脑型血吸虫病临床病理分析

Clinicopathological analysis of cerebral schistosomiasis

目的研讨脑型血吸虫病的临床病理学特征,以提高临床对该病的诊治水平。方法回顾分析经病理证实的20例脑型血吸虫病临床表现、实验室检查、影像学特征、病理学特征和随访结果。结果20例均来自疫区,有颅内高压症状,影像学均提示颅内占位性病变,血吸虫酶联免疫试验3例阳性,显微镜下20例均有血吸虫虫卵沉积,可见活的虫卵周围弥漫性嗜酸性粒细胞及淋巴细胞、浆细胞浸润,可见嗜酸性脓肿和假结核结节形成,病灶周围脑组织水肿,神经元变性坏死。结论嗜酸性脓肿和以退变虫卵为中心的结核样结节是脑型血吸虫病的主要病理特征。有血吸虫疫水接触史和颅内高压的症状,影像学表现为颅内占位性病变的病例要考虑到脑型血吸虫病。

Objective To explore the clinical and pathologic characteristics of cerebral schistosomiasis for improving the diagnosis and treament level of cerebral schistosomiasis. Methods The clinic features,experimental data,image characteristic, pathological feathures of 20 cases of cerebral schistosomiasis were analysed retrospectively,clinical follow up was collected. Results 20 cases came from schistosomiasis epidemic area,all of them presented intracranial hypertension and intracranial nodutar focus on image,3 cases＇s blood fluke ELISA were postive ,microscopically,schistosomal ova were detected in the brain,there were heavy infiltration of eosinophilics, lymphocytes, plasmacytes, epithilioid cells round lively schistosomal ova. Eosinophilic abscess and pseudotubercle were seen. Cerebral edema round nodular focus,neuron degeneration and necrosis. Conclusion Eosinophilic and psedotubercle are main pathological features of cerebral schistosomiasis. If patients from schstosomal area have symptoms of intracranial hypertension and present intracranial nodular focus on image, the diagnosis of cerebral schistosomiasis should be considered.