儿童肺吸虫病临床、病理及影像学分析  

Clinical, pathologic and radiologic analysis of paragonimiasis in children

作　　者：刘琦[1] 章虎[1] 赵一呜[2] 周玲玲[3] 高宝辉[3] 陈益平[1] 

机构地区：[1]温州医科大学附属第二医院儿童感染科,325027 [2]温州医科大学附属第二医院儿童外科 [3]温州医科大学附属第二医院病理科

出　　处：《中华病理学杂志》2017年第2期108-111,共4页Chinese Journal of Pathology

摘　　要：目的分析儿童肺吸虫病的临床、病理及影像学特征，以提高临床诊治水平。方法收集温州医科大学附属第二医院2002至2016年确诊的31例儿童肺吸虫病（分为温州市县组14例及外来流动儿童组17例），分析其临床、病理、影像学等特征及诊疗情况。结果流动儿童组血清免疫球蛋白E[IgE（2379±944）IU／mL]明显高于温州市县组（1552±1121）IU／mL，二者差异具有统计学意义（t=-2．23，P〈0．05）；流动儿童组治疗天数（13．8±6．5）d明显高于温州市县组（9．9±3．4）d，二者差异有统计学意义（t=-2．15，P〈0．05）。所有患儿中10例为多浆膜腔积液，表现为不同程度的胸腔积液、腹腔积液及心包积液；5例肺吸虫脑病，MRI示异常多位于顶叶，T1WI呈稍低信号，囊壁呈等灰质信号，T2WI呈高信号，周围可见水肿带，Gd-DTPA增强后可见明显环形强化。病理学发现活虫体2条，见较多的嗜酸性粒细胞浸润及肺吸虫虫体移行遗留的隧道。所有患儿肺吸虫血清抗体均阳性。结论流动儿童组，临床表现多样，出现多型并存，病情严重复杂；温州市县组表现为单一型，疗程短，治疗效果显著。儿童肺吸虫病临床表现无明显特异性，对于早期发现嗜酸性粒细胞增高显著，或不明原因的多浆膜腔积液，应立即进行全身反复细致检查和针对性实验室检查，做到早诊断早治疗，避免发生严重并发症。Objective To analyze the clinical, pathological and radiological characteristics of paragonimiasis in children for accurate diagnosis and therapy. Methods A total of 31 patients with paragonimiasis treated from 2002 to 2016 were selected ,including 17 cases from migrant areas and 14 cases from Wenzhou area. Results In migrant children group, the serum IgE was significantly higher than that in Wenzhou area group [（2 379±944） IU/mL： （1 552±1 121） IU/mL, t= -2.23,P〈0.05], and the duration of therapy was remarkable longer [ （ 13.8 ± 6. 5 ） days： （9. 9 ± 3.4） days, t = - 2. 15, P 〈 0. 051. Among all cases, 10 showed polyserositis including pleural effusion, ascites and perieardial effusion at different degrees on chest CT scans. Five cases with cerebral paragonimiasis were confirmed by MR imaging. Most of the lesions were located in the parietal lobe with slight low signal on T1WI but high signal on T2WI surrounded by disproportionate edema. Annular enhancement was prominent by Gd-DTPA. Paragonimiasis serum antibody was positive in all cases by ELISA. Pathologic features included formation of irregular lacunae or sinus tracts, presence of paragonimus bodies, and eosinophilic infiltration in the adjacent tissues. Conclusions Clinical manifestations of paragonimiasis are complex and non-specific in children. In migrant children group, clinical manifestations are diverse, more serious with more complications and difficulties in treatment, while patients in Wenzhou area group have favorable prognosis and less complicated treatment. The early diagnosis and timely treatment should be determined by patient＇s detailed history, eosinophilic count, radiologic findings and immunological test to avoid serious complications.

关 键 词：肺疾病 儿童 病理状态 体征和症状 

分 类 号：R725.3[医药卫生—儿科]