四川藏区脑泡型包虫病流行病学及临床特征研究  

Epidemiology and clinical characteristics of cerebral alveolar echinococcosis in the Tibetan region of Sichuan

作　　者：李涛[1] 张伟[2] 沈良伟[2] 王翔[1] Li Tao;Zhang Wei;Shen Liangwei;Wang Xiang(Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Neurosurgery,People′s Hospital of Garze Tibetan Autonomous Prefecture(West China Hospital of Sichuan University,Garze Hospital),Kangding 626000,China)

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]甘孜藏族自治州人民医院(四川大学华西医院甘孜医院)神经外科,康定626000

出　　处：《中华神经科杂志》2023年第10期1136-1142,共7页Chinese Journal of Neurology

摘　　要：目的总结四川藏区脑泡型包虫病的流行病学及临床特征。方法回顾性研究2016年1月至2021年6月四川省甘孜藏族自治州6家医疗单位收治的脑泡型包虫病住院患者的病例特点,总结其临床表现、影像学特征等。采用简单随机抽样法抽取相等数量的肝、脑泡型包虫病例组成数据样本,通过Logistic回归分析脑泡型包虫病易感因素。结果共收集119例脑泡型包虫病患者,其中男性76例,女性43例;农民62例,牧民46例,僧人9例,学生2例。年龄(43.9±13.9)岁,主要临床表现为头晕头痛、癫痫。脑泡型包虫发病最为集中在肝泡型包虫诊断后的4年内(77/119,64.7%)。颅内包虫病灶多发者86例(72.3%),病灶平均大小2.0 cm×2.5 cm;影像学特征显示病灶主要集中在前循环供血区域,周围有宽大水肿带,增强扫描后明显强化,病灶内有多发聚集性小囊泡结构是其独特的影像特征。98例随访病例中62例(63.3%)可生活自理,死亡18例(18.4%),5年生存率约81.6%。多元回归分析结果显示易感脑泡型包虫病因素包括女性(OR=2.742,95%CI 1.039~7.236,P=0.042)、食用生肉/生水(OR=7.638,95%CI 1.216~47.966,P=0.030)、有肝包虫病史(OR=0.380,95%CI 0.178~0.811,P=0.012)以及合并其他部位包虫(OR=2.968,95%CI 1.113~7.910,P=0.030)。结论四川藏区脑泡型包虫病以农牧民患病为主,中青年女性更易感染,定期对初诊肝泡型包虫病且不合并其他部位包虫患者进行检查有助于监测预防脑泡型包虫病的发生,提高对四川藏区脑泡型包虫病的认识,从各个方面加强对脑泡型包虫病的早期诊断及防治。Objective To summarize the epidemiology and clinical characteristics of cerebral alveolar echinococcosis(CAE)in the Tibetan region of Sichuan.Methods A retrospective analysis of hospitalised cases of CAE from 6 medical units in the Garze Tibetan Autonomous Prefecture,Sichuan Province from January 2016 to June 2021 was conducted.The study focused on the characteristics,clinical presentation,and imaging features of the disease.Simple random sampling method was used to select equal number of cases of hepatic and cerebral blastomycosis to form the data sample,and the susceptibility factors of CAE were analyzed by Logistic regression.Results Out of 119 CAE patients,76 were male and 43 were female.Occupationally,62 were farmers,46 were herdsmen,9 were monks,and 2 were students.The age was(43.9±13.9)years.The primary clinical manifestations were dizziness,headaches,and epilepsy.The incidence of CAE was most concentrated within 4 years after the diagnosis of hepatic alveolar echinococcosis(77/119,64.7%).There were 86 cases(72.3%)with multiple intracranial echinococcosis lesions,with an average size of 2.0 cm×2.5 cm.The imaging features showed that the lesion was mainly concentrated in the anterior circulation blood supply area,surrounded by a wide edema band,which was significantly enhanced after enhanced scanning,and the lesion had multiple aggregated small vesicular structures as its unique imaging features.Among 98 follow-up cases,62 could live independently(63.3%),with 18 deaths(18.4%),and an approximate five-year survival rate of 81.6%.The results of multiple regression analysis showed that susceptibility factors for CAE included female(OR=2.742,95%CI 1.039-7.236,P=0.042),consumption of raw meat/raw water(OR=7.638,95%CI 1.216-47.966,P=0.030),a history of hepatic encephalopathy(OR=0.380,95%CI 0.178-0.811,P=0.012),the presence of other parts of echinococcosis(OR=2.968,95%CI 1.113-7.910,P=0.030).Conclusions CAE predominantly affects farmers and herdsmen,with a higher susceptibility among young and middle-aged individ

关 键 词：棘球蚴病 中枢神经系统寄生虫感染 少数民族卫生 流行病学 四川藏区 

分 类 号：R532.32[医药卫生—内科学]