儿童并殖吸虫病患者肝脏CT影像学特征分析

doi:10.3969/j.issn.1672-2302.2023.03.011

摘要/Abstract

摘要：

目的探讨儿童并殖吸虫病肝脏CT影像学特点，提高对该病肝脏影像表现的认识。方法回顾性分析昆明市第三人民医院2019—2021年确诊或临床诊断为并殖吸虫病的儿童一般情况、实验室检查结果及CT影像学表现，并将患儿根据腹部CT观察是否存在肝脏病变分为两组，对比两组患儿的一般情况及实验室检查结果，分析并殖吸虫病患儿的肝脏CT影像学特征。结果共有63例患儿纳入分析，其中肝脏病变组19例（占30.2%），无肝脏病变组44例（占69.8%），肝脏病变组患儿外周血嗜酸性粒细胞百分比[46.39%（27.81%，59.53%）]高于无肝脏病变组[26.62%（18.42%，46.70%）]（Z=2.022，P<0.05），肝脏病变组患儿血清白球比[0.80（0.70，1.00）]低于无肝脏病变组[1.00（0.80，1.20）]（Z=-1.997，P<0.05）。19例肝脏病变患儿的CT影像学表现中，病灶多发13例（占68.4%），病灶单发6例（占31.6%）；表现为“虫体隧道征”16例（占84.2%），脓肿5例（占26.3%），“蕈伞征”5例（占26.3%）。此外所有肝脏病变患儿均合并胸腔积液、肺实变表现，4例（占21.1%）患儿合并皮肤及软组织肿胀，2例（占10.5%）患儿合并脑实质内低密度影。结论近三分之一的并殖吸虫病患儿合并肝脏病变，增强CT扫描出现“虫体隧道征”、脓肿及“蕈伞征”对儿童肝型并殖吸虫病具有很高的诊断价值。

关键词: 儿童, 肝脏, 并殖吸虫病, 影像学特征

Abstract:

Objective To investigate the demonstration CT imaging of hepatic in children with paragonimiasis for improving understanding of the imaging manifestations of this disease. Methods Retrospective analysis was performed regarding the general information, laboratory findings and CT images in children confirmed or clinically diagnosed as paragonimiasis in Kunming Third People's Hospital between 2019 and 2021. The cases were divided into two groups according to the presence of liver lesions identified on abdominal CT, with the general condition and laboratory findings of the two groups compared, and the CT imaging of children with liver lesions was analyzed. Results A total of 63 children were included in the analysis, 19 (30.2%) had liver lesions, and another 44 (69.8%) had no liver lesions. The percentage of peripheral blood eosinophils was higher in children with liver lesions [46.39% (27.81%, 59.53%)] than in children without liver lesions [26.62% (18.42%, 46.70%)](Z=2.022, P<0.05), yet the ratio of serum albumin to globulin in children with liver lesions was lower than in children without liver lesions [0.80 (0.70, 1.00) vs. 1.00 (0.80, 1.20); Z=-1.997, P<0.05]. In the 19 children with liver lesions, 13 (68.4%) had multiple lesions, 6 (31.6%) had a single lesion, 16 (84.2%) had "worm tunnel sign", 5 (26.3%) had abscess, and 5 (26.3%) had "mushroom sign". In addition, all children with liver lesions were complicated with pleural effusion and pulmonary consolidation. Four children (21.1%) were complicated with skin and soft tissue swelling, and 2 (10.5%) demonstrated hypodensity in the cerebral parenchyma. Conclusion Nearly one-third of children with paragonimiasis are complicated with liver lesions, and the presence of "worm tunnel sign", abscess and "mushroom sign" of CT-enhanced scan is of higher diagnostic value for hepatic paragonimiasis.

Key words: Children, Liver, Paragonimiasis, Imaging Features

中图分类号:

R532.22

李翔, 付旭文, 许艳玲, 魏佳璐, 杞敏, 干玮, 黄瑛. 儿童并殖吸虫病患者肝脏CT影像学特征分析[J]. 热带病与寄生虫学, 2023, 21(3): 169-173.

LI Xiang, FU Xu-wen, XU Yan-ling, WEI Jia-lu, QI Min, GAN Wei, HUANG Ying. Analysis of hepatic features on CT imaging in children of paragonimiasis[J]. Journal of Tropical Diseases and Parasitology, 2023, 21(3): 169-173.

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实验室检查指标	无肝脏病变组（n=44）	肝脏病变组（n=19）	Z值	P值
白细胞总数（×10⁹/L）	12.73（9.37，16.88）	13.67（9.60，17.58）	0.547	>0.05
嗜酸性粒细胞计数（×10⁹/L）	3.61（1.85，7.24）	6.74（3.11，9.52）	1.572	>0.05
嗜酸性粒细胞百分比（%）	26.62（18.42，46.70）	46.39（27.81，59.53）	2.022	<0.05
总胆红素（μmol/L）	5.90（4.30，7.62）	6.40（4.45，8.20）	0.157	>0.05
直接胆红素（μmol/L）	1.90（1.48，2.22）	2.00（1.55，2.85）	0.390	>0.05
间接胆红素（μmol/L）	3.95（2.90，5.25）	4.10（3.15，5.15）	0.135	>0.05
谷丙转氨酶（U/L）	15.00（11.00，19.25）	14.00（8.70，17.50）	-1.118	>0.05
谷草转氨酶（U/L）	22.50（17.75，27.00）	20.00（17.00，23.00）	-0.547	>0.05
球蛋白（g/L）	36.35（30.98，42.93）	41.70（33.85，47.05）	1.662	>0.05
白球比	1.00（0.80，1.20）	0.80（0.70，1.00）	-1.997	<0.05