50例并殖吸虫病相关性浆膜腔积液患者临床特征

Clinical analysis of 50 cases of serous cavity effusion related with paragonimiasis

目的分析并殖吸虫病相关性浆膜腔积液患者的临床特征,为提高临床诊治水平提供参考依据。方法收集2015-2017年在西南医科大学附属医院诊治的50例并殖吸虫病相关性浆膜腔积液患者临床资料,进行回顾性分析。结果50例并殖吸虫病相关性浆膜腔积液患者中,男性35例,女性15例;儿童35例,成人15例;18例有明确疫源接触史。儿童患者中,有呼吸道症状者占68.6%(24/35),有消化道症状者占22.9%(8/35),无明显症状者占8.6%(3/35)。成人患者中,有呼吸道症状者占93.3%(14/15),腹胀者占6.7%(1/15)。血清抗并殖吸虫抗体均为阳性。胸片和CT检查主要表现为肺部炎性渗出、浆膜腔积液。25例(50.0%)患者外周血嗜酸性粒细胞(Eos)增高,12例浆膜腔积液镜见大量Eos,7例胸膜刷片见较多Eos浸润。给予引流积液、吡喹酮抗并殖吸虫治疗均治愈。结论并殖吸虫病临床表现特异性不明显,常合并浆膜腔积液,临床易误诊为结核、恶性肿瘤等。外周血、浆膜腔积液和胸膜Eos增高需考虑并殖吸虫感染可能。

Objective To analyze the clinical characteristics of serous cavity effusion related with paragonimiasis,so as to improve the physician＇s ability of the clinical diagnosis and treatment. Methods The clinical data of 50 cases of serous cavity effusion related with paragonimiasis diagnosed in a hospital in recent 3 years were collected and retrospectively analyzed. Re.sults Among the 50 patients,there were 35 males and 15 females,and 35 children and 15 adults. Eighteen patients had a clear history of exposure to the foci. Among the children,the respiratory symptoms accounted for 68.6%（24/35）,gastrointesti.nal symptoms for 22.9%（8/35）,and no apparent symptoms for 8.6%（3/35）;among the adults,the respiratory symptoms ac.counted for 93.3%（14/15）and the abdominal distention for 6.7%（1/15）. The paragonimus antibody was positive in all the pa.tients. The chest radiography or CT showed pulmonary inflammatory exudation and serous cavity effusion. Eosinophilia in blood was found in 25 cases,a large number of eosinophils in serous cavity effusion were found under microscopy in 12 cases,and eo.sinophil infiltration of pleura was found in 7 cases. All were cured after the patients received chemotherapy（praziquantel）and drainage fluid. Conclusions The clinical manifestations of paragonimiasis are not very specific and paragonimiasis is often ac.companied with serous cavity effusions. Clinically,paragonimiasis is easily misdiagnosed as tuberculosis or cancer. We should consider about the possibility of paragonimiasis when eosinophil is high in blood,serous cavity effusion and pleura.