摘要
目的分析83例脑裂头蚴病患者的临床特点、治疗和预后,为脑裂头蚴病救治提供参考。方法收集2004年7月至2020年1月广东三九脑科医院收治的83例脑裂头蚴病患者的临床资料,总结并分析其一般情况、临床表现、实验室检查、影像学特征、治疗和预后等。应用SPSS 19.0统计学软件进行统计分析。结果83例患者来自广东46例、湖南12例、广西11例、江西8例、其他省(直辖市、自治区) 6例。男性48例、女性35例。年龄最小8岁,最大71岁。病程最长360个月,最短2 d。有明确的不洁饮食史者占68.7%(57/83)。临床症状主要为癫痫(84.3%, 70/83)、头痛(32.5%, 27/83)、肢体轻度偏瘫(26.5%, 22/83)、言语障碍(10.8%, 9/83)、视力障碍(7.2%, 6/83)、感觉异常(6%, 5/83)等。83例行血常规检查,7例白细胞升高,9例嗜酸粒细胞升高,4例淋巴细胞升高。27例行C反应蛋白检测,2例升高。80例行血清学裂头蚴抗体ELISA检测,77例阳性。46例行脑脊液裂头蚴抗体ELISA检测,23例阳性。70例行脑电图检查,30例有慢波异常,17例有癫痫样放电及临床发作。颅脑CT平扫41例可见钙化,颅脑MRI增强75例呈现"隧道征",83例呈现"串珠样"强化。58例行开颅手术治疗,42例取出白色扁平棉线样虫体(43条);随访3个月~8年不等,52例治愈,6例病情仍有进展或未愈;55例伴有癫痫者术后随访,44例达到改良Engel分级Ⅰ级。25例口服吡喹酮驱虫治疗,随访3个月~8年不等,7例治愈,18例病情仍有进展或未愈;另外11例伴有癫痫者采用驱虫治疗后随访,仅3例达到改良Engel分级Ⅰ级。结论脑裂头蚴病患者临床表现多为癫痫发作,根据血清免疫学检查及影像学特征即可作出临床诊断,外科手术多数能成功取出活虫并治愈。
Objective To analyze the clinical features, treatment and prognosis of cerebral sparganosis,providing reference for clinical managemet. Methods Clinical data of 83 patients with cerebral sparganosis in Guangdong 999 Brain Hospital from July 2004 to January 2020 were collected, and the general conditions, clinical manifestations, laboratory examination, imaging features, treatment and prognosis were analyzed. Statistical analysis was performed using the SPSS 19.0 software. Results The 83 patients came from different areas of China, including46 from Guangdong Province, 12 from Hunan Province, 11 Guangxi Province, 8 Jiangxi Province and 6 other Provinces(municipalities/autonomous regions). There were 48 males and 35 females. The youngest case was 8 years old and the oldest was 71. The longest course of disease was 360 months and the shortest was 2 days. A clear history of unhygienic diet was found in 68.7%(57/83) patients. The main clinical symptoms were epilepsy(84.3%,70/83), headache(32.5%, 27/83), mild limb hemiplegia(26.5%, 22/83), speech disorder(10.8%, 9/83), visual impairment(7.2%, 6/83), and paresthesia(6%, 5/83). All patients received Routine blood examination was provided for all patients, and found an increase of leukocyte count in 7 of 83 cases, 9 cases with increased eosinophils count,and 4 cases with increased lymphocytes. C-reactive protein detection was performed in 27 cases, and 2 cases showed elevation. Serological detection of metacercaria antibody by ELISA was performed in 80 patients, and 77 cases showed positive results. Detection of antibody against metacercaria in cerebrospinal fluid was examined by ELISA for 46 cases, of them 23 cases were found positive. Seventy patients were examined by electroencephalogram, 30 cases showed abnormal slow wave, and 17 cases had epileptiform discharge and clinical seizure. Calcification was observed on CT scan of 41 cases. Brain MRI enhancement showed tunnel sign-like changes in 75 cases and beading-like enhancement in 83 cases. Fifty-eight patients were treated with surgery, and 43 white flat cotton threadlike live worms were obtained from 42 of them. At follow-up of 3 months to 8 years, 52 cases were cured, 6 cases were still progressing or not cured;55 patients with epilepsy who underwent surgery were followed up, of them 80%(44/55)reached the modified Engel classification class Ⅰ. Twenty-five cases were treated with praziquantel, and at follow up for 3 months to 8 years, 7 cases were cured, 18 cases were still progressing or not cured. Eleven patients with epilepsy were treated with praziquantel and followed up, and only 27.3%(3/11) reached the modified Engel classⅠ. Conclusion Epileptic seizures are the main clinical manifestations of cerebral sparganosis. Clinical diagnosis can be made based on serum immunological examination and imaging features. Surgery is an effective approach to remove live worms and cure the disease.
作者
闫学强
李晓龙
孙祯卿
吴杰
YAN Xue-qiang;LI Xiao-long;SUN Zhen-qing;WU Jie(Department of Neurosurgery,Guangdong 999 Brain Hospital,Guangzhou 510510,China)
出处
《中国寄生虫学与寄生虫病杂志》
CAS
CSCD
北大核心
2021年第2期240-245,共6页
Chinese Journal of Parasitology and Parasitic Diseases
关键词
脑裂头蚴病
活虫
癫痫
磁共振成像
显微外科手术
Cerebral sparganosis
Live worm
Epilepsy
Magnetic resonance imaging
Microsurgery
