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淋巴丝虫病的诊断、治疗与预防

Author
Amy D Klion, MD
Section Editor
Peter F Weller, MD, MACP
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
曾伟锋, 主治医师

引言

丝虫病是由寄生在淋巴系统和皮下组织的线虫(圆虫)所引起。有3种丝虫可导致淋巴丝虫病：班氏吴策丝虫(Wuchereria bancrofti)、马来布鲁丝虫(Brugia malayi)和帝汶布鲁丝虫(Brugia timori)。感染通过蚊媒传播；人类是终宿主。淋巴丝虫病是在流行地区引起毁容和失能的一个主要原因，可导致显著的经济和心理社会影响。

本文将总结淋巴丝虫病的诊断、治疗和预防。淋巴丝虫病及其他丝虫感染(包括盘尾丝虫病、罗阿丝虫病和曼森丝虫病)的流行病学、发病机制和临床特征将单独讨论。 (参见“淋巴丝虫病的流行病学、发病机制及临床表现”和“Onchocerciasis”和“Loiasis (Loa loa infection)”)

诊断

如果患者有适当的暴露史，并有特征性的症状和体征或不明原因的嗜酸性粒细胞增多，应考虑淋巴丝虫病。 (参见“淋巴丝虫病的流行病学、发病机制及临床表现”)

通过在循环中检出丝虫抗原(只针对班氏吴策丝虫感染)，在血液中检出微丝蚴或丝虫DNA，或在淋巴组织中发现成虫，可确诊。极少数情况下，微丝蚴和/或成虫可在组织活检或细胞学标本中被偶然发现[1]。外周血嗜酸性粒细胞增多在患者中常见，可能超过3000/μL。丝虫病所致嗜酸性粒细胞增多的发病率难以确定，因为在流行地区，患者常同时存在其他蠕虫感染[2]。其他非特异性的实验室检查结果包括血清IgE升高、镜下血尿，以及蛋白尿。 (参见“淋巴丝虫病的流行病学、发病机制及临床表现”，关于‘肾脏受累’一节)

循环抗原检测 — 目前已研发出诊断班氏吴策丝虫感染的循环丝虫抗原(circulating filarial antigen, CFA)检测，但尚没有针对布鲁丝虫病的CFA检测。CFA检测可发现丝虫成虫释放的抗原，因此即使在无微丝蚴血症患者中也可能呈阳性[3]。另外，抗原水平在日间和夜间保持平稳，因此这些检测可随时进行。

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-15.
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