Clinical characteristics of fascioliasis and primary liver cancer patients

doi:10.12140/j.issn.1000-7423.2025.06.009

Abstract

Abstract:

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.

Key words: Fascioliasis, Primary liver cancer, Clinical characteristic, Comparative analysis

CLC Number:

R683.2

HUANG Lihua, LI Nan, GU Wei. Clinical characteristics of fascioliasis and primary liver cancer patients[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2025, 43(6): 806-813.

Figures/Tables 7

Table 1

Table 2

Table 3

Table 4

Comparison of laboratory parameters between fasciolosisis and primary liver cancer patients

指标 Index	片形吸虫病（n = 110）Fascioliasis （n = 110）	原发性肝癌（n = 110）Primary liver cancer （n = 110）	统计值 Statistic value	P 值 P value
肿瘤标志物 Tumor marker
甲胎蛋白 Alpha-fetoprotein/ng·ml^-1	3.31（2.31,5.35）	400.00（16.26,1 210.00）	Z = -10.65	< 0.01
癌胚抗原 Carcinoembryonic antigen/ng·ml^-1	2.18（0.93,4.80）	3.06（2.16,4.80）	Z = -3.03	< 0.05
糖类抗原 Carbohydrate antigen 125/U·ml^-1	14.40（9.71,18.17）	41.89（19.18,222.90）	Z = -7.99	< 0.01
糖类抗原 Carbohydrate antigen 153/U·ml^-1	9.97（6.59,14.72）	15.84（11.24,25.39）	Z = -6.05	< 0.01
糖类抗原 Carbohydrate antigen 199/U·ml^-1	14.03（5.08,19.26）	26.66（14.65,70.98）	Z = -6.30	< 0.01
凝血功能 Coagulation function
凝血酶原时间 Prothrombin time/s	12.60（11.80,13.70）	12.45（11.30,13.78）	Z = -0.50	> 0.05
部分凝血酶原时间 Activated partial thromboplastin time/s	31.84 ± 7.47	31.18 ± 6.37	t = -0.70	> 0.05
凝血酶时间 Thrombin time/s	17.60（16.57,18.50）	17.90（16.60,19.38）	Z = -1.36	> 0.05
纤维蛋白原 Fibrinogen/g·L^-1	3.35（2.79,4.41）	3.06（2.40,3.89）	Z = -2.65	< 0.05
血常规 Complete blood count
白细胞 White blood cell/ × 10⁹·L^-1	8.43（6.23,12.07）	6.12（4.70,7.91）	Z = -5.63	< 0.01
中性粒细胞百分比 Percentage of neutrophils/%	38.30（30.13,46.85）	65.25（56.42,72.80）	Z = -10.20	< 0.01
嗜酸细胞百分比 Percentage of eosinophils/%	29.15（16.40,38.18）	1.65（0.70,3.08）	Z = -12.00	< 0.01
嗜酸细胞绝对值 Absolute eosinophil count/ × 10⁹·L^-1	2.00（0.94,3.83）	0.09（0.04,0.16）	Z = -12.05	< 0.01
嗜酸细胞百分比 Percentage of eosinophils/%			χ² = 138.70	< 0.01
正常 Normal	12（10.9%）	80（72.7%）
升高 Increase	98（89.1%）	11（10.0%）
降低 Decrease	0（0）	19（17.3%）
嗜酸细胞绝对值 Absolute eosinophil count/%			χ² = 153.34	< 0.01
正常 Norma	18（16.4%）	98（89.1%）
升高 Increase	92（83.6%）	2（1.8%）
降低 Decrease	0（0）	10（9.1%）
红细胞 Red blood cell/ × 10¹²·L^-1	4.50（3.98,4.80）	4.31（3.73,4.99）	Z = -0.32	> 0.05
血红蛋白 Hemoglobin/g·L^-1	132.00（121.50,142.00）	124.50（109.25,137.75）	Z = -2.76	< 0.05
血小板 Platelet/ × 10⁹·L^-1	245.50（194.25,310.25）	157.00（110.25,200.50）	Z = -7.75	< 0.01
血生化 Blood biochemistry
总胆红素 Total bilirubin/µmol·L^-1	9.25（7.03,12.40）	17.35（11.98,30.68）	Z = -7.70	< 0.01
直接胆红素 Direct bilirubin/µmol·L^-1	3.50（2.70,4.70）	6.80（4.70,16.35）	Z = -8.00	< 0.01
间接胆红素 Indirect bilirubin/µmol·L^-1	5.40（4.00,7.77）	10.06（6.62,15.45）	Z = -6.69	< 0.01
谷丙转氨酶 Alanine aminotransferase/U·L^-1	24.00（17.00,48.00）	46.50（27.00,68.50）	Z = -4.79	< 0.01
谷草转氨酶 Aspartate aminotransferase/U·L^-1	24.00（18.00,34.00）	71.00（42.50,120.75）	Z = -9.02	< 0.01
碱性磷酸酶 Alkaline phosphatase/U·L^-1	143.00（98.00,190.50）	150.00（111.00,221.75）	Z = -1.71	> 0.05
总蛋白 Total protein/g·L^-1	69.80（66.12,75.45）	67.75（62.08,72.20）	Z = -3.46	< 0.01
白蛋白 Albumin/g·L^-1	36.10（32.92,38.98）	33.75（29.60,37.65）	Z = -2.81	< 0.05
球蛋白 Globulin/g·L^-1	33.05（28.52,40.55）	32.35（28.30,36.38）	Z = -1.69	> 0.05
γ-谷氨酰转肽酶 Gamma-glutamyl transpeptidase/U·L^-1	74.00（44.25,124.50）	138.00（73.00,267.50）	Z = -4.91	< 0.01
尿素 Urea/mmol·L^-1	4.56（3.64,5.50）	4.68（3.92,5.60）	Z = -1.06	> 0.05
肌酐 Creatinine/µmol·L^-1	64.00（55.55,75.00）	67.00（57.00,74.00）	Z = -0.62	> 0.05
尿酸 Uric acid/µmol·L^-1	313.22 ± 80.98	331.15 ± 96.23	t = 1.50	> 0.05
血钾 Serum potassium/mmol·L^-1	3.91 ± 0.41	3.99 ± 0.40	t = 1.48	> 0.05
血钠 Serum sodium/mmol·L^-1	140.00（138.00,142.00）	139.00（138.00,142.00）	Z = -1.60	> 0.05
血氯 Serum chloride/mmol·L^-1	104.40（103.12,106.52）	104.30（101.15,106.18）	Z = -1.41	> 0.05
血钙 Serum calcium/mmol·L^-1	2.22（2.13,2.32）	2.24（2.13,2.32）	Z = -0.36	> 0.05

Table 4

Fig. 1

Fig. 2

Fig. 3

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市（州） Cities (prefectures)	摄入组病例数（占比/%） Number of cases in the ingestion group (Proportion/%)	未摄入组病例数（占比/%） Number of cases in the non-ingestion group (Proportion/%)
昆明市 Kunming City	2（2.0）	1（1/9）
大理白族自治州 Dali Bai Autonomous prefecture	61（60.4）	1（1/9）
临沧市 Lincang City	10（9.9）	2（2/9）
普洱市 Puer city	11（10.9）	2（2/9）
楚雄彝族自治州 Chuxiong Yi Autonomous prefecture	1（1.0）	0（0）
丽江市 Lijiang city	13（12.9）	2（2/9）
保山市 Baoshan city	2（2.0）	1（1/9）
昭通市 Zhaotong city	1（1.0）	0（0）

特征 Feature	片形吸虫病（n = 110） Fasciolopsiasis（n = 110）	原发性肝癌（n = 110） Primary liver cancer（n = 110）	统计值 Statistic value	P值 P value
年龄/岁 Age/year	39.15 ± 15.05	57.85 ± 10.36	t = 10.73	< 0.01
脉搏/次·分^-1Pulse beats per minute	91.58 ± 15.29	88.65 ± 13.32	t = -1.51	> 0.05
收缩压/mmHg Systolic blood pressure/mmHg	118.43 ± 16.57	120.57 ± 17.67	t = 0.93	> 0.05
舒张压/mmHg Diastolic blood pressure/mmHg	76.42 ± 10.37	76.98 ± 10.93	t = 0.39	> 0.05
住院时间/天 Hospitalization/d	7.00（5.00, 10.75）	8.00（5.00, 14.00）	Z = -0.75	> 0.05
性别 Gender
男 Male	44（40.0%）	94（85.5%）	χ² = 48.60	< 0.01
女 Female	66（60.0%）	16（14.6%）
慢性乙型病毒性肝炎 Chronic viral hepatitis B
否No	110（100%）	9（8.2%）	χ² = 186.72	< 0.01
是 Yes	0（0）	101（91.8%）
慢性丙型病毒性肝炎 Chronic viral hepatitis C
否 No	110（100%）	108（98.2%）	χ² = 0.50	> 0.05
是 Yes	0（0）	2（1.8%）
慢性酒精性肝炎 Chronic alcoholic hepatitis
否 No	110（100%）	109（99.1%）	χ² = 1.00	> 0.05
是 Yes	0（0）	1（0.9%）
吸烟 Smoking
否 No	93（84.5%）	47（42.7%）	χ² = 41.56	< 0.01
是 Yes	17（15.5%）	63（57.3%）
饮酒 Alcohol consumption
否 No	89（80.9%）	58（52.7%）	χ² = 19.70	< 0.01
是 Yes	21（19.1%）	52（47.3%）
高血压 Hypertention
否 No	100（90.9%）	94（85.5%）	χ² = 1.57	> 0.05
是 Yes	10（9.1%）	16（14.5%）
糖尿病 Diabetes
否 No	102（92.7%）	100（90.9%）	χ² = 0.24	> 0.05
是 Yes	8（7.3%）	10（9.1%）

临床表现 Clinical manifestation	片形吸虫病病例数（占比/%） Number of fascioliasis cases (Proportion/%)	原发性肝癌病例数（占比/%） Number of primary liver cancer cases (Proportion/%)	χ²值 χ² value	P值 P value
发热 Fever	40（36.4）	2（1.8）	42.49	< 0.01
腹痛 Abdominal pain	41（37.3）	71（64.6）	16.37	< 0.01
腹胀 Abdominal distention	11（10.0）	24（21.8）	5.74	< 0.05
乏力 Hypodynamina	13（11.8）	9（8.2）	0.81	> 0.05
纳差 Poor appetite	7（6.4）	6（5.5）	0.08	> 0.05
恶心 Nausea	1（0.9）	3（2.7）	0.25	> 0.05
厌油腻 Aversion to oil	1（0.9）	4（3.6）	0.82	> 0.05
体质量减轻 Weight loss	2（1.8）	18（16.4）	14.08	< 0.01

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