湖南省2011年新增晚期血吸虫病患者现状调查及救治

Investigation and Treatment of Newly Discovered Advanced Schistosomiasis Cases in Hunan Province in 2011

目的了解湖南省2011年新增晚期血吸虫病(晚血)患者的流行病学特征和病情特点。方法通过问卷调查和体检,了解全省2011年新增晚血患者的基本情况、既往史、现病史、救治情况和转归。结果 2011年湖南省新增晚血患者620例,其中病例最多的3个地区分别是岳阳市(300例,占48.4%)、常德市(193例,占31.1%)和益阳市(123例,占19.8%)。男女比为1.4∶1,平均年龄为(60.4±12.4)岁,小学及以下文化程度者432例(占69.7%),主要职业为农民,占90.3%(560/620)。劳动能力丧失者162例(占26.1%),减弱者442例(占71.3%)。从发现感染到确诊为晚期血吸虫病的平均时间为(24.9±14.3)年。620例患者中,腹水型占67.4%(418/620),巨脾型占32.4%(201/620),结肠增厚型占0.2%(1/620),无侏儒型。查体发现,腹壁静脉显露者172例(占27.7%),肝质地硬者144例(占23.2%),脾质地硬者21例(占3.4%)。B超显示,肝实质纤维化Ⅲ级的患者368例(占59.4%)。620例患者中,接受内科医疗救助者577例(占93.1%),接受外科医疗救助者43例(占6.9%)。经过救治,410例(占66.1%)患者症状和体征明显好转,210例(占33.9%)患者未见明显好转。结论湖南省新增晚血患者主要分布于历史重度流行区,且以中老年农民为主,确诊时健康状况普遍较差。

Objective To understand the epidemiological characteristics and current status of newly comfirmed advanced schistosomiasis patients in Hunan Province in 2011. Methods The cases previously diagnosed or suspected as advanced schistosomiasis in Hunan Province were the subjects of this investigation. Questionnairing （demographical information, disease history, etc.）, clinical examination （ascites syndrome, abdominal palpation）, laboratory examination, and abdomenal uhrasonography were used to confirm the diagnosis. Treatment was given to the patients. Results In 2011, there were 620 newly discovered advanced schistosomiasis patients in Hunan Province, mainly distributed in Yueyang （300 cases, 48.4%）, Changde （193 cases, 31.1%） and Yiyang （123 cases, 19.8%）. The male-to-female ratio was 1.4： 1. The average age of the patients was 60.4＋12.4. 69.7% （432/620） of the patients were illiterate or with primary school education. 90.3% （560/620） of them were farmers. 162（26.1%） cases were labour incapacity and 442 cases （71.3%） were with a weak labor ability before receiving medical treatment. The average time from discovery of schistosome infection to diagnosis of advanced schistosomiasis was （24.9＋14.3） years. Among the 620 patients, 418 cases were with ascites （67.4%）, 201 cases with splenomegaly （32.4%）, and 1 case with multiple grannloma in the colon （0.2%）. 172 cases （27.7%） were with visible abdominal vein, 144 cases （23.2%） with a hard liver texture, and 3.4% （21/620） cases with a hard spleen texture. Abdominal uhrasonography showed that 59.4% （368/620） of the patients were with grade m hepatic fibrosis. 577 cases （93.1%） received medical treatments and 43 cases （6.9%） received surgical treatment. After the trealment, the clinical symptoms and signs of 410 cases （66.1%） were improved and 210 cases （33.9%） needed furthertreatment, Conclusion Newly comfirmed advanced schistosomiasis patients in Hunan Province are mostly distributed in historically endemic areas, mainly middle-aged and older farmers, and generally in poor health when diagnosed.