中国寄生虫学与寄生虫病杂志 ›› 2010, Vol. 28 ›› Issue (3): 12-217.

• 实验研究 • 上一篇    下一篇

浙江省1 060例晚期血吸虫病患者近况调查及救治

张剑锋, 闻礼永*, 朱明东, 严晓岚, 陈文, 李理, 林丽君, 俞丽玲   

  1. 浙江省医学科学院寄生虫病研究所,杭州 310013
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-06-30 发布日期:2010-06-30

Recent Investigation and Treatment of 1 060 AdvancedSchistosomiasis Cases in Zhejiang Province

ZHANG Jian-feng, WEN Li-yong*, ZHU Ming-dong, YAN Xiao-lan,
CHEN Wen, LI Li, LIN Li-jun, YU Li-ling
  

  1. Institute of Parasitic Diseases, Zhejiang Academy of Medical Sciences, Hangzhou 310013, China
  • Received:1900-01-01 Revised:1900-01-01 Online:2010-06-30 Published:2010-06-30

摘要: 【摘要】 目的 了解浙江省晚期血吸虫病患者(简称晚血患者)近况,开展诊治并为今后的病例管理提供依据。 方法 2007年选择有现症晚血患者分布的杭州、嘉兴、绍兴、金华和衢州等5市24个县(市、区)和其它流行县(市、区),采用问卷调查(调查内容包括患者基本信息、既往血吸虫病史等)、 内科体检(腹水征、肝脾触诊)、 血吸虫病血清学检测(间接红细胞凝集试验或斑点金免疫渗滤法或ELISA任选其一)和尼龙绢袋集卵孵化结合沉渣涂片镜检法粪检、腹部超声(肝脾大小、有无腹水及肝纤维化分级)等对历史在册晚血患者和有血吸虫病史患者中的晚血患者进行筛查和确认,对确诊的晚血患者给予对症治疗。 结果 在7市32县(市、区)共确诊晚血患者1 060例,主要分布在水网型流行区,以农民居多,患者家庭经济状况较差。1 060例患者平均年龄(66.3±9.3)岁,以50~80岁年龄组最多,占89.3%。临床分型为巨脾型占71.3%(756/1 060),腹水型占27.6%(292/1 060),结肠增殖型占0.9%(10/1 060),侏儒型占0.2%(2/1 060)。自愿接受内科治疗救助共1 023人,接受救治率为96.5%。对接受救助人员问卷调查结果显示,98.1%的患者曾接受过化疗,69.4%的患者曾出现过严重并发症,52.5%的患者伴有其他系统疾病。目前71.1%的患者有自觉症状。内科体检发现65.2%的患者肝肿大并伴不同程度的肝纤维化,534例未切脾者中有63.5%的患者脾肿大。血吸虫病血清学检测抗体阳性率为15.7%(161/1 023)。用尼龙绢袋集卵孵化结合涂片镜检法粪检均为阴性。38例直肠活检中有24例发现有变性血吸虫虫卵。对1 023例晚血患者给予消除腹水、减轻门脉高压等对症治疗,经过3年救治,有74.3%的患者症状和体征得到缓解,救治效果良好。 结论 浙江省晚血患者病情仍重,50~80岁年龄组为重点,需长期规范救治并给予关怀。

关键词: 晚期血吸虫病, 现状调查, 救治, 浙江省

Abstract:

【Abstract】 Objective To understand the current status of advanced schistosomiasis patients, deliver medical treatment, and improve the case management in Zhejiang Province. Methods The cases previously diagnosed or suspected as advanced schistosomiasis in the province were the subjects of the investigation. Questionnairing (demographical information, disease history, etc.), clinical examination (ascites syndrome, abdominal palpation), laboratory examination (blood biochemistry, anti-Schistosoma japonicum antibody, eggs), and ultrasonography of the abdomen were used confirming the diagnosis. Treatment was given to the patients. Results There were 1 060 advanced schistosomiasis patients in 32 counties of 7 prefectures in the province. Majority of them distributed in water network regions, and lived with poor economic conditions. The average age of the patients was (66.3±9.3), with 89.3% ranged from 50 to 80 years old. Clinically 71.3% of the cases were with splenomegaly, 27.6% with ascites, 0.9% cases of multiple granuloma in the colon and 0.2% cases with dwarfism. 1 023 patients (96.5%) had received medical treatments. 69.4% of the cases had serious complications with advanced schistosomiasis and 52.5% had concurrently disorders in other systems. 71.1% of the patients had subjective symptoms and 65.2% had hepatosplenomegaly with hepatic fibrosis and dysfunction. The serum positive rate of antiS. japonicum antibody was 15.7%. Stool hatching test and microscopy revealed no eggs in fecal samples, but 24 out of 38 cases were found metamorphic eggs by rectal biopsy. Three years′ medical treatment improved the clinical conditions in 74.3% of the cases. Conclusion Situation of the advanced schistosomiasis patients is quite critical. Treatment and care are urgently needed especially for those aged 50 to 80 years old.

Key words: Advanced schistosomiasis, Investigation, Treatment, Zhejiang Province