预防肺吸虫病临床误诊的研究进展

Progress on prevention and misdiagnosis of paragonimiasis

对肺吸虫病(LFD)临床诊治进展进行综述,旨在预防LFD误诊和误治。在万方数据、维普网和中国知网以“肺吸虫病(LFD)”为检索词,检索时间为2009年1月至2019年6月,对检出文献进行筛查、整理、综合,共检出文章155篇,其中以“误诊”为文章标题共94篇(58.06%)。LFD首次确诊率仅11.4%,误诊率高达68.75%~88.60%。误诊原因为对LFD流行病学现状认识不足,询问病史、体格检查不仔细,对实验室和影像学检查缺乏科学的分析,缺乏有效的确诊手段。通过分析文献,结合作者经验,采取以下措施可以预防误诊:一是强化“三基”(基本理论、基本知识、基本技能)训练,科学询问现病史、个人史,寻找肺吸虫入侵的蛛丝马迹;二是强化“三基”体检训练如注意胸肺型LFD“体征与体温分离现象”;三是强化“三基”常规化验、影像结果的分析训练,识别白细胞(WBC)和嗜酸性粒细胞(EOS)异常变化;四是开展易于推广肺吸虫抗原和抗体检测如肺吸虫抗原皮内试验(PAI)等;五是关注传染病流行病学变化。通过详细、科学病史询问,细致的体格检查,科学分析实验室指标和影像结果,进行必要的抗原抗体检测,LFD的误诊是可以避免的。

To review the progression of clinical diagnosis and treatment in paragonimiasis (LFD),and to avoid the misdiagnosis and mistreatment. Total of 155 articles from Wanfang, Weipu and CNKIDatabases were retrieved from January 2009 to June 2019 with the key word of “Paragonimiasis”. Therewere 94 (58.06%) articles of headlines including “misdiagnosis”. The rate of first diagnosis was only11.40%, and the misdiagnosis rate was as high as 68.73%-88.60%. The causes of misdiagnosis includedinsufficient understanding of the epidemiology of LFD, carelessness in history-taking and physicalexamination, lack of the scientific analysis of laboratory and imaging examination and definitive diagnosticmethod. By reviewing the related literatures and combining clinical experience, the following measurescould be taken to prevent misdiagnosis: firstly, strengthen the “three bases”(basic theory, basic knowledge,basic skills) training, the current medical history, personal history of scientific inquiries, looking for cluesto the invasion of paragonimiasis;secondly, strengthen the “three-base” physical examination training suchas attention to chest and lung type LFD “signs and body temperature separation phenomenon”;thirdly,strengthen the “three-base” routine test, imaging results analysis training, identification of white blood cell(WBC) and eosinophil (EOS) abnormal changes;fourthly, to develop the method to promote paragonimusantigen and antibody detection such as paragonimus antigen intradermal test (PAI);Fifthly, pay attentionto the epidemiological changes of infectious diseases. The misdiagnosis of LFD could be avoided with themedical history in detailed, careful physical examination, scientific analysis on laboratory and imaging results, and necessary antigen-antibody detection.