脑型寄生虫病43例临床分析

Forty-three cases of cerebral parasitic disease

目的分析、探讨脑型寄生虫病的诊断及治疗。方法回顾性分析我院2005-2013年间收治的脑型寄生虫43例,对其临床诊断、治疗及转归进行分析。结果 43例患者中囊虫病16例(占37.21%),血吸虫病13例(占30.23%),弓形虫病5例(占11.63%),曼氏裂头蚴病5例(占11.63%),广州管圆线虫病1例(占2.33%),其他寄生虫病3例(占6.98%)。其中治愈6例(13.95%),好转27例(62.79%),无变化5例(11.63%),自动出院3例(6.98%),加重1例(2.33%),死亡1例(2.33%)。结论脑型寄生虫病的诊断,应综合流行病学史,不当饮食史、血象(尤其关注嗜酸粒细胞异常增高)、症状,头颅CT或MRI检查(同时排除其他脑部疾患),和免疫学、病理学及病原学等检查结果判断。其治疗以药物治疗为主,对颅内高压或药物治疗无效者可考虑手术治疗。

We discuss the clinical diagnosis and treatment of cerebral parasitic diseases in this paper.The clinical diagnoses,treatments and outcomes of 43 cases with cerebral parasitic diseases admitted into our hospital from 2005 to 2013 were retrospectively analyzed.Result showed that 16 had cerebral cysticercosis （37.21％） among the 43 patients,13 had cerebral schistosomiasis （30.23 ％）,5 had cerebral toxoplasmosis （11.63 ％）,5 had cerebral sparganosis mansoni （11.63 ％）,1 had cerebral Guangzhou Angiostrongylus disease （2.33％）,and 3 were infected by some other parasites （6.98％）.After treatment,6 patients were cured （13.95 ％）,27 were under an improved condition （62.79 ％）,5 showed no significant improvement of their symptoms （11.63 ％）,3 were discharged before the end of the treatment periods （6.98 ％）,1 had an aggravated condition （2.33％）,1 was dead （2.33％）.Results suggested that the epidemiological history should be considered in diagnosing cerebral parasitic diseases since that patients with CNS symptoms and with CT or MRI evidences showing cranial parasite infection （and at the same time other cerebral diseases were excluded） should be highly suspected for cerebral parasitic diseases,together with immunology and pathology results.The mainstay of treating cerebral parasitic diseases is medication.Surgery can be an option for those patients who are not responding to medication or having an elevated intracranial pressure.