目的 分析片形吸虫病与原发性肝癌患者的临床特征，为两种疾病早期鉴别诊断提供参考。方法 收集2014年1月1日—2024年12月31日大理大学第一附属医院收治的片形吸虫病患者110例和原发性肝癌患者110例的临床资料，比较两组患者的临床特点、实验室指标、影像学特征及病理学表现。计量资料采用t检验或Mann-Whitney U检验，计数资料采用χ²检验或Fisher确切概率法。结果 片形吸虫病患者的发病时间主要分布于7—11月，原发性肝癌患者的发病时间全年各月均匀分布，无明显的时间分布规律。片形吸虫病患者主要来自大理白族自治州（62例，占56.4%）、丽江市（15例，占13.6%）和普洱市（13例，占11.8%）；原发性肝癌患者主要来自大理白族自治州（84例，占76.4%）、怒江傈僳族自治州（10例，占9.1%）和保山市（9例，占8.2%）。片形吸虫病患者的病程（发病至就诊时间）约3 d~1年，比原发性肝癌患者（2~60 d）长。在临床特征和实验室指标方面，片形吸虫病患者在年龄、性别、慢性乙型病毒性肝炎病史、吸烟、饮酒、发热、腹痛、腹胀、体质量减轻，甲胎蛋白、癌胚抗原、糖类抗原125、糖类抗原153、糖类抗原199、纤维蛋白原、白细胞、中性粒细胞百分比、嗜酸粒细胞百分比、嗜酸细胞绝对值、血红蛋白、血小板、总胆红素、直接胆红素、间接胆红素、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、白蛋白水平方面的差异有统计学意义（t = 10.73，χ² = 48.6、186.72、41.56、19.70、42.49、16.37、5.74、14.08， Z = -10.65、-3.03、-7.99、-6.05、-6.30、-2.65、 -5.63、-10.20、-12.00、-12.05、-2.76、-7.75、-7.70、-8.00、-6.69、-4.79、-9.02、-4.91、-2.81，均P < 0.05）。片形吸虫病患者CT显示，肝脏内多发类圆形低密度影，呈簇状分布，增强后动脉期无强化。原发性肝癌患者腹部CT显示，肝脏内结节状低密度病灶，增强后动脉期明显强化。片形吸虫病患者的病理主要表现为肝脏内见不规则隧道样坏死、嗜酸性脓肿及夏科雷登结晶。而原发性肝癌组患者的病理类型均为肝细胞癌。结论 片形吸虫病与原发性肝癌患者在发病时间、年龄分布、性别比例、实验室指标、影像学表现和病理学特征方面存在显著差异，结合流行病学和临床特征可为早期鉴别诊断提供参考。

Objective To analyze the clinical characteristics of fascioliasis and primary liver cancer patients, so as to provide insights into early differential diagnosis of these two diseases. Methdos The clinical data of 110 fascioliasis patients and 110 primary liver cancer patients admitted to The First Affiliated Hospital of Dali University during the period from January 1, 2014, to December 31, 2024 were collected, and the clinical characteristics, laboratory parameters, imaging features, and pathological manifestations were compared between the two groups. Comparisons of measurement data were done using t test or Mann-Whitney U test, while comparisons of count data were conducted with chi-square test or Fisher’s exact probability test. Results The onset date of fascioliasis patients was primarily distributed during the period from July to November, and the onset date of primary liver cancer patients was evenly distributed from January to December, without a clear-cut temporal distribution pattern. Fascioliasis patients were mainly from Dali Bai Autonomous Prefecture (62 cases, 56.4%), Lijiang City (15 cases, 13.6%), and Pu’er City (13 cases, 11.8%), and primary liver cancer patients mainly came from Dali Bai Autonomous Prefecture (84 cases, 76.4%), Nujiang Lisu Autonomous Prefecture (10 cases, 9.1%), and Baoshan City (9 cases, 8.2%). Fascioliasis patients had a disease course (from disease onset to healthcare seeking) of approximately 3 days to one year, which was longer than primary liver cancer patients (2 to 60 days). There were significant differences between fascioliasis and primary liver cancer patients in terms of age, gender distribution, proportion of a medical history of chronic viral hepatitis B, proportion of smoking, proportion of alcohol consumption, proportion of fever, proportion abdominal pain, proportion of abdominal distension, proportion of weight loss, alpha-fetoprotein level, carcinoembryonic antigen level, carbohydrate antigen 125 level, carbohydrate antigen 153 level, carbohydrate antigen 199 level, fibrinogen level, white blood cell count, neutrophils percentage, eosinophils percentage, absolute eosinophil count, hemoglobin level, platelet count, total bilirubin, direct bilirubin, indirect bilirubin, alanine aminotransferase activity, aspartate aminotransferase, gamma-glutamyl transpeptidase activity, and albumin level (t = 10.73, χ² = 48.6, 186.72, 41.56, 19.70, 42.49, 16.37, 5.74, 14.08, Z = -10.65, -3.03, -7.99, -6.05, -6.30, -2.65, -5.63, -10.20, -12.00, -12.05, -2.76, -7.75, -7.70, -8.00, -6.69, -4.79, -9.02, -4.91, -2.81, all P < 0.05). CT scans displayed multiple round-like low-density shadows in fascioliasis patients’ livers, which appeared a clustered distribution pattern; however, no enhancement was seen in the arterial phase following contrast enhancement. Contrast, abdominal CT scans displayed nodular low-density lesions with obvious enhancement in the arterial phase following contrast enhancement among primary liver cancer patients. In addition, the major pathological manifestations of fascioliasis patients included irregular tunnel-like necrosis, eosinophilic abscesses, and Charcot-Leyden crystals in the liver, while all primary liver cancer patients had a pathological type of hepatocellular carcinoma. Conclusion There are significant differences between fascioliasis and primary liver cancer patients in terms of time of disease onset, age distribution, gender ratio, laboratory parameters, imaging findings, and pathological characteristics. Combining epidemiological and clinical features may provide insights into early differential diagnosis.