大囊型脑囊虫病患者抗囊治疗前后临床特征的研究

目的 研究大囊型脑囊虫病患者抗囊治疗前后的临床、影像学、免疫学及脑电图改变.方法 对59例大囊型脑囊虫病患者的临床、影像学、免疫学和脑电图资料进行系统性回顾研究.结果 本组患者中有38.98%以癫痫发作为首发症状,45.76%表现为头痛、头晕、恶心伴有呕吐症状;脑CT或MRI主要特征为圆形或类圆形低密度灶病灶,直径大小为20～73 mm;血IHA、ELISA、CAg阳性率分别为91.53%、98.31%和88.14%;脑电图异常率为89.83%,主要表现为弥漫性慢波和局限性慢波活动.59例患者经3～4个疗程的抗囊治疗后,临床上有91.30%患者癫痫症状得到完全控制,88.89%患者头痛、头晕、恶心伴有呕吐者恢复正常,其他如肢体麻木、语言障碍等症状全部消失;复查脑CT或MRI有96.61%患者病灶全部吸收,3.39%患者转化为钙化点;56例观察了免疫学的动态变化,血IHA、ELISA、CAg阳性率分别为89.29%、96.42%和5.36%;51例复查了脑电图,恢复正常和明显好转的分别为78.43%和21.57%;患者抗囊治疗前后对比除IHA、ELISA结果无统计学意义外均差异有显著性(P<0.01);临床治愈率96.61%,显效率3.39%,总有效率100%.结论 大囊型脑囊虫病患者抗囊治疗后临床症状、异常脑功能和病理形态学改变可以逐渐恢复;影像学、免疫学及脑电图检查从不同方面对脑囊虫病的诊断、疗效考核具有重要的应用价值.

Observation of clinical manifestation of patients with large cystic cereberal cysticercosis

Objective To observe the changes of clinical,imaging,immunology and EEG pro-post-treat-ment with albendazole praziquantel in patients with large cystic cereberal cysticercosis. Methods The data of clin-ical features,imaging,immunology and EEG of 59 patients with large cystic cereberal cysticercosis were retrospec-tively analyzed. Results Among these patients, the rate of epileptic seizures was 38.98% and headache, dizzi-ness, nausea and vomiting were 45.76% ;CT or MRI showed that shapes of the low density loci were round or para round,its diameter was 20 -73mm. The positive rates of serum of patients by IHA, ELISA and CAg were 91.53 % , 98.31% and 88.14% respectively. The abnormal rate of EEG was 89.83% in patients,which mainly showed the diffuse and localized slow waves. After 3～4 courses of treatment,91.30% of epileptic seizure was controlled, 88.89% of the symptoms of headache, dizziness, nausea and vomiting were recovered, and the symptoms of limb numbness,language barriers also disappeared;CT or MRI showed that the low density foci were all absorbed in 96.61% and calcified in 3.39% of the patients. The positive rates of blood IHA ,ELISA and CAg were 89.29%, 96.42% and 5.36% respectively. The normal and improved EEGS were observed in 78.43% and 21.57%. There were significant differences in cure rate, effective rate and total effective rate before and after treatment, being 96.61% and 3.39% respectively, excluded IHA, ELISA (P<0.01). Conclusion Clinical symptoms, cerebral function and pathological changes are gradually recovered in patients after treatment. Imaging, immunology and EEG check are valuable for diagnosis and the treatment of patients with large cystic cereberal cysticercosis.