non- endemic regions with higher level of eosinophilia and patchy low density occupying changes in liver by imaging. It was necessary to detect Clonorchis sinensis eggs in feces even if in the trial anthelmintic treatment process, and the rate of misdiagnosis and missed diagnosis of Clonorchis sinensis could be reduced.

关 键 词：肝吸虫病 临床表现 实验室检查 影像 

分 类 号：R532.2[医药卫生—内科学]