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            <h1 id="seo-header">寄生虫二：医学蠕虫之吸虫</h1>
            
            
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                <p>寄生人体的吸虫都属于复殖目，称为复殖吸虫。生活史有世代交替，无性世代寄生在软体动物，有性世代多寄生在脊椎动物。除裂体科是雌雄异体，其他均是雌雄同体。可进行异体受精或自体受精。</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="肝吸虫-华支睾吸虫"><a href="#肝吸虫-华支睾吸虫" class="headerlink" title="肝吸虫&#x2F;华支睾吸虫"></a>肝吸虫&#x2F;华支睾吸虫</h2><p>主要保虫宿主为猫、狗和猪，水中存在第一第二中间宿舍，人群习惯吃不熟的淡水鱼虾。</p>
<p>成虫睾丸一对前后排列于虫体后部，分支状。虫卵是人体最小的寄生虫卵；窄的一端有卵盖，周围形成肩峰，对侧有小疣。成虫寄生在人的肝胆管内，偶见于胰腺管，以胆管黏膜分泌物、上皮细胞为食，寿命可达20~30年。虫卵在水中不易孵出，被第一中间宿主淡水螺类摄取后，经胞蚴、雷蚴，形成尾蚴逸出，侵入第二中间宿主淡水鱼和虾，脱尾形成囊蚴。囊蚴随鱼虾肉进入人体，经蛋白酶消化外壁，虫体逸出，从十二指肠经胆总管进入肝胆管。</p>
<p>进入人体的肝吸虫囊蚴，潜伏期1个月，上腹部持续性刺痛和腹泻。阻塞性黄疸、胆道炎症、胆石症，胆汁性肝硬化、门脉高压。</p>
<p>诊断可以用涂片法和集卵法，以及十二指肠引流胆汁检查。也可以免疫检查和影像检查。</p>
<p>治疗首选吡喹酮，阿苯达唑。</p>
<h2 id="姜片虫-布氏姜片吸虫"><a href="#姜片虫-布氏姜片吸虫" class="headerlink" title="姜片虫&#x2F;布氏姜片吸虫"></a>姜片虫&#x2F;布氏姜片吸虫</h2><p>猪感染姜片虫较普遍，是最重要的保虫宿主。虫卵是常见寄生虫中最大的，卵盖小不明显。</p>
<p>姜片虫腹吸盘较大，寄生在小肠，卵入水中孵出毛蚴，钻入第一中间宿主扁卷螺，经雷蚴至尾蚴，附着在第二媒介菱角、荸荠等水生植物上发育成有感染能力的囊蚴。被人或猪吞食后，在十二指肠囊壁被消化，尾蚴逸出用腹吸盘附着在肠黏膜表面。</p>
<p>姜片虫主要引起消化道症状。强力的吸盘可以造成肠道机械性损伤。可能腹泻与便秘交替出现。偶有肠梗阻。</p>
<p>因为虫卵大，直接涂片法效果好。浓集法可以离心也可以水洗自然沉淀。改良加藤法可以计数。也有免疫学检查。</p>
<p>吡喹酮最有效。硫双二氯酚(别丁）、槟榔煎剂。</p>
<h2 id="肺吸虫-卫氏并殖吸虫和斯氏并殖吸虫"><a href="#肺吸虫-卫氏并殖吸虫和斯氏并殖吸虫" class="headerlink" title="肺吸虫&#x2F;卫氏并殖吸虫和斯氏并殖吸虫"></a>肺吸虫&#x2F;卫氏并殖吸虫和斯氏并殖吸虫</h2><p>哺乳动物均可成为传染源。</p>
<p>成虫常寄生在肺内，虫卵随痰咳出，入水孵化成毛蚴，进入第一宿主淡水螺，经胞蚴、雷蚴到尾蚴，逸出进入第二中间宿主淡水蟹或蝲蛄发育成囊蚴。随进食进入人体，经消化液脱囊作用成为童虫。童虫活动能力强，穿过肠壁进入腹腔浆膜表面，沿肝表面向上移行，贯穿膈肌到达胸腔发育为成虫。</p>
<p>吃进囊蚴前一个月为幼虫移行期，轻症食欲不振、低热，重症高热、腹泻、腹痛，肠、肝损伤。进入肺部后咳带虫卵的铁锈色痰，留在腹部的出现腹痛、腹泻、便血、肝损，皮下可见游走性包块。不慎入脑出现头晕、癫痫、偏瘫、视力障碍。</p>
<p>诊断有痰或粪便找虫、皮下包块或手术后结节找虫，以及免疫学检查。</p>
<p>常用吡喹酮治疗，硫双二氯酚。</p>
<h2 id="血吸虫-日本裂体吸虫"><a href="#血吸虫-日本裂体吸虫" class="headerlink" title="血吸虫&#x2F;日本裂体吸虫"></a>血吸虫&#x2F;日本裂体吸虫</h2><p>雌雄异体。病人和病牛是最重要的传染源。</p>
<p>血吸虫成虫寄生在人和多种哺乳动物的门脉-肠系膜静脉系统，平均4.5年。雌虫在静脉末梢产卵，部分虫卵沉积在结肠肠壁组织小血管中，另一部分虫卵随血流沉积于肝脏。虫卵发育成熟后，肠黏膜内含有毛蚴的虫卵脱落入肠腔，随粪便排出体外。在水中孵出毛蚴，侵入钉螺，经过母胞蚴、子胞蚴，后者进入钉螺肝内分批形成尾蚴。尾蚴成熟后离开钉螺，分布在水体表层，人接触疫水后经皮肤侵入人体，变成童虫。童虫穿入小静脉或淋巴管，经右心、肺、左心后到达全身。大部分童虫进入小静脉，随血流入肝内门静脉，滞留发育。遇到异性童虫开始合抱，并迁移到门静脉-肠系膜静脉寄居，交配产卵。</p>
<p>尾蚴侵入人体发生尾蚴性皮炎，属自限性疾病。童虫移行产生尾蚴性肺炎，成虫对血管的机械性、化学性刺激产生静脉炎、腹痛。代谢物、排泄物引起血吸虫性肾炎。虫卵在肠壁和肝汇管区引起嗜酸性肉芽肿、纤维化，导致门脉高压、食道圩堤静脉曲张，可发生上消化道大出血。</p>
<p>诊断首选粪便水洗沉淀后进行毛蚴孵化。急性期可以粪便直接涂片。此外还有尼龙袋集卵法、肠镜活检法。免疫学和生物标志物结果可参考。</p>
<p>治疗用吡喹酮。蒿甲醚和青蒿琥酯对童虫有很好的杀灭作用。</p>

                
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