中国寄生虫学与寄生虫病杂志

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四川地区脑囊尾蚴病94例临床分析

刘颖,胡田雨,钟册俊,吕晓菊*   

  1. 四川大学华西医院感染性疾病中心,成都 610041
  • 出版日期:2016-04-30 发布日期:2016-06-30

Clinical Analysis of 94 Patients with Neurocysticercosis in Sichuan Province

LIU Ying, HU Tian-yu, ZHONG Ce-jun, LV Xiao-ju*   

  1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
  • Online:2016-04-30 Published:2016-06-30

摘要: 目的 分析四川地区脑囊尾蚴病(neurocysticercosis,NCC)患者的临床特点,为临床诊治提供相关依据。 方法 收集2003年1月至2013年1月四川大学华西医院收治的符合NCC诊断标准的患者的临床资料,回顾性分析其流行病学、临床症状、治疗及转归等情况。 结果 符合纳入标准的NCC患者94例,其中67.0%(63/94)为男性,59.6%(56/94)为30~55岁年龄段,73.4%(69/94)有阿坝、甘孜、凉山州等少数民族聚居地旅居史,80.9%(76/94)居住在农村。NCC的临床表现以癫痫、头痛、颅内压增高为主,ELISA检测囊尾蚴抗体阳性率为96.8%(91/94),头部影像学检查(CT及MRI)95.7%出现有异常信号(90/94)。94例患者中有73例首诊疑诊为NCC,误诊率为22.3%(21/94)。诊断明确后,79例服用阿苯达唑,剂量为20 mg/(kg·d),分2次口服,疗程10 d;11例使用吡喹酮治疗,总剂量为120~180 mg/kg,3次/d × 3 d;4例使用阿苯达唑联合吡喹酮治疗。77例(81.9%)好转,其中12例(15.6%)复发。阿苯达唑治疗组出院时好转率为84.8%(6/11),高于吡喹酮组的54.6%(P<0.05)。 结论 NCC患者以青壮年男性为主,多发于少数民族地区,临床表现特异性不高,诊断需结合头部CT或MRI、囊尾蚴抗体检查,阿苯达唑治疗效果优于吡喹酮。

关键词: 脑囊尾蚴病, 诊疗, 临床分析

Abstract: Objective To analyze the clinical features of neurocysticercosis(NCC) to provide evidence for clinical diagnosis and treatment of the disease. Methods Medical records of NCC patients in the West China Hospital of Sichuan University received between January 2003 and January 2013 were reviewed retrospectively. The epidemiological data, clinical manifestations, therapeutic procedures and outcomes of the patients were analyzed. Results A total of 94 NCC patients met the recruiting criteria, of whom 67.0%(63/94) were male, 59.6%(56/94) ranged 30-55 years old, 73.4%(69/94) had a living history in endemic regions such as Aba, Ganzi and Liangshan prefectures, 80.9%(76/94) lived in rural areas. NCC was clinically characterized by epilepsy, headache and intracranial hypertension. The positive rate for anti-T. solium antibodies by ELISA was 96.8%(91/94), and the total positive scan rate of neuroimaging including CT and MRI was 95.7%(90/94). In addition, 73 patients were suspected to have NCC at the first diagnosis, with a misdiagnosis rate of 22.3%(21/94). Seventy-nine of the patients received albendazole treatment[20 mg/(kg·d), twice per day for 10 days as one treatment course, 1-3 courses as needed]. Eleven patients received praziquantel(total dose of 120-180 mg/kg, 3 times per day for 3 days as one treatment course, 1-3 courses), and 4 received a combination of albendazole and praziquantel. Symptoms improved in 77 cases(81.9%), but 12 of them(12/77, 15.6%) relapsed. The improvement rate of the albendazole group(6/11, 84.8%) was significantly higher than that of the praziquantel group(54.6%)(P<0.05). Conclusion NCC more commonly occurs in young males and lacks specific clinical manifestations. Neuroimaging combined with serum specific antibody tests is crucial for diagnosis. Albendazole has better therapeutic effects than praziquantel.

Key words: Neurocysticercosis, Diagnosis and treatment, Clinical analysis