肺吸虫病临床病理分析

Clinicopathologic analysis of paragonimiasis

目的 探讨肺吸虫病临床与病理特点以及鉴别诊断。方法 回顾性分析临床诊断的9例肺吸虫病,结合文献,对患者的流行病学、临床及病理特点进行分析。结果 9例中4例来自东北疫区,5例来自北京。8例有明确的不洁饮食史,全部或大部分具有以下症状:发热、胸闷或胸痛、痰中带血。9例共同的病理特点:形成不规则坏死腔穴和窦道,可见Charcot-Leyden结晶,部分可见虫体和(或)虫卵,外周可见广泛的大量嗜酸粒细胞浸润。结论 肺吸虫病发病范围扩大,由于旅游等原因人口流动增加,在城市中的散发病例有所上升;组织中找到虫体和(或)虫卵即可确诊。有其他典型病理特点时,结合病史及免疫学、影像学资料亦可诊断;综合临床病史、实验室检查,适当结合病理检查,可以将其与肺结核、肺部肿瘤进行鉴别。

Objective To study the clinical manifestations and pathologic findings of paragonimiasis. Methods Nine cases of paragonimiasis diagnosed in the Peking Union Medical College Hospital during the past 20 years were studied, with literature review and analysis of the epidemiological, clinical and pathologic characteristics. Results Of the 9 cases studied, 4 came from the northeast China and 5 from Beijing. Eight cases had a history of eating raw crabs. Most had symptoms including fever, chest discomfort or pain, and hemoptysis or rusty sputum. All had the following common pathologic features; formation of irregular lacunae or sinus tracts, Charcot-Leyden crystals, sometimes paragonimus body parts and / or eggs, and eosinophil infiltration in the adjacent tissues. Conclusions Paragonimiasis is not as uncommon as previously thought. The incidence is increasing in some cities due to movement of populations. The pathological diagnosis can be confirmed by finding paragonimus body parts and/or eggs. Diagnosis can also be made by correlation with other typical pathologic features, clinical history, immunologic findings and radiography. Paragonimiasis needs to be differentiated from pulmonary tuberculosis and cancer.