双叶槽绦虫肠道感染患者的临床表现特征分析

doi:10.12140/j.issn.1000-7423.2023.04.010

中国寄生虫学与寄生虫病杂志 ›› 2023, Vol. 41 ›› Issue (4): 459-463.doi: 10.12140/j.issn.1000-7423.2023.04.010

双叶槽绦虫肠道感染患者的临床表现特征分析

李小丽(), 栗绍刚, 吴赵永^*()

首都医科大学附属北京友谊医院北京热带医学研究所，北京 100050

收稿日期:2023-02-01 修回日期:2023-04-04 出版日期:2023-08-30 发布日期:2023-09-06
通讯作者: *吴赵永（1969-），男，本科，主管技师，从事热带病及寄生虫病病原体的检验及研究。E-mail：wzy_l@126.com
作者简介:李小丽（1980-），女，博士研究生，副主任医师，从事热带病及寄生虫病的诊治及其病原体的基础研究。E-mail：lixiaoli@ccmu.edu.cn
基金资助:
国家自然科学基金(81702018);首都医科大学附属友谊医院启动基金(yyqdkt2018-34)

Clinical characteristics of patients with intestinal Diphyllobothrium tapeworm infection

LI Xiaoli(), LI Shaogang, WU Zhaoyong^*()

Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Received:2023-02-01 Revised:2023-04-04 Online:2023-08-30 Published:2023-09-06
Contact: *E-mail: wzy_l@126.com
Supported by:
National Natural Science Foundation of China(81702018);Research Foundation of Beijing Friendship Hospital, Capital Medical University(yyqdkt2018-34)

摘要/Abstract

摘要：

目的总结并分析双叶槽绦虫肠道感染病例的临床表现及实验室指标变化特征。方法收集2009年1月—2022年7月在北京友谊医院确诊的18例双叶槽绦虫感染病例的病历资料，包括性别、年龄、流行病学史（居住地、国外旅居史及饮食习惯）、临床表现、入院期间血常规、肝功能、粪便虫卵检测和虫种鉴定、治疗和预后等，对双叶槽绦虫感染的临床特点进行总结，并分析比较其实验室指标差异。结果 18例感染病例中男性、女性各9例，平均年龄为（28.88 ± 11.57）岁，年龄最小为8岁，最大为47岁。流行病学调查结果显示，其中12例为北京本地病例，6例来自其他省份；7例有国外旅居史；所有病例均有食生/半生鱼肉或牛肉史。确诊的18例双叶槽绦虫感染病例临床表现为腹痛、腹胀症状6例，头晕2例，肛周瘙痒、体质量下降均未见，无症状10例。炎性指标白细胞、C-反应蛋白及血沉均未见异常，贫血指标红细胞和血红蛋白未见降低，嗜酸粒细胞未见升高。肝功能指标均未见升高。粪检查见双叶槽绦虫虫卵8例，所有病例粪样中均可见到节片。给予中药槟榔-南瓜子疗法进行驱虫治疗，均治愈。结论双叶槽绦虫感染病例多无临床症状或轻微的消化道症状，血常规及肝功能检测均未见明显异常，可结合粪检等病原学检查和流行病学调查进行早期诊断。

关键词: 双叶槽绦虫, 感染, 临床特点, 流行病学, 食源性寄生虫病

Abstract:

Objective To summarize and analyze the characteristics of clinical manifestation and laboratory indicators of patients with intestinal infection of Diphyllobothrium tapeworm. Methods The medical record, including gender, age, epidemiological history (residence, history of overseas traveling and dietary habits), clinical manifestation, laboratory examinations when admitted (blood routing test, liver function, fecal examination for parasite eggs, and parasite species identification), treatment record and prognosis were collected from 18 diphyllobothriasis cases diagnosed at the Beijing Friendship Hospital, Capital Medical University from January 2009 to July 2022. Information on patients' clinical features and the changes in laboratory findings were summarized and analyzed. Results The 18 cases included 9 male and 9 female respectively, of them the age ranged from 8 to 47 years with an average of (28.88 ± 11.57) years. Epidemiological inquiry indicated that 12 cases were locals from Beijing, while 6 patients were from other provinces, among them 7 patients had overseas traveling history, and all patients had history of consuming raw/undercooked fish meat and beef. The clinical manifestation of the 18 cases were abdominal pain and distension in 6 cases, and dizziness in 2 cases, whereas anal pruritus and body weight loss were not seen, and 10 were asymptomatic. The inflammatory indicator of leukocyte count, C-reactive protein, erythrocyte sedimentation rate, anemia indicator of erythrocyte and hemoglobin, eosinophils count, and liver function showed no abnormal changes. Fecal examination found Diphyllobothrium tapeworm eggs in the samples from 8 cases, and proglottids from all cases. Deworming regime with Chinese medicine areca-pumpkin seed cured all patients. Conclusion Most of the cases infected with Diphyllobothrium tapeworm are asymptomatic or showed only mild gastrointestinal symptoms, with no significant abnormal changes in blood routine test and liver function examination. Early diagnosis could be made by fecal examination etiologically and epidemiological inquiry.

Key words: Diphyllobothrium, Infection, Clinical characteristics, Epidemiology, Food-borne parasitic diseases

中图分类号:

R532.31

李小丽, 栗绍刚, 吴赵永. 双叶槽绦虫肠道感染患者的临床表现特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(4): 459-463.

LI Xiaoli, LI Shaogang, WU Zhaoyong. Clinical characteristics of patients with intestinal Diphyllobothrium tapeworm infection[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(4): 459-463.

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参考文献 19

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临床特点 Clinical characteristics	例数 No. cases (n = 18)
腹痛、腹胀 Abdominal pain and distension	6
头晕 Dizziness	2
无症状 Asymptomatic	10
排节片史 Passage of proglottids	18
病程 Duration of disorder
< 6个月 < 6 months	11
≥ 6个月 ≥ 6 months	7
就诊前服用驱虫药物 Use of albendazole before hospitalization	7
随访时间（> 1年） Follow-up period in years (> 1 year)	18
预后（痊愈） Outcome (recurrence)	18

检测指标 Variable	平均值（最小值，最大值） Mean（Minimum, Maximum）	参考值范围 Range of normal values
外周血常规 Routine blood tests
白细胞 White blood cell（WBC，× 10⁹/L）	5.79 (3.49, 8.39)	3.50~9.50
红细胞 Red blood cell（RBC，× 10¹²/L）	4.77 (4.07, 5.69)	4.30~5.80
血红蛋白 Hemoglobin（HGB，g/L）	142.31 (121.00, 168.00)	130~175
嗜酸粒细胞 Eosinophils（EOS，× 10⁹/L）	0.24 (0.08, 0.65)	0.02~0.52
炎性指标 Inflammatory indicators
C-反应蛋白 C-reactive protein (CRP，mg/L)	3.33 (0.63, 9.00)	0~8
血沉 Erythrocyte sedimentation rate（ESR，mm/h)	9.60 (5.00, 14.00)	0~20
肝功能检测 Liver function tests
丙氨酸转氨酶 Alanine aminotransferase (ALT，U/L)	14.75 (8.00, 32.00)	9~50
天冬氨酸转氨酶 Aspartate aminotransferase (AST，U/L)	17.33 (10.90, 20.90)	15~40
白蛋白 Albumin (ALB，g/L）	42.11 (37.30, 47.70)	40~55

双叶槽绦虫肠道感染患者的临床表现特征分析

Clinical characteristics of patients with intestinal Diphyllobothrium tapeworm infection

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