18例误诊为肺结核的胸肺型并殖吸虫病患者临床特点分析

目的探讨误诊为肺结核的胸肺型并殖吸虫病患者的临床特征、实验室检查结果和影像学特点,分析误诊原因,为临床医师进行鉴别诊断提供依据。方法收集并分析首都医科大学附属北京友谊医院在2016年2月-2019年2月收治确诊的18例误诊为肺结核的胸肺型并殖吸虫病患者的病例资料。结果18例胸肺型并殖吸虫病患者的主要临床表现是发热、咳嗽和胸腔积液。此外,5例患者出现腹痛,3例患者出现皮下结节,1例患者出现头痛,18例患者均有明确的流行病学史。15例患者并殖吸虫IgG抗体呈阳性;17例患者外周血嗜酸性粒细胞水平升高;16例患者出现胸腔积液,其中左侧胸腔积液4例,右侧胸腔积液5例,双侧胸腔积液7例,胸水均为渗出液;胸部CT见10例患者表现为索条、实变及磨玻璃密度灶,6例出现肺部多发结节,3例出现胸膜肥厚。18例患者使用吡喹酮治疗后均达到临床治愈标准。结论本文通过系统总结18例误诊为肺结核的胸肺型并殖吸虫病患者的流行病学史、临床表现和实验室检查结果,为提高临床医师对该病的鉴别诊断提供依据,避免误诊、误治。

Clinical features of 18 patients with thoracopulmonary type paragonimiasis misdiagnosed as pulmonary tuberculosis

Objective To explore the clinical features,laboratory examination results and imaging characteristics of thoracopulmonary type paragonimiasis patients misdiagnosed as pulmonary tuberculosis,analyze the causes of misdiagnosis,and provide evidence for clinicians to make differential diagnosis.Methods Clinical information of 18 patients with thoracopulmonary type paragonimiasis misdiagnosed as pulmonary tuberculosis who were admitted in Beijing Friendship Hospital,Capital Medical University from February 2016 to February 2019 were collected and analyzed.Results The main clinical manifestations of 18 patients with thoracopulmonary type paragonimiasis included fever,cough and pleural effusion.In addition,5 cases had abdominal pain,3 cases had subcutaneous nodules,1 case had headache and 18 cases had clear epidemiological history.Fifteen patients showed positive IgG antibody to paragonimiasis and 17 patients had elevated eosinophils in peripheral blood.Sixteen patients had pleural effusion,including 4 cases of left pleural effusion,5 cases of right pleural effusion and 7 cases of bilateral pleural effusion,pleural effusion was exudate.Ten patients showed cord,consolidation and ground glass density focus by chest CT,6 cases had multiple pulmonary nodules,and 3 cases had pleura thickening.Eighteen patients were cured after treatment with praziquantel.Conclusions In this study,the epidemiological history,clinical manifestations and laboratory examination results of 18 patients with thoracopulmonary type paragonimiasis misdiagnosed as pulmonary tuberculosis are systematically summarized in order to provide evidence for the differential diagnosis of clinicians and reduce misdiagnosis and mistreatment.