非典型脑囊尾蚴病的诊断研究

目的 分析非典型脑囊尾蚴病患者血清免疫学检查和脑CT影像学检查特点，为该病诊断提供参考。方法 以446例疑似脑囊尾蚴病患者作为研究对象，所有患者均给予吡喹酮实验性治疗，根据治疗效果及脑CT 或MRI复查结果确诊非典型脑囊尾蚴病。同时，采用间接ELISA 法检测患者血清和脑脊液抗囊尾蚴特异性IgG抗体，采用McAb?ELISA法检测患者血清和脑脊液抗囊尾蚴特异性IgG4抗体，采用PEG?ELISA法测定囊尾蚴循环抗原（CAg），并进行间接血凝试验（IHA）及脑CT检查。计算上述免疫学检测及脑CT检查的检测效能。结果 446例疑似脑囊尾蚴病患者经吡喹酮实验性治疗后，315例临床症状显著好转，被确诊为非典型脑囊尾蚴病。血清特异IgG、IgG4抗体及囊尾蚴CAg检测阳性率分别为15.47%、15.02%、11.21%， IHA试验阳性率为28.47%，差异有统计学意义（χ2] ＝ 52.45，P＜0.01）。脑CT检查有疑似囊尾蚴病灶者353例，占79.14%。ELISA、McAb?ELISA、PEG?ELISA、IHA和脑CT诊断非典型脑囊尾蚴病的灵敏度为15.36%～96.82%，特异度为63.36%～99.24%，阳性预测值为86.40%～98.52%，阴性预测值为32.83%～98.25%，阳性似然比为2.64～27.86，阴性似然比为0.05～0.81，OR值7.16～52.80；5项检查合并后其OR值为108.00，较CT检查的OR值提高1倍。结论 非典型脑囊尾蚴病主要通过评价实验性抗囊尾蚴治疗效果而确诊，血清免疫学检测及脑CT检查亦具有重要参考价值。

Study on diagnosis of atypical cerebral cysticercosis

Objective To analyze the characteristics of the results of serum immunological tests and brain CT image examinations of atypical cerebral cysticercosis patients， so as to provide the reference for improving the diagnosis of the disease. Methods Totally 446 suspected cerebral cysticercosis patients were chosen as the study objects， all of them were given experimental treatment with praziquantel， and then the patients with atypical cerebral cysticercosis were diagnosed according to the treatment effect and review results of brain CT or MRI. Meanwhile， all the 446 patients were tested for serum specific IgG and IgG4 antibodies and cysticercus circulating antigen （CAg） by ELISA， McAb ELISA and PEG?ELISA respectively， and the IHA test was also performed. All the patients received the brain CT examinations. The test results were analyzed statistically and the test performances of the methods above?mentioned were calculated. Results Among the 446 suspected cerebral cysticercosis patients， after the praziquantel treatment， there were 315 patients whose symptoms were alleviated， and they were diagnosed as atypical cerebral cysticercosis. Among the 446 suspected cerebral cysticercosis patients， the positive rates of specific IgG and IgG4 antibodies， and CAg were 15.47%， 15.02%， and 11.21% respectively， and the positive rate of IHA was 28.47% （χ2] = 52.45， P ＜ 0.01）. The brain CT examinations showed that there were 79.14% （353/446） of patients with suspected cysticercus foci. The sensitivities of ELISA， McAb?ELISA， PEG?ELISA， IHA test and brain CT examination （suspected cysticercus foci） for the diagnosis of atypical cerebral cysticercosis were 15.36%-96.82%， the specificities were 63.36%-99.24%， the positive predictive values were 86.40%-98.52%， the negative predictive values were 32.83%-98.25%， the positive likelihood ratios were 2.64-27.86， the negative likelihood ratios were 0.05-0.81， and the OR values were 7.16-52.80. The consolidation of the five tests above?mentioned showed the OR value was 108.00， which was 2 times of the OR value of CT examination. Conclusion Atypical cerebral cysticercosis is definitely diagnosed mainly by means of evaluating the effect of the diagnostic therapy （anti?cysticercus）， and the serum immunological examinations and brain CT examination also have important reference values.