Objective To understand the Clonorchis sinensis infection situation of freshwater fish and shrimp in Shaoguan city, and the public's awareness and prevention awareness of Clonorchiasis , we provide scientific basis for the relevant departments of Shaoguan City to carry out the prevention and treatment of Clonorchiasis . Methods The questionnaire survey about the prevention and control awareness of clonorchiasis was carried out through the network. The samples of freshwater fish / shrimp were collected from four areas in Shaoguan city from May 2018 to November 2018, and metacercaria of Clonorchis sinensis were detected by tissue compression method. SPSS 21.0 software was used to process and analyze the data. Results The total detection rate of metacercariae of Clonorchis sinensis was 29.55%. The detection rate of freshwater fish (1.78%) was lower than that of freshwater shrimp (58.70%) ( P <0.01). There was a significant difference ( P <0.05) in the detection rate of metacercariae of Clonorchis sinensis among the four area in Shanguan. The highest detection rate was Renhua area (37.50%). The detection rate of fresh water fish / shrimp in the market (39.96%) was higher than that in the wild (2.20%). There was a significant difference between market and wild ( P <0.01). The public's awareness rate of Clonorchis sinensis was 67.35%, and there were statistical differences in the awareness rate among different age groups and different education levels, which were ( χ 2 = 19.411, P <0.05) and ( χ 2 =39.624, P <0.05). The history of eating “Sashimi” was 25.77% (101 persons), and the active susceptible group was 30.87%. Conclusion Freshwater fish and shrimp in some areas of Shaoguan City have a certain degree of Clonorchiasis infection. The public has insufficient attitudes and prevention awareness of Clonorchiasis . Active prevention and control measures of Clonorchiasis should be actively carried out, and the prevention awareness of the people should be strengthen. 摘要：目的 了解广东省韶关市区淡水鱼虾感染肝吸虫囊呦情况, 以及群众对肝吸虫病的认知和防范意识, 为韶 关市相关部门开展肝吸虫病的防治工作提供科学依据。 方法 采集韶关市内4个地区淡水鱼/虾样本, 采用组织压片 法检测囊呦；通过网络随机对群众进行问卷调査分析了解群众防控意识;应用SPSS 21.0统计学软件处理和分析数 据。 结果 肝吸虫囊呦总检出率为29.55%, 淡水鱼检出率 (1.78%)低于淡水虾(58.70%), 两者差异有统计学意义( P <0.01)。韶关市内4个地区之间的肝吸虫囊呦检出率差异有统计学意义( P <0.05), 检出率最高的地区是仁化县 (37.50%)。市售淡水鱼/虾的检出率(39.96%)高于野生的淡水鱼/虾(2.20%), 两者差异有统计学意义( P <0.01)。群众 对肝吸虫病的知晓率为67.35%, 不同年龄组间和不同文化程度间的知晓率差异有统计学意义( χ 2 =19.411, χ 2 =39.624, P <0.05)。调査显示, 有吃生鱼虾史的101人, 占25.77%, 有吃生鱼虾意愿人群占30.87%。 结论 韶关市内部分地区的 淡水鱼虾存在一定程度的肝吸虫囊呦感染, 群众对肝吸虫病防范态度和意识存在不足, 应积极开展有效的肝吸虫病防 控措施, 加强群众防范意识。

Clonorchiasis is by far the most serious food-borne parasitic disease in Guangxi with severe epidemic situation and lagging scientific research. This article introduces the epidemic situation, prevention and control strategy of clonorchiasis and related factors that influencing the disease transmission in Guangxi, so as to provide scientific basis for formulating the prevention and control measures. Key words: Clonorchis sinensis; Guangxi; Epidemiology

Objective To evaluate the clinical value of platelets detection in the diagnosis of children with paragonimiasis. Methods The clinical data of 19 children with paragonimiasis who were treated at Department of Infectious Diseases and Department of Pediatrics of Shiyan City Renmin Hospital from January 2010 to December 2017 were reviewed, retrospectively. The detected parameters included blood platelet count (PLT), white blood count (WBC), eosinophil count (EOS), multi-slice computed tomography (MSCT) and serous cavity color Doppler ultrasonography. The relationship between PLT changes and clinical manifestations and imaging changes of paragonimiasis were analyzed. According to whether the level of PLT was higher than the normal value, the patients were divided into two groups: increased PLT group (12 cases) and normal PLT group (7 cases). Results There were 12 case times with abnormal respiratory symptoms and signs in increased PLT group, MSCT showed all patients with lung lesions in this group (among whom, 9 patients with bilateral pleural effusion and 3 patients with unilateral pleural effusion). There were 1 case with abnormal respiratory symptoms and signs in normal PLT group, MSCT showed pleural effusions in 1 patient. After treatment, the patients in increased PLT group returned to normal with the regression of pulmonary lesions; but there was no change in normal PLT group before and after treatment. The changes of WBC level: 16 patients with normal level of WBC and 3 patients with increased level of WBC. One patient with increased WBC level was complicated with tonsil bacterial infection, intestinal infection and intrapulmonary infection, but the level of WBC returned to normal after antibiotic treatment. No abnormal WBC was found in 19 cases during praziquantel treatment. The changes of EOS level: EOS increased significantly to 15.9%-54.8%. The EOS ratio decreased to less than 2 times of the normal high limit at the end of the deworming course, and decreased to normal level one month after the end of the EOS course. Chest MSCT: 13 case times with lung focus (12 case times with PLT increase, 1 case with PLT normal), 13 case times with pleural effusion (9 case times with bilateral pleural effusion and 3 case times with unilateral pleural effusion in PLT increase group; one case time with unilateral pleural effusion in PLT normal group) were found. There were 2 cases with pericardial effusion (one case in each group), 4 case times with mediastinal and axillary lymph node enlargement (2 case times in each group). With the marked effect of deworming treatment, MSCT showed that the chest lesions disappeared. Thoracopulmonary paragliasis was the main type of paragliasis. Color Doppler ultrasound showed that 13 case times with pleural effusion (including 9 case times on both sides and 4 case times on one side), 2 cases with pericardial hydrops and 2 cases with abdominal effusions. There were 13 cases of pleural effusions (bilateral 9 cases, 4 cases unilateral), 2 cases of pericardial effusion and 2 cases of abdominal effusion. Color Doppler ultrasound was performed in 13 cases of pleural effusion (including 9 cases on both sides and 4 cases on one side), 2 cases of pericardial hydrops and 2 cases of abdominal effusions. There were 13 cases of pleural effusions (bilateral 9 cases, 4 cases unilateral), 2 cases of pericardial effusion and 2 cases of abdominal effusion. Pleural and abdominal effusions were more common in chest, lung type and abdominal paragliasis, and serous effusion disappeared with the effect of deworming. Conclusions The increase of PLT level was of significance in the diagnosis of thoracic and pulmonary paragliasis. Combined with the changes of EOS, it was more beneficial to the diagnosis of pulmonary clonorchiasis. Key words: Paragonimiasis, children; Platelets; Paragonimiasis of lung; Clinical diagnosis

Objective To analyze the clinical characteristics of children′s trematodiasis in order to enhance the level of clinical diagnosis and treatment. Methods The medical history, clinical manifestations, results of laboratory examination, conditions of diagnosis and treatment of 15 confirmed different types of children with trematodiasis from 2002 to 2017 in Shanghai Children′s Medical Center were retrospectively analyzed. Results Seven cases had eaten raw or undercooked freshwater crab, and 2 cases often drank raw stream or caught crabs.Five cases had polyserositis such as pleural effusion, ascites and pericardial effusion in different degrees.The eosinophil counts of 11 cases(73.3%) and IgE of 10 cases(76.9%) increased.Fifteen cases, trematodiasis serum antibody tests were positive, and 1 case′s fecal clonorchiasis was positive.Fifteen cases were improved by praziquantel. Conclusion The clinical characteristics of childhood trematodiasis are complex and atypical.Trematodiasis should be understood more deeply for clinician to avoid misdiagnosis.Praziquantel is a safe and effective drug for trematodiasis. Key words: Trematodiasis; Clinical features; Children

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare tumor arising from epithelia of bile duct, with a better prognosis compared with common cholangiocarcinoma. IPNB can occur anywhere along the biliary tree, and cause the dilation of the bile duct and acute cholangitis. Recent large case series of this peculiar disease in the far eastern countries showed greater incidences of hepatolithiasis and clonorchiasis compared with Western series. According to the immunochemistry features, IPNB can be classified into four subtypes, pancreaticobiliary, intestinal, gastric and oncocytic types. The pancreaticobiliary type is the most common and is usually associated with invasive lesions. Patients without distant metastasis can undergo surgical resection, surgical procedures include pancreaticoduodenectomy, hemihepatectomy, segmental liver resection and liver transplantation, and regional lymphectomy is necessary. Key words: Bile tract neoplams; Papillary neoplasms; Diagnosis; Therapy

Objective To investigate the clinical features of three unusual cases of clonorchiasis diagnosed in our department. Methods The clinical symptoms, physical examinations, laboratory data, imaging findings,pathological characteristics and treatment of three patients with clonorchiasis combined with pulmonary infiltration and eosinophilia were retrospectively analyzed. Results The mean age of three patients was 56.7 years old, they had a history of ingestion of raw fish and a chronically clinical manifestations of pulmonary symptom.The first patient had irritating cough for six months, especially at night, accompanied with night sweats. The second patient had paroxysmal wheezing for more than two years, the effect of spasmolytic antiasthmatic treatment was poor.The third patient had shortness of breath for two years, and multiple organ damage or failure.The first two cases had wheezing rale in the lung.The lung biopsy result showed eosinophilic infiltration in the lung and increased eosinophil count in the peripheral blood of the three cases. The examination for clonorchis sinensis ova and clonorchis-specific antibody were positive.Their condition improved after treatment with praziquantel. Conclusions For the patients who are from the epidemic area of clonorchiasis, have a history of eating raw fish, have pulmonary symptoms not be explained by common lung diseases, are accompanied by significantly increased eosinophils in peripheral blood or tissue, and the anti-inflammatory, anti-tuberculosis, antifungal and antispasmodic treatment is invalid, it may be considered as the lung disease caused by clonorchis sinensis infection. The detection of clonorchis sinensis ova and clonorchis-specific antibody is a reliable diagnostic method of clonorchiasis. Praziquantel is safe and effective drug for treatment of clonorchiasis. Key words: Clonorchiasis; Eosinophilia; Allergic asthma; Pulmonary infiltration

Objective To compare and evaluate the value of Kato-Katz method,bile precipitate microscopic examination,colloid gold labeled immunochromatographic (CGIA) and enzyme-linked immunosorbent assay (ELISA) for the diagnosis of Clonorchis sinensis (C.sinensis) infection.Methods The feces,bile and serum specimens from 92 patients with gallstone were collected.The feces and bile were examined under microscopy for C.sinensis eggs using Kato-Katz method and bile precipitation respectively.Meanwhile,the serum IgG of C.sinensis was detected with CGIA and ELISA.Finally,the detection rate,sensitivity,specificity,positive predictive value(PPV),negative predictive value (NPV) and Youden index (YI) were analyzed and compared.Results Of the 92 patients,49 cases were diagnosed with C.sinensis infection using Kato-Katz method combined with bile precipitation microscopic examination,and the infection rate was 53.3％.Comparing to this,the coincidence rates of Kato-Katz method,bile precipitation microscopic examination,CGIA,and ELISA were 80.4％,84.8％,90.2％ and 96.7％,respectively.Meanwhile,the diagnostic values of Kato-Katz method,bile precipitation microscopic examination,CGIA and ELISA were 63.3％,93.9％,98.0％ and 93.9％ in sensitivity;100％,100％,69.8％ and 86.0％ in specificity; 70.5％,93.5％,96.8％ and 92.5％ in NPV,100％,100％,78.7％ and 88.5％ in PPV and 0.63,0.94,0.68 and 0.80 in YI,respectively.Conclusion Bile precipitation microscopic examination is the most preferred diagnostic method of C.sinensis infection for the gallstone patients subject ed surgery.Whereas,for those subjects who can not provide bile,serum IgG antibody detection to exclude C.sinensis infection and feces Kato-Katz method to confirm infection have good clinical application value. Key words: Clonorchiasis ; Bile ; Serum ; Sensitivity ; Specificity ; Positive predictive value ;

Objective To establish a national reference for evaluation of detection reagent of antiClonorchis sinensis IgG.Methods A total of 26 serum samples of clonorchiasis patients confirmed by positive stool examination was collected in Guangzhou during 2010-2012,and 15 plasma samples of healthy blood donors were bought for each 200 ml.Samples were screened and evaluated with two domestic registered diagnostic kits for anti-Clonorchis sinensis.The composition of reference was determined,and sub-package accuracy and water content were detected.Three collaborative units were selected to calibrate and to detect the coincidence of positive reference and negative reference and the detection limit.Results The panel of Clonorchis sinensis IgG serum consisted of 9 positive and 10 negative samples,and one lowest detection sample,and one precision sample.Sub-package accuracy was 0.6％ and 0.7％.Water content was 2.8％.The coincidence of both positive reference and negative reference was100％,and the detection limit was no more than 1:32.Conclusion The national reference panel of Anti-Clonorchis sinensis IgG serum was established. Key words: Clonorchis sinensis; Detection reagent; National reference

Objective To understand the epidemic situation of Clonorchis sinensis in Sanjiang County of Guangxi thus to provide a reference for control and prevention of the disease.Methods Tongle Township was chosen as the investigation spot where the residents have the habit of eating raw fish.The stool samples of various minority ethnic residents were collected.The samples were treated by washing precipitation or aldehyde ether then examined under microscopy.The infection rate and infectiosity were calculated.Results There are minorities of Dong,Miao and Yao living in 3 villages with the total population of 3 287 among them 826 samples were collected with the collection rate of 25.13％(826/3 287) and the positive rate was 77.85％(643/826) in the Tongle Township.There were cases of clonorechis found in each age group of men and women while the infection rate in 1-9 year old group was 30.56％(22/72),67.19％(43/64) in 10-19 year old group and up to 80％ in all groups older than 20 years.The infection rates in three minorities were higher between 75.73％-100％ with the average infectiosity of 6 563 eggs/g faeces.Conclusion The Clonorchis sinensis infection is very serious in minorities of eating sashimi in this county. Key words: Clonorchiasis sinensis; The sashimi (sliced fish) ; Infection rate

Objective To investigate the changes of cytokines in rats with Clonorchiasis and the protective effects of Milkvetch Root on liver tissue.Methods Adult 32 male rats were randomly divided into four groups:control group,model group,Albendazole (ALB) group and Albendazole combined with Milkvetch Root (ALB + MR) group (8 rats / group).The experimental rats were infected with 50 metacercariae of C.sinensis or equal physiological saline through a gavage needle.The ALB group and ALB + MR group received ALB (50mg/kg/d) orally for 5days,or with MR intraperitoneally (800 mg/kg/d) for 30 days.All rats were sacrificed after 14 weeks of infection.Histopathological examination of rats' livers was performed.The levels of IL-2 and IL-4 in the serum of the rats were detected by ELISA assays.Results The vacuolization of hepatocytes and infiltration of white cells were observed in the model group,but did not observed in control group under light microscope.The injury of liver tissue of rats in ALB + MR group was milder than ALB group.The level of IL-4 in serum of rats in model group increased significantly(F =10.44,P =0.003 4),but the level of IL-2 decreased significantly compared with control group (F =18.3,P =0.000 2).The level of IL-4 in serum of rats in ALB group and in A LB + MR group decreased significantly (F =9.69,P =0.0046 ; F =7.61,P =0.010 7),while the level of IL-2 of rats in ALB group and in ALB + MR group increased significantly (F =8.69,P =0.006 8 ; F =5.5,P =0.027 3).Conclusion Our results suggested that IL-2 and IL-4 were involved in the pathogenesis of clonorchis sinensis.Milkvetch Root could provide protection to the liver tissue against Clonorchis sinensis,which might associate with the regulation of disturbed cytokines. Key words: Clonorchis sinensis ; Cytokine ; Milkvetch Root; Albendazole

Objective To investigate the epidemiological features of the cases with clonorchiasis sinensis in Guigang City,Guangxi Province and provide a reference for controlling the disease.Methods About 30-50 g fecal samples were collected from each patient and examined by sedimentation technique.Definitive diagnosis of sinensis infection would be made once the Clonorchis sinensis eggs were detected.Number of eggs was counted by Stoll's method and the infectiosity was determined based on the number of eggs per gram of (EPG).Results Among the 299 cases of Clonorchis sinensis,59 cases showed medium or heavy intensity of infection,144 cases showed moderate and 96 cases showed mild.The age of the patients was from 7 to 80 years old.79.93％ (239/299) of them were in the age group of from 30 to 59 years old.93.98％(281/299) of the case were male,30.10％ (90/299) were self-employed.81.61％ (244/299) of the cases were Han nationality 64.88％ (194/299) of the cases lived in the Downtown,and 35.12％ ( 105/299 ) in the rural The cases distributed in 60％ of all townships. 148 cases had clinical complications (49.50％ ).94.65％ (283/299) of the cases had a habit of eating raw fish.The duration from eating raw fish to definitive diagnosis of clonorchiasis was from 20 days to 70 years.Conclusion Most of the sinensis cases were males and there were more cases in urban area than that in rural area of Guigang City. Key words: Clonorchis sinensis ; Clinic ; Epidemiology ;

Objective To investigate the liver injury and pathological changes of rat and patients with Clonorchis sinensis(C, sinensis) infection, and to clarify the role of apoptosis in the injury induced by C. sinensis.Methods Wistar rats were divided into two group: 60 in infection group and 20 in control. The rats in infection group were infected with C. sinensis via oral feeding encysted cercaria;rats in control group were fed with normal saline. The rats were sacrificed 4, 6, 8 and 12 weeks after infection, respectively. Liver tissue specimens of the patients infected with C. sinensis were collected. The pathological changes of liver tissue were observed by light microscopy and the apoptofic rate of hepatocyte was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL) assay. Results Parasites and eggs could he seen around the bile duct, and the duct was associated with mucosa and adenoma papillary hyperplasia, wall thickening, inflammatory cell infiltration, a small amount of fibrous tissue hyperplasia, and periportal liver cells surrounded by a number of nuclear condensation, all these changes meant morphological characteristics of apoptosis. Apoptotic rates of liver cells in infection group 4, 6,8 and 12 weeks after infection were (7.15 ± 1.50)%,(11.61 ± 3.09)%,(13.21 ± 3.47)% and (11.26 ± 4.06)%,respectively, which was significantly higher than that in control group [(2.57 ± 0.72)%, (3.17 + 0.77)%, (3.67 ±0.96)% and (2.84 ± 0.87)%, t values were 4.45, 5.49, 5.95 and 4.74, respectively, all P < 0.01]. Conclusions These findings indicate that C, sinensis can stimulate both hepatoeytic apoptosis and degeneration which may he related to clinical manifestations and liver lesions in patients with clonorchiasis. Key words: Clonorchis sinensis; Infection; Apoptosis; Hepatoeyte

Objective To investigate the diagnostic value of coding gene of Sj26, Sj32 and Sj14-3-3 amplified by PCR for chronic Schistosomiasis japonica. Methods The DNA was extracted from sera of 40 patients with chronic Schistosomiasis japonica, the coding gene of Sj26, Sj32 and Sj14-3-3 was amplified by PCR and identified by 1.2% agarose gel electrophoresis. DNA from the sera of 21 patients with Clonorchiasis sinensis, 13 patients with Parogonimiasis westermani and 43 healthy donors was taken as control. Results A total of 399 bp coding gene of Sj14-3-3 was amplified successfully from sera of the patients with chronic Schistosomiasis japonica,but Sj26(676 bp) and Sj32( 1270 bp) coding gene were not obtained. Control groups were all negative. Conclusions Sj14-3-3 coding gene amplified by PCR can be used for genetic diagnosis of chronic schistosomiasis. Key words: Schistosomiasis japonica; Polymerase chain reaction; Gene therapy

Objective To study the diagnostic value of rSj26-Sj32-IgG-ELISA for acute schistosomiasis japonica. Methods Purified rSj26-Sj32 fusion protein and crude Schistosoma japonicum antigen (SjAWA)were used to establish IgG-ELISA to detect serum of patients with acute schistosomiasis, and clonorchiasis sinensis,paragonimiasis westermani, alveolar echinococcosis, cystic echinococcosis, type B hepatitis, lung tuberculosis patients and healthy human serum were used as control. Results The sensitivity and specialty were 90.00%(45/50) ,97.67% (42/43) and 92.00% (46/50),97.67% (42/43) in detection of acute schistosomiasis japonica with rSj26-Sj32and SjAWA, respectively, and the difference was not statistically significant(x2 were both 0.0, all P ＞0.05). The serum cross-reaction reactivity was 20.00%(2/10) in patients with alveolar echinococcosis with SjAWA,but no cross-reaction with rSj26-Sj32, the difference was not statistically significant(x2 = 0.5, P ＞ 0.05). The serum cross-reactivity were 14.29% (3/21 ), 7.69% (1/13) and 19.05% (4/21 ), 7.69% (1/13) among patients with clonorchiasis sinensis and paragonimiasis westermani by rSj26-Sj32 and SjAWA, but no cross reaction with type B hepatitis and lung tuberculosis patients, the difference was not statistically significant (x2 were both 0.0, all P ＞ 0.05). The positive predictive value, the negative predictive value and the diagnostic efficiency with acute schistosomiasis japonicum by rSj26-Sj32-IgG-ELISA and SjAWA-IgG-ELISA were 97.83% (45/46),89.36% (42/47),93.55% (87/93)and 97.87% (46/47),91.30% (42/46),94.62% (88/93), respectively, and the difference was not statistically significant (x2 were both 0.0, all P ＞ 0.05). Conclusion rSj26-Sj32 fusion protein can be used for the immune diagnosis of acute schistosomiasis japonica. Key words: Schistosomiasis japonica; Diagnosis; Enzyme-linked immunosorbent assay; Immunologic tests

Objective To evaluate the diagnostic value of the recombinant protein Sj_Ts4 in immunodiagnosis of Schistosomiasis japonica.Methods Seventy-four blood samples of schistosomiasis japonica patients(acute, chronic and advanced)were used for evaluating the sensitivity.Blood samples from 24 Clonorchiasis patients,8 patients with hookworm infections and 30 normal persons from the areas without Schistosomiasis were used ror patients.Results The positivity rates were 97.1%(33/34),100.0%(16/16),87.5%(21/24)in rSj-Ts4-ELISA and 100%(34/34),100.0%(16/16),75.0%(18/24)in SjAWA-ELISA in acute,chmnic and advanced Schistosomiasis. respectively.Statistical analysis revealed no significant difference in sensitivity(X2=1.23,P＞0.05)between both recombinant and crude antigens.The false positive reaction was found to be 6.7%(2/30)in rSj-Ts4-ELISA and 3.3%(1/30)in SjAWA-ELISA when detected in 30 cases of normal control sera.but no statisticallv significant difference was noted(x2=0.35,P＞0.05).Twelve point five percent(3/24),20.8%(5/24)and 12.5%(1/8),37.5% (3/8),of cross-reactions were observed between rSj-Ts4-ELISA and SjAWA-ELISA for detecting the sera of patients with clonorehiasis and hookworms.There was no significant difference of cross-reaction in two parasitic infections (x2=0.60,1.33,P＞0.05)with the two tests.Conclusions The rSj-Ts4 antigen shows higher sensitivity and specificity for the diagnosis of Schistosomiasis japonica,which is helpful in the serological diagnosis of Schistosomiasis japonica in endemic areas. Key words: Recombinant proteins; Schistosomajaponicum; Diagnosis.immunological

A 70-year-old lady was investigated because of an intermittent fever over the preceding 12 months. More recent symptoms included anorexia and weight loss. Her past history included an episode of jaundice that resolved spontaneously. She was born in southern China and moved to Singapore as a teenager. Her liver was mildly enlarged with a firm edge. Laboratory investigations including liver function tests were within the reference range. An ultrasound study revealed a complex mass lesion adjacent to the right lobe of the liver with echogenic material in the region of the gallbladder neck. A contrast-enhanced computed tomography scan revealed marked dilatation of the bile duct with intraluminal filling-defects and stretching of the portal vein (Fig. 1). Magnetic resonance cholangiopancreatography confirmed the presence of gross dilatation of the bile duct with smooth tapering of the duct in the region of the ampulla (Fig. 2). She was diagnosed with clonorchiasis, largely on the basis of filling-defects within the bile duct consistent with clumps of liver flukes. Endoscopic biliary drainage was not performed because of the risk of precipitating life-threatening cholangitis in a relatively well patient. She was offered antihelminthic therapy but declined. On follow-up after 12 months, she remains well with normal liver function tests. Infection with Clonorchis sinensis is endemic in some parts of southern China where there is consumption of raw fish along with relatively poor sanitation. The definitive hosts are pigs, dogs, cats and humans. The eggs are excreted in feces and are eaten by fresh water snails. Subsequently, the snails excrete cercariae which penetrate susceptible fish and encyst within muscle. The life cycle is completed when raw fish is ingested by the definitive host and metacercariae excyst in the duodenum and migrate into the bile duct. Infestation of the biliary system by adult worms is often asymptomatic. The mature worms (flukes) can live for up to 30 years within the biliary system and have been associated with recurrent cholangitis, cirrhosis and cholangiocarcinoma. The diagnosis of clonorchiasis is confirmed by visualization of the adult worm in duodenal aspirates or bile or the presence of ova in stool. Drug-therapy with praziquantel is usually effective but biliary drainage procedures may be necessary for cholangitis. The case outlined above highlights the fact that infested patients may seek medical attention many years after moving from an endemic area. Contributed by

目的 探讨肝吸虫病的CT表现.方法 回顾性分析80例肝吸虫病的CT表现.结果 80例肝吸虫病患者CT检查均发现肝内胆管扩张,肝外胆管不扩张;肝内胆管轻度扩张47例,中度扩张33例;肝被膜下小胆管囊状扩张60例.结论 肝吸虫病具有较特征性的CT表现。

目的 研究华支睾吸虫病患者血清中Th1/Th2细胞因子IL-2和IL-4的水平变化,并探讨其在肝吸虫致病机制中的作用.方法分别采集华支睾吸虫病人和健康人的血清,用ELISA方法检测血清中Th1/Th2细胞因子IL-2和IL-4的水平.结果华支睾吸虫病人血清IL-2的水平与正常对照组相比(P＜0.01)显著降低,IL-4的水平与正常对照组相比显著升高(P＜0.05).结论华支睾吸虫感染病人血清细胞因子水平异常,表现为Th1型细胞因子水平下降,Th2型细胞因子水平升高,病人细胞免疫功能下降,体液免疫功能增强升高,本研究结果表明肝吸虫感染后引起的细胞因子紊乱参与肝吸虫致病过程。

目的 探讨CT及内镜下逆行胰胆管造影(ERCP)对肝吸虫性胆道梗阻的价值.方法回顾手术证实的肝吸虫及其团块引起的急性胆道梗阻47例,其中由内镜下十二指肠乳头括约肌(Oddi's括约肌)切开术(EST)证实20例,胆总管探查术证实27例,分析其CT及ERCP特点.结果 43例患者见不同程度的弥漫性肝内胆管从肝门向被膜方向均匀扩张,39例轻中度肝外胆管扩张,两者扩张不成比例.41例被膜下胆管末端呈囊状或杵状扩张.38例胆囊扩大,9例胆囊内可见软组织团块影.13例见胰腺肿胀,8例见胰管扩张.20例ERCP中16例见肝外胆管轻中度扩张,18例见肝内胆管呈迂曲扩张延伸,末梢呈囊状扩张,可见肝内扩张小胆管突然中断征象,在胆管内可见泥沙样、絮状不规则充盈缺损.3例见肝囊肿与扩张胆管相通.同时20例行EST术,成功解除梗阻.结论急性梗阻性黄疸患者,CT显示肝内胆管均匀弥漫扩张,肝内胆管末端呈囊状改变,伴或不伴肝外胆管扩张,可诊断肝吸虫性梗阻.ERCP可通过抽取胆汁,找到肝吸虫或其虫卵而证实,并可通过EST术解除梗阻。

目的 探讨老年人在合并华支睾吸虫感染时胆道疾病的外科治疗特点.方法手术治疗胆道疾病合并华支睾吸虫感染老年患者85例,其中包括胆道结石62例(72.9%),单纯吸虫引起的梗阻11例(12.9%),胆道恶性肿瘤12例(14.1%).合并急性胰腺炎5例(5.9%),其中3例由胆道结石引起,1例由吸虫梗阻引起,1例由胆管癌引起.手术以胆囊切除加胆总管探查和内镜下十二指肠乳头扩约肌切开术(EST)为主.结果良性病变均于术后痊愈出院.12例恶性病变中2例在围手术期内死亡,10例生存期2～6个月.结论老年人华支睾吸虫感染后更易引起相关的胆道外科疾病,外科治疗的同时应注意对吸虫本身的处理。