胆管梗阻合并华支睾吸虫感染患者临床特征分析

目的　分析胆管梗阻合并华支睾吸虫感染患者临床特征，为该病临床诊疗提供参考。方法　收集2012年10月—2019年9月在哈尔滨医科大学附属第二医院就诊的45例胆管梗阻合并华支睾吸虫感染患者，并随机选取同期就诊的45例单纯胆管梗阻患者作为对照。采用单因素分析华支睾吸虫感染相关流行病学特征、临床表现、实验室检查结果及影像学表现，并将有统计学意义的单因素作为自变量进行多因素logistic回归分析。结果　与单纯胆管梗阻患者相比，胆管梗阻合并华支睾吸虫感染患者中男性占比更高（91.11% vs. 46.67%；χ2] = 20.737，P < 0.01）、农村病例占比更高（62.22% vs. 22.22%；χ2] = 14.757，P < 0.01），主要临床症状为黄疸（45例，占100%）和腹痛（40例，占88.89%）。多因素logistic回归分析显示，男性比值比（OR） = 10.717，95%可信区间（CI）: （2.571，44.662）]和有饮酒史OR = 4.474，95% CI: （1.019，19.642）]是胆管梗阻合并华支睾吸虫感染危险因素；居住地为城市OR = 0.128，95% CI: （0.038，0.435）]为保护因素。实验室检查发现，胆管梗阻合并华支睾吸虫感染患者较单纯胆管梗阻患者总胆红素和直接胆红素水平降低，而间接胆红素水平升高，差异均有统计学意义（Z = -2.566、-3.454和-3.821，P均< 0.05）。影像学检查发现，胆管梗阻合并华支睾吸虫感染患者胆管管壁增厚、肝内胆管扩张。结论　胆管梗阻合并华支睾吸虫感染患者临床表现具有特征性，在临床工作中可结合患者流行病学特征、临床症状、实验室及影像学检查结果等进行综合鉴别诊断。

Clinical characteristics of biliary obstruction patients with Clonorchis sinensis infections

Objective　To analyze the clinical characteristics of biliary obstruction patients with Clonorchis sinensis infections, so as to provide insights into the clinical diagnosis and therapy of this comorbidity. Methods　A total of 45 biliary obstruction patients with C. sinensis infections that were admitted to the Second Affiliated Hospital of Harbin Medical University from October 2012 to September 2019 were enrolled, and 45 patients with biliary obstruction alone at the hospital during the same study period were recruited as controls. Univariate analysis was performed to analyze the epidemiological characteristics, clinical manifestations, laboratory examination results and imaging manifestations related to C. sinensis infection, and the statistically significant univariate was used as an independent variable for multivariate logistic regression analysis. Results　Compared with biliary obstruction alone, males (91.11% vs. 46.67%; χ2] = 20.737, P < 0.01) and rural areas (62.22% vs. 22.22%; χ2] = 14.757, P < 0.01) showed a significantly higher proportion in biliary obstruction patients with C. sinensis infections. The major clinical symptoms involved in had jaundice (45 cases, 100%) and abdominal pain (40 cases, 88.89%) in C. sinensis?infected patients. Logistic regression analysis showed that males odds ratio (OR) = 10.717，95% confidential interval (CI): (2.571, 44.662)] and drinking alcohol OR = 4.474，95% CI: (1.019, 19.642)] were risk factors for biliary obstruction patients with C. sinensis infections, while living in city OR = 0.128，95% CI: (0.038, 0.435)] was a protective factor. Additionally, in biliary obstruction patients with C. sinensis infections, lower total bilirubin (Z = -2.566, P < 0.05) and direct bilirubin (Z = -3.454, P < 0.05), higher indirect bilirubin (Z = -3.821, sive diagnosis requires to be made based on clinical symptoms, laboratory and imaging examinations, in order to improve the diagnosis of biliary obstruction patients with C. sinensis infections.