脑寄生虫病24例临床特点分析

Clinical characteristics of 24 cases with parasitic encephalopathy

目的分析脑寄生虫病的流行病学、临床特点、治疗和转归情况,提出诊疗中常见难题的解决措施。方法回顾性分析第三军医大学大坪医院2004年11月至2011年6月收治24例脑寄生虫病的临床资料。结果 24例脑寄生虫病中脑囊虫病7例(29.17%)、脑包虫病3例(12.50%)、脑血吸虫病8例(33.33%)、脑肺吸虫病6例(25.00%);脑包虫病中2例有牧区生活史,有生食肉、青蛙、鱼虾蟹史8例(33.33%);手术联合口服肠虫清治疗脑包虫病效果优于单纯口服肠虫清患者;脑寄生虫病多脑叶发病常见,脑肺吸虫病伴发胸腔积液多见;脑血吸虫病、脑囊虫病经口服吡喹酮结合应用糖皮质激素可治愈;病灶累及脑干者,治疗效果欠佳。结论脑寄生虫病的发病同生活区域、个人生食习惯有一定关系;准确诊断是治疗关键,确诊主要依靠临床表现、头颅MR增强扫描结合血清免疫学结果;对于无条件进行血清免疫学检查或血清免疫学检查阴性者,诊断性治疗是较好选择。

Objective To analyze the epidemiology, clinical characteristics, therapeutic treatments and outcomes of the brain parasitic disease, and reveal the common problems and possible solutions during therapeutic treatment. Methods Clinical data of 24 cases with brain parasites from November 2004 to June 2011 in Daping Hospital,Third Military Medical University were retrospectively analyzed. Results Of the 24 cases, 7 cases （ 29. 17% ） were neurocysticercosis, 3 cases （ 12. 50% ） cerebral hydatid disease, 8 cases （33.33%） cerebral schistosomiasis, and 6 cases （25.00%）cerebral paragonimiasis. Of the cerebral hydatid disease, 2 cases had an ex- perience of living in pastoral areas,8 cases had a history of eating raw meat, fish, shrimp and crab. Surgery combined with oral alben- dazole tablet was better than simple oral albendazole tablet. Multilobar parasites were common in brain parasitic disease, and cerebral paragonimiasis were always accompanied with pleural effusion. Cerebral schistosomiasis and cerebral cysticercosis can be cured with oral praziquantel and the combination of glucocorticoids. However, the treatment is ineffective when lesions were involved the brain stem. Conclusion Cerebral parasitic diseases is related to the living area,personal hygiene and eating habits. Accurate diagnosis is the key for treatment of cerebral parasitic diseases. It mainly relies on clinical manifestations, cranial MRI and immunological studies to make a definite diagnosis. Diagnostic treatment is a better choice for those who have no condition to conduct the serological test or who are nega- tive in serological test.