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            <h1 id="seo-header">寄生虫一：医学蠕虫之线虫</h1>
            
            
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                <p>线虫一般呈线性或圆柱形，体表光滑，两侧对称，不分节。前端一般较钝圆，后端逐渐变细。线虫雌雄异体，通常雌虫较大，尾端尖直，略向腹面弯曲，生殖器官大多为双管型；雌虫较小，尾端卷曲呈钩状或尾端膨大呈伞状，生殖器官呈单管型。线虫卵一般为椭圆形，黄色、棕黄色或无色。卵壳由外层的卵黄膜（或受精膜）、中层的壳制层和内层的蛔苷层（或脂层）三层结构组成。</p>
<p><img src="https://img-cdn.limour.top/2022/10/08/634180326dad1.png" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload></p>
<h2 id="蛔虫-似蚓蛔线虫"><a href="#蛔虫-似蚓蛔线虫" class="headerlink" title="蛔虫&#x2F;似蚓蛔线虫"></a>蛔虫&#x2F;似蚓蛔线虫</h2><p>人是唯一宿主。蛔虫是人体最大的肠道线虫，主要在温暖潮湿的地区流行，农村感染率高于城市，温暖潮湿地区高于寒冷干燥地区。</p>
<p>成虫雌雄异体，生活在人体小肠，寿命一年，有肛门开口，口孔位于虫体顶端，周围有三个唇瓣，排列成品字形。排出到外界的虫卵，如果受精，会在卵内发育成幼虫，卵内幼虫蜕一次皮后，虫卵成为感染期卵，被人误食后在小肠孵出幼虫，侵入肠黏膜和黏膜下层，进入静脉或淋巴管，先后经肝、右心、到达肺，穿破肺毛细血管进入肺泡，沿支气管、气管逆行至咽部，随吞咽动作再次进入消化道，最后在小肠内发育为成虫。</p>
<p>蛔虫的幼虫移行阶段可引起蛔虫性肺炎或蛔虫性哮喘，经过肝脏时可以引起轻微的炎症，但主要的还是成虫致病。胆道蛔虫症、蛔虫性胰腺炎、蛔虫性阑尾炎，蛔虫性肠梗阻可进一步发展成肠扭转、肠套叠、肠坏死。其中胆道蛔虫症最常见，可引起梗阻性胆管炎和肝脓肿。</p>
<p>蛔虫幼虫致病时，患者可发烧、干咳、哮喘、胸痛、咯血、荨麻诊，肺部散在游走性片状阴影。外周血中嗜酸性粒细胞增多，称为 Loeffler’s 综合征。多数病例两周内自愈。</p>
<p>成虫致病，常有腹部不适或间歇性脐周疼痛。代谢产物和排泄物引起毒性和变态反应，出现食欲不振、恶心、烦躁、夜间磨牙、瘙痒、荨麻诊、哮喘，甚至出现中毒性脑病，儿童偶有异嗜症。</p>
<p>生理盐水直接涂片法是首选的诊断方法，三片检出率可达95%。饱和盐水漂浮法或粪便沉淀法可以提高虫卵检出率。对于蛔蚴性肺炎，可以痰液涂片。</p>
<p>常用驱虫药有阿苯达唑、甲苯达唑、三苯双脒和伊维菌素。</p>
<h2 id="鞭虫-毛首鞭形线虫"><a href="#鞭虫-毛首鞭形线虫" class="headerlink" title="鞭虫&#x2F;毛首鞭形线虫"></a>鞭虫&#x2F;毛首鞭形线虫</h2><p>人是唯一宿主。主要流行在热带、亚热带发展中国家和地区。农村感染率高于城市。</p>
<p>鞭虫因形似马鞭而得名，虫卵两端各有一个透明栓。成虫一般寄生在盲肠，寿命3~5年，严重时可寄生于结肠、直肠甚至回肠下端，排出到外界的虫卵经三周发育为含有幼虫的感染期卵。经口食入后在小肠内孵出，仅钻入小肠上皮，10天后回到肠腔，移行至盲肠发育为成虫。</p>
<p>幼虫侵入肠壁有轻微炎症但常无自觉症状。成虫有机械性损伤和代谢产物刺激，引起肠黏膜出血、炎症和溃疡，长期慢性炎症可以引起肉芽肿。表现为腹部不适、腹痛、腹泻、贫血、心慌、脱肛。</p>
<p>首选饱和盐水漂浮法，也可以用直接涂片法、改良加藤厚涂片法。（光）纤维结肠镜检查发现虫体。</p>
<p>常用驱虫药有阿苯达唑、甲苯达唑、奥克太尔。</p>
<h2 id="蛲虫-蠕形住肠线虫"><a href="#蛲虫-蠕形住肠线虫" class="headerlink" title="蛲虫&#x2F;蠕形住肠线虫"></a>蛲虫&#x2F;蠕形住肠线虫</h2><p>人是唯一宿主。可经空气传播，感染率儿童高于成人，幼儿园感染率高，有家庭聚集性。</p>
<p>蛲虫前端角皮膨大形成头翼，咽管末端肌肉发达形成咽管球。卵内含一胚胎。成虫常寄生在盲肠，因肠腔低氧，雌虫几乎不产卵。宿主入睡后。受孕雌虫移行至肛门外，虫卵产在肛周，卵内幼虫经6小时发育为感染期卵。经手-口或空气吸入的卵，在十二指肠孵出，沿小肠下行。肛门处孵化的幼虫也可逆行感染。</p>
<p>肛周产卵引起瘙痒，患者常有烦躁、失眠、食欲缺乏、消瘦、夜间磨牙、夜惊、学习成绩下降。挠痒抓破皮肤可继发感染。吸入的虫卵可引起哮喘。</p>
<p>首选透明胶纸法进行检查。也可以用肛门拭子法和肛周找虫法。</p>
<p>常用阿苯达唑和甲苯达唑治疗。局部外用3%噻嘧啶软膏。</p>
<h2 id="钩虫-十二指肠钩口线虫和美洲板口线虫"><a href="#钩虫-十二指肠钩口线虫和美洲板口线虫" class="headerlink" title="钩虫&#x2F;十二指肠钩口线虫和美洲板口线虫"></a>钩虫&#x2F;十二指肠钩口线虫和美洲板口线虫</h2><p>人是唯一宿主。含虫卵的粪便污染土壤，田间劳作时裸露的皮肤接触疫土。主要流行在黄河以南的广大农村地区。</p>
<p>十二指肠钩口线虫呈C形，美洲板口线虫呈S形，口囊内钩齿或板齿。钩虫卵壳薄，内有卵细胞，间隙明显。成虫咬附小肠黏膜，以血液和淋巴液为食。排出到外界的虫卵经1~2天孵出杆状蚴，再经一周发育成具有感染能力的丝状蚴。丝状蚴钻入皮肤，经小静脉或淋巴管进入右心、肺，穿过肺毛细血管进入肺泡、支气管、气管，在咽部随吞咽进入小肠，蜕皮后发育为成虫。</p>
<p>幼虫可以引起钩蚴性皮炎，移行到肺部引起 Loeffler’s 综合征。成虫吸取血液，分泌抗凝物质，使伤口长时间渗血。丢失大量血红蛋白，损失的铁无法得到补充，小细胞低色素性贫血。损失肠黏膜，可出现上腹部疼痛或腹泻。缺铁引起异嗜症。此外，十二指肠钩虫也可以经口感染，钩蚴也可以经过胎盘或母乳感染胎儿或婴儿。</p>
<p>优选饱和盐水漂浮法。感染严重时可以直接涂片法。钩蚴培养法也行。</p>
<p>常用阿苯达唑、甲苯达唑、噻嘧啶，驱虫时需要补充铁剂。</p>
<h2 id="旋毛虫-旋毛形线虫"><a href="#旋毛虫-旋毛形线虫" class="headerlink" title="旋毛虫&#x2F;旋毛形线虫"></a>旋毛虫&#x2F;旋毛形线虫</h2><p><img src="https://img-cdn.limour.top/2022/10/08/63419e6a8209d.png" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload></p>
<p>除人外，许多哺乳动物如猪、老鼠、犬、野生动物等均可作为保虫宿主。旋毛虫是寄生人体最小的线虫。流行具有地方性、群体性和食源性。</p>
<p>成虫主要寄生在十二指肠和空肠上段，雌雄交配产生幼虫，幼虫侵入局部淋巴管或小静脉，抵达骨骼肌进一步发育，刺激肌细胞形成囊包。囊包幼虫为感染期，需要转换新的宿主才能完成生活史，否则大部分在半年后钙化。</p>
<p>侵入时在十二指肠和空肠产生广泛性肠炎，恶心、呕吐、腹痛、腹泻，伴有厌食、乏力、畏寒、低热，持续一周，易误诊。幼虫进入肌肉时，有全身中毒、过敏症状，血管炎、肌炎，眼睑和面部水肿，可因心衰、呼吸道并发症死亡。</p>
<p>常用活检法，取腓肠肌或肱二头肌进行活检。收取吃剩的猪肉也可作为佐证。免疫诊断常用ELISA法，敏感性高、特异性强，适用于急性期病人的早期诊断。</p>
<p>阿苯达唑是首选药，能杀死肌肉中的幼虫。感染一周内用药，治愈率可达100%。</p>
<h2 id="丝虫-班氏吴策线虫和马来布鲁线虫"><a href="#丝虫-班氏吴策线虫和马来布鲁线虫" class="headerlink" title="丝虫&#x2F;班氏吴策线虫和马来布鲁线虫"></a>丝虫&#x2F;班氏吴策线虫和马来布鲁线虫</h2><p>班氏微丝蚴</p>
<p>马来微丝蚴</p>
<p>大小</p>
<p>大</p>
<p>小</p>
<p>体态</p>
<p>自然</p>
<p>僵硬</p>
<p>头间隙</p>
<p>短</p>
<p>长</p>
<p>体核</p>
<p>圆、清晰</p>
<p>椭圆、重叠</p>
<p>尾核</p>
<p>无</p>
<p>2个</p>
<p>人是终宿主、蚊是中间宿主。经蚊虫叮咬传播。</p>
<p>成虫寄生在淋巴管内。微丝蚴白天聚集在肺部的毛细血管中，夜晚进入外周血液中。经蚊虫吸入后，发育成腊肠期幼虫、感染期幼虫（丝状蚴），叮咬人后进入人体。</p>
<p>微丝蚴血症，仅有发热和淋巴管炎症状，可持续10年以上。幼虫和成虫的分泌排泄裂解物刺激，出现淋巴管&#x2F;结炎、精索炎、附睾炎、睾丸炎，慢性期发生淋巴阻塞，淋巴水肿和象皮肿、鞘膜积液、乳糜尿。</p>
<p>夜间取血检查微丝蚴，首选厚血膜法，尿液和体液中也可检查微丝蚴。免疫学可以皮内试验或检测抗体和循环抗原。</p>
<p>治疗用海群生（乙胺嗪）、呋喃嘧酮、阿苯达唑、伊维菌素。保泰松治疗急性淋巴管炎。</p>

                
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