肺吸虫病"积分诊断量表"的建立——临床表现联合实验室和影像学检查

目的根据肺吸虫病（LFD）临床表现、实验室检查、影像学检查建立LFD"积分诊断量表",以提高LFD诊断水平。 方法回顾性分析2008年1月至2019年6月十堰市人民医院（湖北医药学院附属人民医院）临床确诊的56例LFD患者的临床资料。记录患者的临床症状、体征、流行病学史;分析白细胞（WBC）、嗜酸性粒细胞计数（EOS）、血小板（PLT）计数,浆膜腔积液指标、组织病理检查、痰涂片细胞学培养;分析核磁共振成像（MRI）、多层螺旋CT（MSCT）、彩色多普勒超声检查结果。将肺吸虫定植部位胸肺部、皮下、脑脊髓、腹部症状和（或）体征每个部位积分2分。将LFD个人史（生食溪蟹或蝲蛄、饮生水）记2分。将WBC 10 × 10⁹/L记0分,每增加1 × 10⁹/L记0.1分。将EOS 0.30 × 10⁹/L记0分,每增加0.03 × 10⁹/L计0.1分。将PLT 300 × 10⁹/L记0分,每增加10 × 10⁹/L计0.1分。将浆膜腔积液EOS增高、组织EOS浸润每项计2分。将MRI、MSCT、超声等检测出胸肺、皮下、脑脊髓、腹腔病灶每一个脏器病灶计2分。将组织发现肺吸虫虫体或虫卵、痰液或大便发现肺吸虫虫卵直接计8分。根据传染病诊断标准,进行LFD病原学确诊的肺吸虫抗原皮内实验（PAIT）和肺吸虫抗体检测（ELISA-PAb）。"积分诊断量表"阳性患者与PAIT和ELISA-PAb对比分析"积分诊断量表"诊断LFD的敏感性和特异性。 结果根据患者临床表现（临床症状和体征、个人史）、实验室检查、影像学检查结果建立LFD"积分诊断量表",当患者积分达9.31分以上,通过临床表现（病史、体检）,实验室、影像学、病理学检查排除引起EOS升高的嗜酸性粒细胞增多症等相关疾病,提示LFD可能。"积分诊断量表"积分越高,LFD可能性越大。LFD患者积分为9.31～25.58。"积分诊断量表"诊断LFD的敏感性100%,特异性93.33%。 结论"积分诊断量表"诊断LFD敏感性和特异性好,适用于LFD临床诊断。

Establishment and validation of the integral assessment approach for the diagnosis of patients with lung fluke disease

ObjectiveTo establish an integral assessment diagnostic approach of lung fluke disease (LFD), which based on clinical manifestations, laboratory examination and imaging tests, and to improve the diagnostic level of LFD. MethodsThe clinical data of 56 patients with clinically diagnosed LFD in Renmin Hospital of Shiyan City (Renmin Hospital, Hubei University of Medicine) from January 2008 to June 2019 were analyzed, retrospectively. The clinical symptoms, signs, epidemiological history of the patients were recorded; levels of white blood cell (WBC), eosinophil (EOS) count, platelet (PLT) count, serosal cavity effusion index, histopathological examination, sputum smear cytology culture were analyzed, respectively. The nuclear magnetic resonance imaging (MRI), multilayered spiral CT (MSCT), color doppler ultrasound findings were also analyzed, and integration of lung-pulmonary, subcutaneous, cerebrospinal, abdominal symptoms and/or signs at the site of pneumonitis colonization into 2 points per site. With LFD personal history (eating raw crab or crab, drinking raw water) was scored 2 points. WBC 10 × 10⁹/L was scored as 0, increasing 0.1 point for each increased 1 × 10⁹/L. EOS 0.30 × 10⁹/L was scored as 0, increasing 0.1 points for each increased 0.03 × 10⁹/L. Score PLT 300 × 10⁹/L was scored as 0, increasing 0.1 point for each increased 10 × 10⁹/L. The EOS of serous cavity effusion increased and tissue EOS invaded were both scored as 2 points. MRI, MSCT, ultrasound and other detection of chest lung, subcutaneous, spinal cord, abdominal cavity lesions of each organ lesion were all scored as 2 points. Tissue discovery of paragonimus body or eggs, sputum or stool discovery of paragonimus eggs directly was scored as 8 points. The paragonimiasis antigen intradermal test (PAIT) and paragonimiasis antibody test (ELISA-PAb) of paragonimiasis antigen were carried out according to diagnostic criteria of infectious diseases. The sensitivity and specificity of the diagnostic LFD of the "integral diagnostic scale" were analyzed by comparing the positive patients with PAIT and ELISA-PAb, respectively. ResultsAccording to clinical manifestations (clinical symptoms and signs, personal history), laboratory examination, imaging results, establishment of LFD "integral diagnostic scale " were establishmented. when the patient’s integral diagnostic scale was higher than 9.31, excluding EOS caused by eosinophilia and other related diseases through clinical manifestations (history, physical examination), laboratory examination, imaging examination, pathological examination it could suggest possible LFD. The higher of integral diagnostic scale was, the more possibility likely to LFD. The score of LFD patients was 9.31-25.58. The sensitivity of the diagnostic LFD of integral diagnostic scale was 100% and the specificity was 93.33%. ConclusionsThe diagnostic sensitivity and specificity to LFD of integral diagnostic scale were well and suitable to LFD clinical diagnosis.