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  135. <h1 id="seo-header">寄生虫二:医学蠕虫之吸虫</h1>
  136. <div class="markdown-body">
  137. <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>
  138. <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>
  139. <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>
  140. <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>
  141. <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>
  142. <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>
  143. <p>治疗首选吡喹酮,阿苯达唑。</p>
  144. <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>
  145. <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>
  146. <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>
  147. <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>
  148. <p>吡喹酮最有效。硫双二氯酚(别丁)、槟榔煎剂。</p>
  149. <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>
  150. <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>
  151. <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>
  152. <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>
  153. <p>常用吡喹酮治疗,硫双二氯酚。</p>
  154. <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>
  155. <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>
  156. <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>
  157. <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>
  158. <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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