盐酸左旋咪唑片治疗儿童皮肤蝇蛆病的效果分析

Effect of levamisole hydrochioride tablets in treating skin myiasis in children

目的探讨盐酸左旋咪唑片对儿童皮肤蝇蛆病的治疗效果。方法收集2010年9月至2014年9月于四川省阿坝州人民医院治疗的38例皮肤蝇蛆病患儿的临床资料进行回顾性分析。所有患儿均口服盐酸左旋咪唑片和肾上腺皮质激素，观察该病的发病机制、临床表现及诊治效果，比较治疗前后患儿白细胞计数、嗜酸细胞百分比、高敏C反应蛋白（hs—CRP）水平和肝功能变化（天冬氨酸转氨酶、丙氨酸转氨酶），并进行安全性评价。结果38例患儿均有牲畜密切接触史，临床典型症状为肌肉疼痛、发热、虫体爬出患儿皮肤后所造成的皮肤损害、多发性皮下结节、皮肤呈现游走性的刺痛等，且皮肤的损害呈现多发性。38例患儿经过治疗后，24例蝇蛆自行从皮肤下钻出，10例蝇蛆使用钳夹取出，4例蝇蛆切开取出。所有患儿中有28例痊愈出院，10例患儿出院后仍有蝇蛆排出的情况而进行复诊，1周后，该10例患儿的蝇蛆完全排净。治疗后，患儿白细胞计数、嗜酸细胞百分比、高敏C反应蛋白水平均明显低于治疗前[（9．4±1．6）×109／L比（13．6±2．6）×109／L、（4．2±0．7）％比（6．1±2．0）％、（0．39±0．21）mg／L比（2．34±0．81）mg／L]，差异均有统计学意义（均P〈0．05）。治疗后，患儿天冬氨酸转氨酶、丙氨酸转氨酶与治疗前比较，差异无统计学意义（P〉0．05）。所有患儿均未出现严重不良反应，1例轻微呕吐，2例头晕，均未经治疗白行恢复。结论盐酸左旋咪唑片治疗皮肤蝇蛆病效果较好，安全性较高。

Objective To explore the effect of levamisole hydrochloride tablets in treating skin myiasis in children. Methods Clinical data of 38 children with skin maggot from September 2010 to September 2014 who received levamisole hydrochloride tablets and adrenal cortex hormone were retrospectively analyzed. The white blood cell count, percentage of eosinophils, high-sensitivity C-reactive protein （hs-CRP） levels and liver function （aspartate aminotransferase, alanine aminotransferase） were detected before and after treatment; the safety was also evaluated. Results All 38 cases had close contact with animals. The typical clinical symptoms included muscle pain, fever, skin lesions after polypide climbing out of the skin, multiple subcutaneous nodules, migratory pricking, and multiple skin damage. The maggots drilled from the skin in 24 cases, were taken out using forceps in 10 cases, were taken out by incision. Twenty-eight cases were cured, maggots still discharged in 10 cases and completely drained 1 week later. After treatment, the white blood cell count , hs-CRP, IL-6, TNF-α were signifi- cantly reduced compared with pretreatment [ （9.4 ± 1.6） × 109/L vs （ 13.6 ±2.6） × 109/L, （4.2 ±0.7）% vs （6.1 ±2.0）%,（0.39 ±0.21）mg/L vs （2.34 ±0.81）mg/L] （P〈0.05）. After treatment, the aspartate aminotransferase and alanine aminotransferase were not significantly changed （P 〉 0.05 ）. No serious adverse events were observed; mild vomiting occurred in 1 case, dizziness occurred in 2 cases. Conclusion The effect of levamisole hydrochloride tablets in treating children＇s skin myiasis is well with high safety.