1例以急性严重肝脏损害为主要表现的并殖吸虫病
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摘要
并殖吸虫(Paragonimus)在我国主要有卫氏并殖吸虫(Paragonimus westermani)和斯氏狸殖吸虫(Pagumogonimus skrjabini)两种。斯氏狸殖吸虫导致的并殖吸虫病(俗称肺吸虫病)临床表现复杂。本文报告1例以急性腹胀、纳差、尿黄、黄疸为主要表现的斯氏狸殖吸虫病,经病史、体检、辅助检查、斯氏狸殖吸虫皮试确诊。经吡喹酮驱虫治疗结合护肝、退黄、降酶治疗治愈。提示在斯氏狸殖吸虫流行区肝脏损害病例需要注意排除斯氏狸殖吸虫感染因素,详细的病史询问、注意血常规化验中的嗜酸性粒细胞计数、斯氏狸殖吸虫皮试是确诊的关键,驱虫治疗联合相关治疗可以治愈斯氏狸殖吸虫导致的肝脏损害。
Paragonimus westermani and Pagumogonimus skrjabini are two main paragonimiasis species in our country. The clinical manifestations of paragonimiasis caused by Pagumogonimus skrjabini are more complex. This article reports a case of paragonimiasis caused by Pagumogonimus skrjabini mainly for acute abdominal distension,anorexia,dark urine,jaundice,and conformed by history,physical examination,laboratory examinations and Pagumogonimus skrjabini skin test. It is cured by treatment with praziquantel and combined with liver protection,yellowing and enzyme reduction. This study implied that liver damage cases need to pay attention to exclude Pagumogonimus skrjabini infection factors. The key to confirmation includes detailed medical history enquiries,attention to eosinophil counts in routine blood tests,and test for larvae. Deworming therapy combined with related treatments can cure liver damage caused by Pagumogonimus skrjabini.
Paragonimus westermani and Pagumogonimus skrjabini are two main paragonimiasis species in our country. The clinical manifestations of paragonimiasis caused by Pagumogonimus skrjabini are more complex. This article reports a case of paragonimiasis caused by Pagumogonimus skrjabini mainly for acute abdominal distension,anorexia,dark urine,jaundice,and conformed by history,physical examination,laboratory examinations and Pagumogonimus skrjabini skin test. It is cured by treatment with praziquantel and combined with liver protection,yellowing and enzyme reduction. This study implied that liver damage cases need to pay attention to exclude Pagumogonimus skrjabini infection factors. The key to confirmation includes detailed medical history enquiries,attention to eosinophil counts in routine blood tests,and test for larvae. Deworming therapy combined with related treatments can cure liver damage caused by Pagumogonimus skrjabini.
引文
[1]刘雪艳,严晓峰,吕圣秀,等. 14例肺吸虫病误诊为结核的原因及胸部CT表现分析[J].临床肺科杂志,2018,23(1):119-122.
[2]肖纯凌,赵富玺.病原生物学和免疫学[M]. 7版.北京:人民卫生出版社,2014:244-247.
[3]朱名胜,朱敬,朱艳霞,等.丹江口库区肺吸虫病流行现状调查[J].中国热带医学,2011,11(11):1308-1309.
[4]朱名胜,宋明华,王绍基.湖北省十堰市斯氏肺吸虫病324例诊治报告[J].中国病原生物学杂志,2008,3(3):165,169.
[5]朱名胜,朱艳霞,宋明华,等.南水北调工程库区斯氏肺吸虫病流行病学调查[J].中国病原生物学杂志,2007,2(4):256,259.
[6]张光玉,郭鄂平.十堰地区肺吸虫病区域分布及流行病学[J].湖北医药学院学报,1997,16(1):22-24.
[7]宋明华,朱名胜,耿家荣,等.斯氏肺吸虫成虫抗原皮内试验实用价值的探讨[J].医学动物防制,2006,22(1):1-2.
[8] DE FRAIN M,HOOKER R. North American paragonimiasis:case report of a severe clinical infection[J]. Chest,2002,121(4):1368-1372.
[9]朱霞,杨丽,唐红.肝肺吸虫病误诊为肝脓肿1例[J].临床荟萃,2016,31(10):1144-1146.
[10]蔡迪明,李永忠,林铃,等.肝脏占位的肝肺吸虫病的超声诊断价值[J].中国临床医学影像杂志,2007,18(9):670-671.
[11]郝瑞安,王德华,余列,等.肝肺吸虫病误诊肝癌1例[J].肿瘤预防与治疗,2008,21(2):231-232.
[12]尚兰,邢悦,孔维芳,等.肝肺吸虫误诊为肝癌一例[J].中华放射学杂志,2007,41(10):1149.
[13]赵贺红,冯萍.肝肺吸虫病误诊为肝癌并腹腔多发转移1例[J].中华肝脏病杂志,2014,22(4):309-310.
[14]何生,钟晓刚,宋彬,等.肝良性占位病变误诊为肝癌33例分析[J].腹部外科,2004,17(4):222-223.
[15]刘武剑,何伟,高鸿哲,等.斯氏肺吸虫导致肝损伤2例报告[J].寄生虫病与感染性疾病杂志,2009,7(3):174-175.
[2]肖纯凌,赵富玺.病原生物学和免疫学[M]. 7版.北京:人民卫生出版社,2014:244-247.
[3]朱名胜,朱敬,朱艳霞,等.丹江口库区肺吸虫病流行现状调查[J].中国热带医学,2011,11(11):1308-1309.
[4]朱名胜,宋明华,王绍基.湖北省十堰市斯氏肺吸虫病324例诊治报告[J].中国病原生物学杂志,2008,3(3):165,169.
[5]朱名胜,朱艳霞,宋明华,等.南水北调工程库区斯氏肺吸虫病流行病学调查[J].中国病原生物学杂志,2007,2(4):256,259.
[6]张光玉,郭鄂平.十堰地区肺吸虫病区域分布及流行病学[J].湖北医药学院学报,1997,16(1):22-24.
[7]宋明华,朱名胜,耿家荣,等.斯氏肺吸虫成虫抗原皮内试验实用价值的探讨[J].医学动物防制,2006,22(1):1-2.
[8] DE FRAIN M,HOOKER R. North American paragonimiasis:case report of a severe clinical infection[J]. Chest,2002,121(4):1368-1372.
[9]朱霞,杨丽,唐红.肝肺吸虫病误诊为肝脓肿1例[J].临床荟萃,2016,31(10):1144-1146.
[10]蔡迪明,李永忠,林铃,等.肝脏占位的肝肺吸虫病的超声诊断价值[J].中国临床医学影像杂志,2007,18(9):670-671.
[11]郝瑞安,王德华,余列,等.肝肺吸虫病误诊肝癌1例[J].肿瘤预防与治疗,2008,21(2):231-232.
[12]尚兰,邢悦,孔维芳,等.肝肺吸虫误诊为肝癌一例[J].中华放射学杂志,2007,41(10):1149.
[13]赵贺红,冯萍.肝肺吸虫病误诊为肝癌并腹腔多发转移1例[J].中华肝脏病杂志,2014,22(4):309-310.
[14]何生,钟晓刚,宋彬,等.肝良性占位病变误诊为肝癌33例分析[J].腹部外科,2004,17(4):222-223.
[15]刘武剑,何伟,高鸿哲,等.斯氏肺吸虫导致肝损伤2例报告[J].寄生虫病与感染性疾病杂志,2009,7(3):174-175.