云南省宾川县28例大片形吸虫病患者的临床分析

Clinical analysis of 28 cases with Fasciola gigantica from Binchuan County in Yunnan Provence

目的探讨大片形吸虫病患者的临床特点、诊断及治疗方法。方法回顾性分析28例大片形吸虫病患者的流行病学资料、临床表现、实验室检查结果、影像学表现、肝脏病理和诊断以及治疗转归情况。结果 28例大片形吸虫病患者均来自宾川县州城镇,有家庭聚集现象,以农民青壮年为主(19/28 67.86%),主要表现发热(100%),肝区疼痛及叩痛(100%),嗜酸性粒细胞增多(100%),球蛋白升高(100%),肝肿大(82.14%,23/28),WBC计数升高、贫血(92.86%,26/28);CT/MRI均提示肝实质内散在多发低密度影,肝占位性病变;全粪便水洗沉淀法检查检出片形吸虫虫卵4例;ELISA检测显示,患者大片吸虫可溶性抗原,26例患者阳性率为100%(26/26)。三氯苯达唑治疗该病疗效显著。结论宾川县为大片形吸虫病的自然疫源地,诊断要重视流行病学史,三氯苯达唑是治疗的首选药物,预防的关键是把好"病从口入"的关口,少吃或不吃半生食/生食,加强牲畜的治疗和放牧管理,防止粪便污染;灭螺,消灭和改造椎实螺孳生环境。

Objective To investigate the clinical features, diagnosis and treatment of Fasciolosis gigantica. Methods Total of 28 cases with Fasciola gigantica were analyzed, retrospectively with epidemiological information, clinical performance, laboratory results, imaging findings, hepatic pathology, diagnosis, treatment and the outcome. Results The 28 cases with Fasciola gigantica were all from Zhoucheng Town, Binchuan County, all with family gathered phenomenon, mostly occurring in young farmers（19/28, 67.86%）, mainly showed fever（100%）, liver area pain and percussion pain（100%）, increased eosinophils（100%）, globulin（100%）, hepatomegaly（82.14%, 23/28）, high WBC anemia（92.86%, 26/28）. The images of CT and MRI both showed scattered multiple low density liver lesions in the liver parenchyma. The whole stool washing precipitation method detected four cases of fascioliasis eggs. Serum soluble antigen of Fasciola gigantica of patients was detected by enzyme-liked immunosorbemt assay（ELISA） and the eggs of Fasciola gigantica in stool were observed under micamplificatian. Triclabendazole was remarkable curative effect of treatment. Conclusions Binchuan County is the natural epidemic foci of Fasciola gigantica, the diagnosis should pay attention to the epidemiological history, triclabendazole is the first line choice of treatment drugs for the disease, the key of prevention is to avoid getting disease by the mouth, eat less or not to eat half-raw food or raw food, strengthen the treatment of livestock and grazing management, prevent faecal contamination; snail control, elimination and transformation of the Lymnaea breeding environment.