以胸腔积液为主要表现的20例儿童肺吸虫病临床分析

Clinical analysis of 20 cases of the children paragonimiasis with pleural effusion as the main manifestation

目的分析以胸腔积液为主要表现的儿童肺吸虫病临床特征,以提高临床诊治水平,减少误诊可能。方法回顾2005年2月—2015年2月在宜昌市中心人民医院儿科确诊的20例以胸腔积液为主要表现的儿童肺吸虫病,分析其临床表现及诊疗情况。结果 20例患儿中14例有明确生食溪蟹或疫水接触史,3例有吃蛄史,3例原因不明。以发热、咳嗽为最常见症状,分别占70%及85%,其次为肝肿大和腹痛,多浆膜腔积液及皮下结节偶见。20例患儿外周血嗜酸性粒细胞绝对数及百分比均升高(最高达70%),肺吸虫血清抗体均阳性,胸片或胸部CT均提示胸腔积液。结论儿童肺吸虫病临床表现复杂,应详细询问不洁饮食及疫水接触史,结合临床表现、血嗜酸性粒细胞计数、实验室及影像学检查做到早期诊断及相应治疗。

Objective To analyze the clinical characteristics of children paragonimiasis with pleural effusion as the mainperformance in order to improve the clinical diagnosis and treatment, and reduce misdiagnosis. Methods Review data from20 cases of children paragonimiasis with pleural effusion as the main performance were collected in Pediatrics Department ofYichang Central People＇s Hospital from February 2005 to February 2015 to analyze the clinical manifestations,diagnosis andtreatment. Results Fourteen cases had eaten raw brook crabs or had contact history with infected water, 3 cases with ahistory of eating crayfish and 3 cases with unknown reasons. The most common symptoms were fever and cough, whichaccounted for 70.2% and 85.6% respectively; secondly were hepatomegaly and bellyache, and polyserositis and subcutaneousnodules were rarely seen. Absolute number and percentage of 20 children with peripheral eosinophil were increased（up to70%）.Paragonimiasis serum antibodies were positive and pleural effusion was prompted by chest X- ray or chest CT.Conclusion Clinical characteristics of children paragonimiasis with pleural effusion is complex, the diagnosis call for details ofunclean food and contact history of infected water. Early diagnosis and appropriate treatment should be done combined with theclinical manifestation, blood eosinophil count, laboratory and imaging examinations.