67例肺吸虫病病人临床分析  

Analysis of clinical features of 67 paragonimiasis patients

作　　者：黄美颖[1] 雷文婷[1] 田茂强[1] 束晓梅[1] 刘晖[2] 

机构地区：[1]遵义医学院附属医院,贵州563003 [2]遵义医学院寄生虫教研室

出　　处：《医学动物防制》2017年第7期742-744,F0004,共4页Journal of Medical Pest Control

基　　金：国家自然科学基金(31260286)

摘　　要：目的分析肺吸虫病住院病人的临床特征,提高对肺吸虫病的临床诊治水平。方法回顾分析2012-2016年在某院住院确诊的肺吸虫病病人的临床资料,总结其临床表现、诊疗情况及随访病情转归。结果住院肺吸虫病病人共67例,其中未成年病人56例,成年病人11例,男性47例、女性20例,年龄3~60岁(平均12岁);其中64例病前有疫源接触史;起病症状:45%(30/67)为咳嗽、气促,27%(18/67)为发现体表包块,19%(13/67)为头痛、呕吐,6%(4/67)体检发现胸腔积液,6%(4/67)为肝脏病变,1%(1/67)反复皮疹,1%(1/67)发现眼睑肿胀。辅助检查:88%(59/67)外周血嗜酸性粒细胞增高,42%(28/67)肺吸虫血清抗体检查阳性,15例病灶活检:11例皮下包块、2例颅内病及2例肝脏病变活检符合肺吸虫病病理改变。36例合并浆膜腔积液,17例行胸腔穿刺,其中13例胸水乳酸脱氢酶(Lactate dehydrogenase,LDH)>1 000 U/L,8例腺苷脱氨酶(Adenosine deaminase,ADA)大于45 U/L。治疗:67例病人均诊断为肺吸虫病,予吡喹酮治疗,均取得较好疗效。结论肺吸虫病发病呈逐年上升趋势,且临床可多系统受累,易误诊,应详细询问病史尤其生活饮食习惯,结合病人血嗜酸粒细胞增多、影像学及肺吸虫特异免疫学等检查,早诊断、早治疗,改善病人预后。Objective To analyse the clinical features of inpatients diagnosed with paragonimiasis in the local area,in order to improve the diagnosis and treatment levels of clinicians. Methods We performed a retrospective analysis of clinical data of inpatients with paragonimiasis in different types from 2012 to 2016. The data of clinical characterisitics,treatments and prognosis were collected. Results Toal of 67 patients with paragonimiasis were included,among them 56 minor and 11 adults,47 males and 20 females. Age of onset ranged from 3 to 60 years,with average of 12 years. 64 patients had eaten un-fully cooked freshwater crabs or drank un-boiled water before diagnosis. Most of them were lived in the Chishui River in Guizhou Province which was located in the lower reaches of Changjiang River. 45% of the patients onset with a cough and tachypnea as the first symptoms,19% began with CNS symptoms like headache and vomit,27%（18/67） were discovered by superficial masses,6%（4/67）found pleural effusion during physical examination,6%（4/67） and 1%（1/67） started with recurrent rash and liver lesions respectively. Laboratory findings： 88%（59/67） patients had increased peripheral eosinophil count,42%（28/67） patients were positive in para gonimous antibody tests. 15 patients had undergone biopsy（15 skin lesions,two intracranial lesions,two liver biopsy） and all were confirmed to have paragonimiasis-specific changes. 36 patients had serous effusion,17 underwent pleural puncture,and 13 were LDH positive,8 had ADA over 45 U/L. Treatment： all patients were diagnosed with paragonimiasis and treated with praziquantel,had 0. 5 ~ 2 years of follow-up,and everyone had satisfying outcome. Conclusion The incidence of paragonimiasis is increasing in our local area,multiple organs and systems could be affected,it is easy to misdiagnose,most of the patients were preschool kids,praziquantel was available. History of ingesting uncooked food and water is important and should be inquired carefully,increased eosinophil

关 键 词：肺吸虫病 治疗 吡喹酮 误诊 

分 类 号：R532.22[医药卫生—内科学]