小儿肝包虫病早期诊断研究

目的：探讨早期诊断小儿肝包虫病的新途径。方法：对在河南省发现的28例进行回顾性分析。26例生活在疫区与牲畜有密切接触史(河南籍2例。其祖父及父亲有同样生活史)。28例嗜酸细胞均明显升高,血沉明显增快。血清蛋白纸上电泳检查25例,白蛋白、β球蛋白降低者分别为21例和16例,γ、α1、α2球蛋白均升高者16例。X线腹部平片检查28例,显示细丝环状钙化影16例,弥漫性丛点状钙化影4例,隐约可见半月形钙化影8例。腹部肝区CT扫描11例与X线腹部平片检查结果相符(更清晰)。分别误诊为肝脓肿、慢性肝炎、肝癌和肝结核共12例,时间达4个月～3a。结果：2例晚期患者自动出院后死亡。经手术辅佐药物治疗的26例,治愈22例,死亡4例。结论：小儿肝包虫病的早期诊断新途径是(1)X线腹部平片或CT显示特殊钙化影者;(2)来自疫区与牲畜有密切接触史;(3)血嗜酸细胞明显升高(排除其他寄生虫病);(4)血沉增快(排除其他疾病);(5)血清蛋白纸上电泳白蛋白和β球蛋白降低,γ、α1、α2球蛋白均升高者。符合以上5项中第1项者,即可初步诊断,如果符合第1项再加第2项和第3项者即可确诊。如果具备了第4项第5项者更有确诊意义。

Study on the early diagnosis of echinococcosis of liver in children

Objective To explore the new ways of early diagnosis of echinococcosis of liver in children. Methods Twenty -eight patients were analyzed retrospectively, 26 of which came from infected area and had close contact with domesticanimals. All patients' eosinophils count and erythrocyte sedimentation rate were greatly elevated. Serum protein electrophoresis of 25 cases revealed that the level of albumin decreased in 21 cases and the level of beta globulin decreased in 16 cases and gramma,alpha-1 and alpha-2 globulins were elevated in 16 cases. 28 cases were offered abdomen X-ray films and the result recalled circular calcification shadow in 16 cases,diffuse small calcification focus in 4 cases,dim semilunar calcification in 8 cases. 11 cases were offered CT scans of the abdomen and the result was consistent with that of abdomen X-ray(the pictures of CT scans were clearer). 12 patients were misdiag-nosed as liver abscess,hepatocarcinoma,chronis hepatitis and liver tuberculosis respectively and the misdiagnosed time lasted for from 4 months to 3 years. Results Two patients whose illness had reached advanced stage and died after they volunteered to be discharged from hospital because of giving up further treatment. 26 cases were performed operations and given assessory medicinal treatment,22 of which were cured and 4 cases died. Conclusion The new ways of early diagnosis of echinococcdsis of liver are as follows. (1) Abdomen X-ray or CT scan shows the specific calcification shadow. (2)The patient comes from infected area and has close contact with domestic animals. (3)The eosimophils count is markedly elevated (exclude other parasitosises). (4) Erythrocyte sedimentation rate is markedly eldvated(exclude other diseases). (5)Albumin and beta globulin decrease;gramma,alpha-1 and alpha-2 increase by serum protein electrophoreses. If one only has the first item, the primary diagnosis may be made. If one has not only the first but also the second and the third item, the definite diagnosis may be made. If one has all the above items, this will be of more importance to diagnose definitely.