三峡库区重庆段斯氏肺吸虫病流行病学及临床研究-附58例斯氏肺吸虫病误诊原因分析

目的为了解重庆地区人群斯氏肺吸虫病流行的现状、临床表现和诊断，并分析导致其误诊的原因。方法进行肺吸虫病现场流行病学调查和收集误诊病例的临床资料。采用肺吸虫抗原皮试（IDT）和ELISA检测易感人群；检测中间宿主溪蟹的肺吸虫囊蚴携带率以及保虫宿主犬、猫的肺吸虫感染情况。结果重庆地区人群的IDT阳性率为14．36％（104／724），ELISA为21．96％（92／419），当地溪蟹的肺吸虫囊蚴携带率为4．08％，虫种鉴定为斯氏肺吸虫（Pagumogonimus skrjabini）。三峡库区的人群有生食和半生食溪蟹的习惯，且感染与职业、年龄有关，差异有统计学意义（P〈0．05）；并分析了58例斯氏肺吸虫病的误诊原因。结论重庆地区人群的肺吸虫病呈点状、散在流行，并有局部扩散流行的可能性。应加强肺吸虫病防治知识的宣传和教育，制定相应的防制措施，阻断该病在重庆地区的流行。

Paragonimiasis Skrjabini in Chongqing Region-Epidemic Situation, Clinical Manifestation, and Analysis on 58 Misdiagnosed Cases

Objective To ascertain epidemic situation,clinical manifestation and diagnosis of paragonimiasis skrjabini in Chongqing region.Method Field investigation,data collection in misdiagnosed cases,IDT(intradermal test)and ELISA for detection of susceptible persons,freshwater crab and reservoir host examination etc.were performed.Result The positive rates of IDT and ELISA were 14.36%(104/724)and 21.96%(92/419)respectively.The infection rate of freshwater crab infected by metacercaria of Paragonimus was 4.08%.The species was identified as Pagumogonimns skrjabini.Varied clinical manifestations,difficult in finding pathogen,and unqualified medical workers in grass-roots were the main reasons in misdiagnosis.Conclusion The paragonimiasis revealed point and sporadic feature but epidemic spread in local areas would be possible.To control paragonmiasis in Chongqing region,comprehensive control measures and health education should be strengthened.