以肝脏呈低密度占位性改变的1例非典型肝吸虫病例报道
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摘要
目的分析1例肝脏呈低密度占位性改变的非典型肝吸虫病病例的诊治过程,为该表现的肝吸虫病的及时就诊、早期诊断和对症治疗提供参考。方法回顾性分析2018年深圳市人民医院收治的1例肝脏呈低密度占位性改变的非典型肝吸虫病病例的流行病学、临床表现、辅助检查、诊治情况。结果该患者有明确的肝吸虫流行区居住史,曾在该地食用鱼生。其呈发热、腹痛、周身不适、白细胞及嗜酸性粒细胞增加,腹部CT提示肝S6可疑片状密度减低;查寄生虫抗体检查,提示肝吸虫IgG抗体阳性。结论肝吸虫因主要以胆道受累,胆囊息肉,胆结石和胆道梗阻,合并肝胆管扩张为主,但也有极少部分患者是以肝脏本身的病理改变为主,如遇以肝脏变化为主,但又有肝吸虫特征的患者时应注意考虑该疾病,以免漏诊及耽误治疗。
Objective To analyze the diagnosis and treatment of a case of atypical hepatic clonorchiasis with low density lesions in order to provide reference for the timely diagnosis, early diagnosis and symptomatic treatment of hepatic clonorchiasis.Methods Epidemiology, clinical manifestation, auxiliary examination, diagnosis and treatment of a case of atypical hepatic paragonimiasis with low density space occupying change in 2018 in Shenzhen People′s Hospital were analyzed retrospectively.Results the patient had a clear history of habitation of paragonimiasis and had eaten fish in the area. It showed fever, abdominal pain, body discomfort, increased white blood cells and eosinophils. Abdominal CT suggested that the liver S6 was suspected to be reduced in lamellar density, and the parasite antibody test showed that IgG antibody was positive in trematodes hepatica.Conclusion the main causes of paragonimiasis are biliary tract involvement, gallbladder polyps,gallstones and biliary obstruction, combined with hepatobiliary dilatation, but only a few of the patients are mainly pathological changes of the liver itself, such as liver changes. However, patients with hepatic trematosis should consider the disease in order to avoid missed diagnosis and delayed treatment.
Objective To analyze the diagnosis and treatment of a case of atypical hepatic clonorchiasis with low density lesions in order to provide reference for the timely diagnosis, early diagnosis and symptomatic treatment of hepatic clonorchiasis.Methods Epidemiology, clinical manifestation, auxiliary examination, diagnosis and treatment of a case of atypical hepatic paragonimiasis with low density space occupying change in 2018 in Shenzhen People′s Hospital were analyzed retrospectively.Results the patient had a clear history of habitation of paragonimiasis and had eaten fish in the area. It showed fever, abdominal pain, body discomfort, increased white blood cells and eosinophils. Abdominal CT suggested that the liver S6 was suspected to be reduced in lamellar density, and the parasite antibody test showed that IgG antibody was positive in trematodes hepatica.Conclusion the main causes of paragonimiasis are biliary tract involvement, gallbladder polyps,gallstones and biliary obstruction, combined with hepatobiliary dilatation, but only a few of the patients are mainly pathological changes of the liver itself, such as liver changes. However, patients with hepatic trematosis should consider the disease in order to avoid missed diagnosis and delayed treatment.
引文
[1]钱门宝,周晓农,方悦怡,等.加强中国华支睾吸虫病研究[J].中国寄生虫学与寄生虫病杂志,2011,29(3):211-214.
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[12]KIM B G,KANG D H,CHOI C W,et al.A case of clonorchiasis with focal intrahepatic ductdilatation mimicking an intrahepatic cholangiocarcinoma[J].Clin Endosc,2011,44(1):55-58.
[13]HUANGS Y,ZHAOG H,FUB Q,et al.Genomics and molecular genetics of Clonorchis sinensis:Current status and perspectives[J].Parasitol Int,2012,61(1):71-76.
[2]卢艳,许学年,冯正,等.肝吸虫与肝胆疾病[J].国际医学寄生虫病杂志,2007,34(2):107-112.
[3]BAIMAB,STICHERLING M.Demodicidosis revisited[J].Acta Derm Venereol,2002,82(1):3-6.
[4]MORSYT A,FAYADM E,MORSYA T,et al.Demodex folliculorum causing pathological lesions in immunocompetent children[J].JEgypt Soc Parasitol,2000,30(3):851-854.
[5]李朝品,田晔.百特药液体外抑杀人体蠕形螨作用的实验研究[J].中国病原生物学杂志,2007,2(5):374-376.
[6]李朝品,田晔.百特药液体外抑杀人体蠕形螨作用的实验研究[J].中国病原生物学杂志,2007,2(5):374-376.
[7]李坊贞,张文斌.人体肝吸虫病的地域分布特点和规律的研究[J].赣南医学院学报,2008,28(2):297-300.
[8]中华人民共和国卫生部.华支睾吸虫病诊断标准:WS309-2009[S].北京:中华人民共和国卫生部,2009.
[9]黄嘉殷,方小衡.华支睾吸虫感染与肝胆疾病的关系[J].热带医学杂志,2010,10(2):226-228.
[10]陈祖泽,方悦怡,张启明,等.华支睾吸虫感染与急性胆囊炎的关系-流行区调查与临床资料分析[J].中国寄生虫病防治杂志,1997,10(1):31-33.
[11]黄尉梅,温媛,郭生梅,等.华支睾吸虫病82例超声所见[J].热带医学杂志,2001,1(2):152-153.
[12]KIM B G,KANG D H,CHOI C W,et al.A case of clonorchiasis with focal intrahepatic ductdilatation mimicking an intrahepatic cholangiocarcinoma[J].Clin Endosc,2011,44(1):55-58.
[13]HUANGS Y,ZHAOG H,FUB Q,et al.Genomics and molecular genetics of Clonorchis sinensis:Current status and perspectives[J].Parasitol Int,2012,61(1):71-76.