脑囊虫病课件.pptx

1、脑脑 囊 虫 病（cerebral cysticercosis）According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline定义定义l链状带绦虫：又称猪带绦虫，是我国主要的人体绦虫。其成虫寄生在人的小肠内，引起猪带绦虫病；幼虫可寄生在人体皮下、肌肉、脑等

2、处，引起猪囊尾蚴病或囊虫病。l脑囊虫病是由猪绦虫幼虫（囊尾蚴）寄生脑组织形成包裹所致。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline流行病学流行病学l地理分布：l除因宗教教规而禁食猪肉的国家和民族外，世界各地均有散在病例，尤其以发展中国家较

3、多，如中、南美洲，拉丁美洲和南亚地区。l我国东北、华北地区流行广泛，广西、云南等少数地区感染率也较高，呈区域性流行。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline流行病学流行病学l流行因素：居民生活习惯、猪的饲养方式l人的感染：与居民饮食习

4、惯有关。广西、云南等少数民族地区有食生肉、半生肉的习惯；我国多数地区感染一般是由于加工猪肉时温度不均、蒸煮时间不足，猪囊尾蚴没有全部被杀死。l猪的感染：由于居民随地大便、厕所简陋或猪圈与人厕连在一起，使猪能吃到人的粪便。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and se

5、lf-discipline感染途径感染途径l自体外感染：体内有成虫寄生，误食自己排出的虫卵。l自体内感染：体内有成虫寄生，恶心、呕吐 妊娠节片或虫卵反流入胃而再次感染。l异体感染：非绦虫患者误食绦虫卵或妊娠节片。l虫卵进入十二指肠内-孵化溢出六钩蚴-血液循环-分布全身并发育成囊尾蚴According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Ente

6、rprise leaders integrity and self-discipline病理病理l广泛型：在脑实质内有大小不等的囊虫结节广泛分布。l孤立型：在脑室内（以第四脑室为最常见）有孤立性囊虫囊肿，常致梗阻性脑积水。l葡萄串状囊肿：连结成串，在脑底部、脑膜、蛛网膜下腔。可见显著的炎性反应与脑膜增厚。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of stat

7、e-owned Enterprise leaders integrity and self-discipline临床表现临床表现l猪带绦虫病（成虫）：常无明显症状，患者多因粪便内发现节片方来就诊。少数患者可有腹部不适、消化不良、腹胀以及消瘦等症状。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders in

8、tegrity and self-discipline临床表现临床表现猪囊尾蚴病（幼虫）皮下及肌肉囊尾蚴病脑囊尾蚴病眼囊尾蚴病According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline囊尾蚴引起脑病变的发病机理主要有：囊尾蚴引起脑病变的发病机理主要有：

9、l囊尾蚴对周围脑组织的压迫和破坏；l作为异种蛋白引起脑组织变态反应与炎症；l阻塞脑脊液循环通路引起颅内压增高。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline脑囊尾蚴病临床表现（按部位）脑囊尾蚴病临床表现（按部位）l1.脑实质型：皮质全身性和

10、部分性痫性发作，可出现偏瘫、感觉缺失、偏盲和失语；小脑共济失调；血管受损卒中；额、颞叶精神症状及智能障碍。罕见情况是在感染初期发生急性弥漫性脑炎，引起意识障碍甚至昏迷。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplinel2.蛛网膜型：脑膜的包囊

11、破裂或死亡可引起脑膜刺激征阳性、交通性脑积水和脑膜炎等表现。l3.脑室型：以颅内压增高为突出表现；常位于脑室内，可致阻塞性脑积水；布龙征（Brun sign）：第四脑室内漂浮于CSF中的孤立性囊虫可随头位改变而突然阻塞第四脑室的正中孔与侧孔，导致颅内压骤然升高，出现发作性眩晕、恶心、呕吐及意识障碍，有时可因呼吸骤停而猝死。l4.脊髓型：非常罕见，临床表现缺乏特异性。According to the assessment requirements of party conduct and clean government,combined with the five regulations an

12、d five new requirements of state-owned Enterprise leaders integrity and self-discipline脑囊尾蚴病临床表现（按临床特点）脑囊尾蚴病临床表现（按临床特点）l癫痫型l颅内压增高型l癫痫合并颅内压增高型l精神障碍型l癫痫、颅内压增高及精神障碍型l脑膜脑炎型l神经衰弱型：少见，神经症表现，如头痛头晕、失眠多梦、记忆力减退等According to the assessment requirements of party conduct and clean government,combined with the fi

13、ve regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline辅助检查辅助检查l血常规：嗜酸性粒细胞增多；lCSF可能正常或淋巴细胞数增多和压力升高，蛋白质正常或轻度升高，糖、氯化物正常；l血清及脑脊液囊虫抗体阳性。According to the assessment requirements of party conduct and clean government,combined with the five regulations and f

14、ive new requirements of state-owned Enterprise leaders integrity and self-disciplineCT表现表现l主要为集中或散在的直径0.5-1,0cm的圆形或类圆形阴影，可呈低密度、高密度或高低混杂密度影；增强扫描头节可强化。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-ow

15、ned Enterprise leaders integrity and self-disciplineMRI表现表现 根据囊虫感染的先后时间不同，可分为不同时期，有不同表现。特征性的表现为多发小囊型，多散在分布于脑实质的皮质区，能见到囊壁内侧偏于一侧有一点状影为头节，增强后囊壁或头节不增强或轻度增强。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state

16、-owned Enterprise leaders integrity and self-disciplineAccording to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplineAccording to the assessment requirements o

17、f party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplineAccording to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements

18、 of state-owned Enterprise leaders integrity and self-discipline脑囊虫病确诊标准脑囊虫病确诊标准l1、有便绦虫史和食米猪肉史。l2、有局灶或弥散性脑部损害症状和体征并排除了其他病因所造成的脑组织损害。l3、CSF囊虫免疫学检验阳性。l4、颅脑CT或MRI检查显示有典型囊虫寄生改变。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new

19、requirements of state-owned Enterprise leaders integrity and self-discipline鉴别诊断鉴别诊断l其他原因所致症状性癫痫l脑肿瘤l脑脓肿l脑膜炎According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self

20、-discipline治疗治疗l病因治疗1、吡喹酮：广谱抗寄生虫药2、阿苯达唑：广谱抗寄生虫药 注意：用药后，死亡的囊尾蚴可引起严重的急性炎症反应和脑水肿，可致颅内压急骤增高并引起脑疝，用药过程中必须严密监测，应给予皮质类固醇或脱水剂治疗。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integr

21、ity and self-disciplinel对症治疗单个病灶（尤其脑室内）可手术摘除；脑积水者可行脑脊液分流术；癫痫者可使用抗癫痫药物。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline预防预防l治疗患者l加强粪便管理l改进养猪方法l严格肉类检查l加强卫生宣传谢谢聆听！谢谢聆听！