摘要
目的 分析在我科诊断的3例特殊的华支睾吸虫病患者临床特点,以提高对此病的认识.方法 回顾性分析在我科诊断的3例华支睾吸虫感染伴肺浸润的嗜酸粒细胞增多患者的临床表现、实验室结果、影像表现、病理、治疗及转归.结果 3例患者均为中老年人,男2例,女1例,平均年龄为56.7岁,均有吃鱼生史.3例患者均慢性起病,均以肺部症状为主要表现.例1表现为刺激性干咳6个月,夜间明显,伴有盗汗.例2发作性喘息2年余,解痉平喘治疗效果差.例3活动后气促2年,且出现多脏器受损甚至功能衰竭的表现.前2例患者肺部可闻及哮鸣音.3例患者经肺活检证实嗜酸粒细胞肺浸润和外周血嗜酸粒细胞计数增高,大便找肝吸虫卵(+),血清肝吸虫抗体(+).经吡喹酮治疗后病情好转.结论 对来自肝吸虫病流行区,有吃鱼生史,患者以肺部症状起病,不能用肺部常见疾病来解释,抗炎、抗结核、抗真菌和解痉平喘治疗无效时,同时伴有周围或组织嗜酸粒细胞明显增多,就要考虑到肝吸虫感染引起的肺部疾病的可能.大便找到肝吸虫卵、肝吸虫酶标抗体阳性是肝吸虫病的可靠诊断方法.吡喹酮是治疗肝吸虫病安全、有效的药物.
Objective To investigate the clinical features of three unusual cases of clonorchiasis diagnosed in our department.Methods The clinical symptoms,physical examinations,laboratory data,imaging findings,pathological characteristics and treatment of three patients with clonorchiasis combined with pulmonary infiltration and eosinophilia were retrospectively analyzed.Results The mean age of three patients was 56.7 years old,they had a history of ingestion of raw fish and a chronically clinical manifestations of pulmonary symptom.The first patient had irritating cough for six months,especially at night,accompanied with night sweats.The second patient had paroxysmal wheezing for more than two years,the effect of spasmolytic antiasthmatic treatment was poor.The third patient had shortness of breath for two years,and multiple organ damage or failure.The first two cases had wheezing rale in the lung.The lung biopsy result showed eosinophilic infiltration in the lung and increased eosinophil count in the peripheral blood of the three cases.The examination for clonorchis sinensis ova and clonorchis-specific antibody were positive.Their condition improved after treatment with praziquantel.Conclusions For the patients who are from the epidemic area of clonorchiasis,have a history of eating raw fish,have pulmonary symptoms not be explained by common lung diseases,are accompanied by significantly increased eosinophils in peripheral blood or tissue,and the anti-inflammatory,anti-tuberculosis,antifungal and antispasmodic treatment is invalid,it may be considered as the lung disease caused by clonorchis sinensis infection.The detection of clonorchis sinensis ova and clonorchis-specific antibody is a reliable diagnostic method of clonorchiasis.Praziquantel is safe and effective drug for treatment of clonorchiasis.
出处
《国际呼吸杂志》
2015年第8期570-575,共6页
International Journal of Respiration