25例重症广州管圆线虫病患者的临床观察

Clinical Observation on 25 Cases of Severe Angiostrongyliasis Cantonensis

目的观察广州管圆线虫病重症患者的临床表现。方法2006年6～9月北京市广州管圆线虫病局部暴发,观察分析25例重症患者的症状、体征、辅助检查及预后等。结果流行病学调查,发病前均有食生或半生的福寿螺螺肉史。发热是早期症状之一(16例,占64.0%),其中低、中、高热分别为8、7、1例。神经系统受损较重:①均有头痛(呈持续性、搏动性、胀痛或针刺样)且阵发性加剧。其中全头痛14例(占56.0%),局部头痛11例(占44.0%),多在枕部;②颈部均有强直感及轻度抵抗,但病理反射阴性,其中伴恶心、呕吐12例(占48.0%);③皮肤感觉异常(如刺痛、灼痛、麻木感等)20例(占80.0%),其中5例剧烈疼痛伴局部痛觉过敏,3例麻木,2例温度觉减退;④视神经受损及视觉障碍11例(占44.0%),其中畏光3例,视物模糊5例,复视、视野缺损和飞虫征各1例;⑤面神经损伤,4例(占16.0%)鼻唇沟变浅,口角歪斜。2例(占8.0%)单侧眼睑不能闭合;⑥听神经受损,阵发性或持续性耳鸣4例。实验室检查,外周血及脑脊液嗜酸粒细胞增高。头颅磁共振(MRI)检查14例(占56.0%),均见软脑膜线状强化异常信号或脑实质强化灶。胸部CT检查7例(占28.0%),肺部有小结节影和斑片状毛玻璃影典型改变。出院后1～3个月随访,7例(占28.0%)皮肤仍有刺痛感,1例伴胸、腹部冷、热感觉异常,3例偶有头痛,1例有视野缺损。结论广州管圆线虫病重症患者中枢神经系统受损较重,神经根损伤恢复期较长。

Objective To summarize the clinical features of severe angiostrongyliasis cantonensis （AC） patients. Methods Clinical data on symptoms,physical signs,auxiliary examination and prognosis of 25 severe AC patients hospitalized in June-Sept 2006 were analyzed. Results Epidemiologically,all cases had eaten uncooked fresh water snails. One of the early symptoms was fever （16 cases,64.0%）,including 8 cases with low-grade fever,7 cases with mid-range fever,and 1 case high fever. Nervous system manifestation：① All cases had headache,entire headache （56.0%）or partial（44.0%）,especially in occipitalis. ② Patients had distinct degree neck rigidity,with negative pathologic reflex;12 cases had nausea and vomiting（48.0%）. ③ 20 cases（80.0%） had skin paresthesia,5 had severe pain and hyperalgia on skin;3 cases with skin numbness,and 2 with thermohypesthesia. ④ 11 cases（44.0%）appear distinct degree depraved vision;3 cases had photophobia,5 with blur vision,1 each with diplopia,defect of field vision or bug sign,respectively. ⑤ Nasolabial groove became shallow and distortion of commissure in 4 cases （16.0%）,and 2 cases（8.0%）couldn’t close up eyelid. ⑥ 4 cases had sustained or durative tinnitus. Laboratory examination showed that eosinophilic granulocytes increased in both peripheral blood and cerebrospinal fluid. Skull MRI for 14 cases revealed linear enhancement in local meninx or abnormal enhancement in cerebral parenchyma. Chest CT examination in 7 cases showed nodule shadow and spot flaky ground-glass shadow in lungs. One and 3 months after being discharged from hospital,12 patients（48.0%） still had sequelaes——7 cases had tingling sensation on skin,1 case had temperature sensation dysfunction on the skin of chest and abdomen,3 cases had headache occasionally,and 1 case still had defect of field vision. Conclusion Central nervous system has been impaired in the angiostrongyliasis cantonensis patients who may need a longer convalescent period.