北京市6例输入性曼氏血吸虫病临床特点分析  

Clinical features of imported schistosomiasis mansoni in Beijing City:a report of 6 cases

作　　者：邹洋[1] 王磊[1] 李小丽[1] 田小军[1] 李威[1] 安亦君 齐志群[1] 李晶晶[1] 王非[1] 黄敏君[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,北京100050

出　　处：《中国血吸虫病防治杂志》2017年第2期150-154,共5页Chinese Journal of Schistosomiasis Control

基　　金：北京市医院管理局临床技术创新项目(XMLX201502);北京市卫生系统高层次卫生技术人才培养计划(2015-3-010);国家临床重点专科建设项目

摘　　要：目的分析6例输入性曼氏血吸虫病患者的临床特点,为提高临床医师的诊治水平提供资料依据。方法收集2009年1月-2016年7月确诊的6例输入性曼氏血吸虫病患者的临床资料,并进行分析。结果 6例输入性曼氏血吸虫病患者均有明确的流行病学史。主要临床表现为发热和嗜酸性粒细胞增高,50%患者伴有腹泻;肠黏膜组织压片均可以找到曼氏血吸虫卵,但日本血吸虫IgG抗体阳性率仅为33.3%。所有患者CD3^+CD8^+T细胞比例明显下降,B细胞比例明显上调,血免疫球蛋白以IgG抗体为主;16.6%的患者腹部超声见腹腔积液或脾脏增厚,16.6%患者磁共振检查见肝脏出现多发小结节或肠壁增厚,所有患者电子结肠镜检查均可见结肠炎,其中66.6%的患者合并多发溃疡,肠黏膜病理学均可见大量嗜酸性粒细胞浸润。6例患者经吡喹酮治疗后均达到临床治愈标准。结论本文通过系统总结6例输入性曼氏血吸虫病患者的流行病学史、临床和实验室多方面资料,为提高临床医师对该病的认知及诊治水平提供依据。Objective To analyze the clinical features of 6 patients with imported schistosomiasis mansoni,including the epidemic history,clinical manifestations,laboratory tests and therapeutic effect,so as to provide references for improving the levels of diagnosis and treatment of physicians. Methods The clinical data of 6 patients with imported schistosomiasis mansoni from January 2009 to July 2016 were collected and analyzed. Results All the 6 imported patients with schistosomiasis mansoni had a clear history of cercarial infested water exposure. The main manifestations were continuous fever and eosinophilia. Three （50%）patients were accompanied with diarrhea. Anti-Schistosoma japonicum IgG antibody were cross positive in 2（33.3%）pa-tients,while live eggs of S. mansoni were explored in intestinal mucosa specimens of all the patients. CD3＋CD8＋T cell ratio was decreased significantly but B cell ratio was elevated in all the patients,and the main immunoglobulin of the patients was IgG. Hydroperitoneum and splenomegaly signs were discovered by abdominal ultrasonography in 16.6%（1/6）of the patients. Multi-ple liver nodules and wall thickening of rectum and sigmoid colon were revealed by pelvic MR scan in 16.6%（1/6）of the pa-tients. Colitis was found in all the patients,and 66.6%（4/6）of the patients were combined with multiple colonic ulcers by the electronic colonoscopy examination. Chronic inflammation and eosinophil infiltration were found in all the patients by rectum pa-thology. All 6 patients were cured with chemotherapy named praziquantel. Conclusion Comprehensive analysis of clinical data including epidemiological history,specific manifestations,laboratory tests and intestinal mucosa pathology may be benefit of the management of schistosomiasis mansoni.

关 键 词：曼氏血吸虫病 嗜酸性粒细胞 病原学检测 吡喹酮 输入性病例 北京市 

分 类 号：R532.21[医药卫生—内科学]