蠕蟲(chóng)卵的鑒別與鑒別診斷

1、蠕蟲(chóng)卵的鑒別與鑒別診斷1 一 蠕蟲(chóng)卵檢查常用方法1 生理鹽水直接涂片法2 Kato-Katz法3 浮聚法（飽和鹽水浮聚法、硫酸鋅離心浮聚法等）4 濃聚法（自然沉淀法、離心沉淀法、汞碘醛離心沉淀法等）5 尼龍絹集卵法6 試管濾紙培養(yǎng)法7 肛門(mén)拭子法（棉簽拭子法、透明膠帶紙肛拭法）2 二 蠕蟲(chóng)病原檢查常見(jiàn)標(biāo)本1 糞便2 痰液（肺吸蟲(chóng)卵、糞類園線蟲(chóng)幼蟲(chóng)、蛔幼、鉤幼、等)3 十二指腸液和膽汁（姜片蟲(chóng)卵、華枝睪吸蟲(chóng)卵、肝片形吸蟲(chóng)卵等）4 其他：肌肉、腸粘膜活體組織檢查、皮膚及皮下活體組織檢查等3 三 蠕蟲(chóng)卵鑒別要點(diǎn)與分類檢索 1 鑒定蠕蟲(chóng)卵常用的術(shù)語(yǔ)2 蟲(chóng)卵鑒別要點(diǎn): 大小、形狀、顏色、卵殼和附屬物、內(nèi)

2、含物3 蟲(chóng)卵的分類檢索4 常見(jiàn)蠕蟲(chóng)卵在Kato-Katz厚涂片中形態(tài)識(shí)別5 蟲(chóng)卵的鑒別與定種4 （一）鑒定蠕蟲(chóng)卵常用的術(shù)語(yǔ)5 （二） 蠕蟲(chóng)卵的鑒別要點(diǎn)1 大小、2 形狀、3 顏色、4 卵殼和附屬物5 內(nèi)含物6 1、蟲(chóng)卵的大小姜片蟲(chóng)卵:140m蛔蟲(chóng)卵:60肝吸蟲(chóng)卵:32測(cè)微尺直接測(cè)量常見(jiàn)受精蛔蟲(chóng)卵的比較7 巨片吸蟲(chóng)蟲(chóng)卵與受精蛔蟲(chóng)卵馬來(lái)棘口吸蟲(chóng)卵與受精蛔蟲(chóng)卵日本棘隙吸蟲(chóng)卵與受精蛔蟲(chóng)卵宮崎并殖吸蟲(chóng)卵與受精蛔蟲(chóng)卵大小與受精蛔蟲(chóng)卵的比較8 胰闊盤(pán)吸蟲(chóng)卵與受精蛔蟲(chóng)卵華支睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵麝貓后睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵鐮刀星隙吸蟲(chóng)卵與受精蛔蟲(chóng)卵9 日本血吸蟲(chóng)卵與受精蛔蟲(chóng)卵牛帶絳蟲(chóng)卵與受精蛔蟲(chóng)卵縮小膜殼絳蟲(chóng)卵與

3、受精蛔蟲(chóng)卵克氏假裸頭絳蟲(chóng)卵與受精蛔蟲(chóng)卵10 2、蟲(chóng)卵的形狀各種蟲(chóng)卵的形狀差異很大，蟲(chóng)卵的外形描述大致可以分為13種。蠕蟲(chóng)卵外形的區(qū)別模式圖對(duì)稱上下不對(duì)稱兩側(cè)不對(duì)稱圓形長(zhǎng)圓形橢圓形長(zhǎng)圓形長(zhǎng)橢圓形短橢圓形紡錘形卵形長(zhǎng)卵形短卵形梨形11 掌握哪幾種蟲(chóng)卵是不對(duì)稱的東方毛圓線蟲(chóng)卵蟯蟲(chóng)卵衛(wèi)氏并殖吸蟲(chóng)卵未受精蛔蟲(chóng)卵支雙腔吸蟲(chóng)卵曼氏迭宮絳蟲(chóng)卵12 (1). 無(wú)色透明： 一般的薄殼線蟲(chóng)卵和絳蟲(chóng)卵。鉤蟲(chóng)卵與受精蛔蟲(chóng)卵鉤蟲(chóng)卵與毛圓線蟲(chóng)卵3、蟲(chóng)卵的顏色13 糞類圓線蟲(chóng)卵與蛔蟲(chóng)卵福氏類圓線蟲(chóng)卵與鉤蟲(chóng)卵結(jié)節(jié)線蟲(chóng)卵與受精蛔蟲(chóng)卵捻轉(zhuǎn)血矛線蟲(chóng)卵與受精蛔蟲(chóng)卵14 蟯蟲(chóng)卵短膜殼絳蟲(chóng)卵司氏伯特絳蟲(chóng)卵線中殖孔絳蟲(chóng)卵15 (2). 淡黃

4、色：布氏姜片蟲(chóng)卵、棘口科吸蟲(chóng)卵、日本血吸蟲(chóng)卵、闊節(jié)裂頭絳蟲(chóng)卵、大復(fù)殖孔絳蟲(chóng)卵和薄蛋白膜未受精蛔蟲(chóng)卵。布氏姜片吸蟲(chóng)卵日本棘隙吸蟲(chóng)卵與受精蛔蟲(chóng)卵16 未受精蛔蟲(chóng)卵闊節(jié)裂頭絳蟲(chóng)卵日本血吸蟲(chóng)卵與湄公血吸蟲(chóng)卵大復(fù)殖孔絳蟲(chóng)卵17 (3). 黃褐色或棕黃色：肝片吸蟲(chóng)卵、華支睪吸蟲(chóng)卵、橫川后殖吸蟲(chóng)卵、貓后睪吸蟲(chóng)卵、長(zhǎng)膜殼絳蟲(chóng)卵、克氏假裸頭絳蟲(chóng)卵、曼氏迭宮絳蟲(chóng)卵、鞭蟲(chóng)卵和厚蛋白膜蛔蟲(chóng)卵華支睪吸蟲(chóng)卵肝片吸蟲(chóng)卵與受精蛔蟲(chóng)卵橫川后殖吸蟲(chóng)卵與受精蛔蟲(chóng)卵貓后睪吸蟲(chóng)卵鞭蟲(chóng)卵與受精蛔蟲(chóng)卵厚蛋白膜蛔蟲(chóng)卵18 鐮刀星隙吸蟲(chóng)卵與受精蛔蟲(chóng)卵(4). 褐色：鐮刀星隙吸蟲(chóng)卵、臺(tái)灣棘帶吸蟲(chóng)卵臺(tái)灣棘帶吸蟲(chóng)卵19 支雙腔吸蟲(chóng)卵與受精蛔蟲(chóng)卵胰闊

5、盤(pán)吸蟲(chóng)卵與受精蛔蟲(chóng)卵(5). 暗褐色：支雙腔吸蟲(chóng)卵、胰闊盤(pán)吸蟲(chóng)卵20 衛(wèi)氏并殖吸蟲(chóng)卵與闊節(jié)裂頭絳蟲(chóng)卵(6). 金黃色：衛(wèi)氏并殖吸蟲(chóng)卵21 帶絳蟲(chóng)卵卵殼脫落帶絳蟲(chóng)卵帶有卵殼（1）卵殼 所有蟲(chóng)卵都有卵殼。這一形態(tài)特征是把糞便中非蟲(chóng)卵物質(zhì)與蟲(chóng)卵區(qū)別開(kāi)的最重要特征。4、卵殼及其附屬物例外:帶絳蟲(chóng)卵的卵殼很薄，經(jīng)常在糞便中脫落，所見(jiàn)近似卵殼之物其實(shí)是胚膜。22 蟯蟲(chóng)卵 卵殼厚度：除蟯蟲(chóng)卵、鞭蟲(chóng)卵、蛔蟲(chóng)卵、腎膨結(jié)線蟲(chóng)卵和肝毛細(xì)線蟲(chóng)卵外，其余多數(shù)線蟲(chóng)卵的卵殼均較薄。鞭蟲(chóng)卵蛔蟲(chóng)卵肝毛細(xì)線蟲(chóng)腎膨節(jié)線蟲(chóng)卵毛圓線蟲(chóng)卵23 異形異形吸蟲(chóng)卵（放大）華支睪吸蟲(chóng)卵貓后睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵麝貓后睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵小型吸蟲(chóng)卵

6、多數(shù)卵殼厚24 支雙腔吸蟲(chóng)卵胰闊盤(pán)吸蟲(chóng)卵衛(wèi)氏并殖吸蟲(chóng)卵中型吸蟲(chóng)卵卵殼較厚如支雙腔吸蟲(chóng)卵、胰闊盤(pán)吸蟲(chóng)卵，或厚薄不均如衛(wèi)氏并殖吸蟲(chóng)卵，而大型吸蟲(chóng)卵則卵殼較薄。布氏姜片吸蟲(chóng)卵25 肝毛細(xì)線蟲(chóng)卵、鞭蟲(chóng)卵與受精蛔蟲(chóng)卵肝毛細(xì)線蟲(chóng)卵與菲律賓毛細(xì)線蟲(chóng)卵帶絳蟲(chóng)卵(2). 橫紋線：肝毛細(xì)線蟲(chóng)卵、菲律賓毛細(xì)線蟲(chóng)卵和喉比翼線蟲(chóng)卵的卵殼表面以及帶絳蟲(chóng)卵胚膜表面都有細(xì)橫紋線。26 肝毛細(xì)線蟲(chóng)卵與菲律賓線蟲(chóng)卵腎膨結(jié)線蟲(chóng)卵(3). 小凹陷：肝毛細(xì)線蟲(chóng)卵、菲律賓毛細(xì)線蟲(chóng)卵、腎膨結(jié)線蟲(chóng)卵、棘腭口線蟲(chóng)卵的卵殼表面都有許多小凹陷。27 絲瓜筋紋理結(jié)構(gòu)電鏡臺(tái)灣棘帶吸蟲(chóng)卵(4). 絲瓜筋樣紋理：電鏡下可見(jiàn)華支睪吸蟲(chóng)卵和臺(tái)灣棘帶吸蟲(chóng)卵的卵

7、殼表面都有絲瓜筋樣的紋理包繞，光鏡下可見(jiàn)卵殼表面不光滑，較粗糙。華支睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵臺(tái)灣棘帶吸蟲(chóng)卵與受精蛔蟲(chóng)卵28 （5）卵殼的附屬物卵蓋：卵殼的一端有卵蓋是除血吸蟲(chóng)卵外大多數(shù)吸蟲(chóng)卵的特征。假葉目絳蟲(chóng)卵也有卵蓋。線蟲(chóng)卵、圓葉目絳蟲(chóng)卵、棘頭蟲(chóng)卵及血吸蟲(chóng)卵都無(wú)蓋。華支睪吸蟲(chóng)卵（放大）肝片吸蟲(chóng)卵衛(wèi)氏并殖吸蟲(chóng)卵闊節(jié)裂頭絳蟲(chóng)卵29 豬巨吻棘頭蟲(chóng)卵與受精蛔蟲(chóng)卵長(zhǎng)、短膜殼絳蟲(chóng)卵鉤蟲(chóng)卵日本血吸蟲(chóng)卵30 (6)塞狀物：鞭蟲(chóng)卵、肝毛細(xì)線蟲(chóng)卵、菲律賓毛細(xì)線蟲(chóng)卵和喉比翼線蟲(chóng)卵的兩端有無(wú)色透明的塞狀物。棘腭口線蟲(chóng)卵和剛刺腭口線蟲(chóng)卵一端有透明的帽狀隆起，杜氏腭口線蟲(chóng)卵兩端有透明的帽狀隆起。棘顎口線蟲(chóng)卵與蛔蟲(chóng)卵鞭蟲(chóng)卵鞭

8、蟲(chóng)卵與菲律賓毛細(xì)線蟲(chóng)卵肝毛細(xì)線蟲(chóng)卵與菲律賓毛細(xì)線蟲(chóng)卵鞭蟲(chóng)卵與肝毛細(xì)線蟲(chóng)卵棘顎口線蟲(chóng)卵31 (7)小棘：華支睪吸蟲(chóng)卵、橫川后殖吸蟲(chóng)卵、異形吸蟲(chóng)卵、大復(fù)殖孔絳蟲(chóng)卵和闊節(jié)裂頭絳蟲(chóng)卵的卵蓋對(duì)端有時(shí)可見(jiàn)到逗點(diǎn)狀的小突起。華支睪吸蟲(chóng)卵闊節(jié)裂頭絳蟲(chóng)卵橫川后殖吸蟲(chóng)卵32 日本血吸蟲(chóng)卵與湄公血吸蟲(chóng)卵馬來(lái)血吸蟲(chóng)卵與受精蛔蟲(chóng)卵日本血吸蟲(chóng)卵和蛔蟲(chóng)卵(8)短小側(cè)棘：日本血吸蟲(chóng)卵、湄公血吸蟲(chóng)卵在卵殼側(cè)面有短小的側(cè)棘，但常因位置不定及蟲(chóng)卵外周附有雜物而有時(shí)不易見(jiàn)到。33 曼氏血吸蟲(chóng)卵埃及血吸蟲(chóng)卵(9) 長(zhǎng)大的側(cè)棘或終刺：曼氏血吸蟲(chóng)卵有長(zhǎng)大的側(cè)刺，埃及血吸蟲(chóng)卵、間插血吸蟲(chóng)卵有終刺。34 受精蛔蟲(chóng)卵（一）含一個(gè)卵細(xì)胞（未分裂）

9、1. 單細(xì)胞（整個(gè)蟲(chóng)卵只含一個(gè)卵細(xì)胞）：受精蛔蟲(chóng)卵、鞭蟲(chóng)卵、肝毛細(xì)線蟲(chóng)卵和菲律賓毛細(xì)線蟲(chóng)卵鞭蟲(chóng)卵5、蟲(chóng)卵的內(nèi)含物肝毛細(xì)線蟲(chóng)卵菲律賓毛細(xì)線蟲(chóng)卵根據(jù)新排出蟲(chóng)卵的胚胎發(fā)育階段可以把蠕蟲(chóng)卵分成3類。35 2. 多細(xì)胞 （蟲(chóng)卵內(nèi)含一個(gè)卵細(xì)胞和多個(gè)卵黃細(xì)胞）：見(jiàn)于大、中型有蓋吸蟲(chóng)卵，以及假葉目絳蟲(chóng)卵（闊節(jié)裂頭絳蟲(chóng)卵等）肝片吸蟲(chóng)卵與受精蛔蟲(chóng)卵肝片吸蟲(chóng)卵抱莖棘隙吸蟲(chóng)卵與受精蛔蟲(chóng)卵斯氏并殖吸蟲(chóng)卵與受精蛔蟲(chóng)卵闊節(jié)裂頭絳蟲(chóng)卵36 鉤蟲(chóng)卵與受精蛔蟲(chóng)卵（二）卵細(xì)胞早期分裂階段見(jiàn)于鉤蟲(chóng)卵、毛圓線蟲(chóng)卵、結(jié)節(jié)線蟲(chóng)卵、捻轉(zhuǎn)血矛線蟲(chóng)卵和喉比翼線蟲(chóng)卵等。鉤蟲(chóng)卵與毛圓線蟲(chóng)卵結(jié)節(jié)線蟲(chóng)卵與受精蛔蟲(chóng)卵捻轉(zhuǎn)血矛線蟲(chóng)卵與受精蛔蟲(chóng)卵37 蟯蟲(chóng)卵

10、（三）含幼蟲(chóng)1. 線狀幼蟲(chóng)：蟯蟲(chóng)卵、糞類圓線蟲(chóng)卵、福氏類圓線蟲(chóng)卵、結(jié)膜吸吮線蟲(chóng)卵、長(zhǎng)后圓線蟲(chóng)卵等。泡翼線蟲(chóng)屬蟲(chóng)卵糞類圓線蟲(chóng)卵與受精蛔蟲(chóng)卵福氏類圓線蟲(chóng)卵與受精蛔蟲(chóng)卵結(jié)膜吸吮線蟲(chóng)卵與受精蛔蟲(chóng)卵38 感染性蛔蟲(chóng)卵感染性蛔蟲(chóng)卵感染性鞭蟲(chóng)卵鉤蟲(chóng)卵內(nèi)含幼蟲(chóng)39 2. 毛蚴：見(jiàn)于血吸蟲(chóng)卵和小型吸蟲(chóng)卵，如支雙腔吸蟲(chóng)卵、胰闊盤(pán)吸蟲(chóng)卵、異形科吸蟲(chóng)卵、后睪科吸蟲(chóng)卵等。日本血吸蟲(chóng)卵湄公血吸蟲(chóng)卵埃及血吸蟲(chóng)卵曼氏血吸蟲(chóng)卵40 胰闊盤(pán)吸蟲(chóng)卵支雙腔吸蟲(chóng)卵華支睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵華支睪吸蟲(chóng)卵（放大）41 異形異形吸蟲(chóng)卵橫川后殖吸蟲(chóng)卵42 3. 六鉤蚴：見(jiàn)于圓葉目絳蟲(chóng)卵、如帶絳蟲(chóng)卵、長(zhǎng)膜殼絳蟲(chóng)卵、短膜殼絳蟲(chóng)卵、克氏假裸頭絳蟲(chóng)卵、

11、犬復(fù)孔絳蟲(chóng)卵、西里伯瑞列絳蟲(chóng)卵、線中殖孔絳蟲(chóng)卵和司氏伯特絳蟲(chóng)卵等。長(zhǎng)膜殼絳蟲(chóng)卵短膜殼絳蟲(chóng)卵（放大）43 犬復(fù)孔絳蟲(chóng)卵線中殖孔絳蟲(chóng)卵司氏伯特絳蟲(chóng)卵帶絳蟲(chóng)44 蠕蟲(chóng)卵的檢索要運(yùn)用鑒別蠕蟲(chóng)卵的幾個(gè)要點(diǎn)。先看有無(wú)卵蓋。有卵蓋者根據(jù)大小（長(zhǎng)徑平均值）又分大型、中型和小型卵。再看內(nèi)含物和其他特征。無(wú)蓋卵按內(nèi)含物如卵黃顆粒、單細(xì)胞、多細(xì)胞、幼蟲(chóng)（線狀幼蟲(chóng)、棘頭蚴、六鉤蚴、毛蚴）等，再結(jié)合考慮其他特征鑒別。蠕蟲(chóng)卵的檢索（三）、 蠕蟲(chóng)卵的分類檢索45 有蓋蠕蟲(chóng)卵的檢索46 有蓋蠕蟲(chóng)卵大小、形狀比較47 無(wú)蓋蠕蟲(chóng)卵的檢索48 無(wú)蓋蠕蟲(chóng)卵大小、形狀比較49 （四 ）常見(jiàn)蠕蟲(chóng)卵在Kato厚涂片中形態(tài)識(shí)別50 蛔蟲(chóng)-成

12、蟲(chóng) 51 ()蛔蟲(chóng)卵1. 直接涂片中： 45-7535-5045-7535-5088-9439-442. Kato-Katz厚涂片中2. Kato-Katz厚涂片中52 鞭蟲(chóng)-成蟲(chóng) 53 鞭蟲(chóng)卵1. 直接涂片中：50-5422-232. Kato-Katz厚涂片中54 鉤蟲(chóng)-成蟲(chóng)顏色：活體呈乳白色，如含有血液較時(shí)，則蟲(chóng)體后2/3部分呈淡紅色。 外形：蟲(chóng)體細(xì)長(zhǎng)略彎曲55 1 直接涂片中： 鉤蟲(chóng)卵呈短橢圓形，兩端鈍圓或一端稍扁平，卵殼薄，無(wú)色透明，新鮮卵內(nèi)含2-8個(gè)灰色顆粒細(xì)胞，以4個(gè)最為常見(jiàn)，但有時(shí)只有1個(gè)或多于8個(gè)。 鉤蟲(chóng)卵56-7636-4056-7636-40 鉤蟲(chóng)卵56 鉤蟲(chóng)卵57 Ka

13、to-Katz厚涂片中：直接涂片58 鉤蟲(chóng)卵透明后的變化(室溫10)Kato-20分鐘Kato-2小時(shí)Kato-4小時(shí)59 Kato-24小時(shí)Kato-25小時(shí)鉤蟲(chóng)卵透明后的變化(室溫10)60 雌蟲(chóng)雌蟲(chóng)： 813mm x 0.30.5mm頭部較細(xì)，尾端直而尖細(xì)蟯蟲(chóng)-成蟲(chóng)61 蟯蟲(chóng)卵62 2.蟲(chóng)卵63 蟯蟲(chóng)卵直接涂片透明膠紙Kato-Katz厚涂片50-6020-3064 65 直接涂片-血吸蟲(chóng)卵66 改良加藤厚涂片中血吸蟲(chóng)卵形態(tài) 典型血吸蟲(chóng)卵直接涂片Kato-Katz厚涂片65-10650-80 (8362) m67 Kato-Katz厚涂片中典型血吸蟲(chóng)卵68 Kato-Katz厚涂片中典型

14、血吸蟲(chóng)卵69 布氏姜片吸蟲(chóng)-成蟲(chóng)70 片形科吸蟲(chóng)卵1. 直接涂片中:2. Kato-Katz厚涂片布氏姜片吸蟲(chóng)卵肝片吸蟲(chóng)卵與受精蛔蟲(chóng)卵布氏姜片吸蟲(chóng)卵肝片吸蟲(chóng)卵71 華支睪吸蟲(chóng)-成蟲(chóng)72 華支睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵73 Kato-Katz 厚涂片中 在厚涂片中小型吸蟲(chóng)卵內(nèi)含的毛蚴有時(shí)可以見(jiàn)到，但小型吸蟲(chóng)卵很難鑒別，有的需加做沉淀鏡檢，甚至要驅(qū)出成蟲(chóng)才能確定。華支睪吸蟲(chóng)卵與受精蛔蟲(chóng)卵27351520直接涂片2 Kato-Katz厚涂片74 華支睪吸蟲(chóng)卵與其他小型吸蟲(chóng)卵鑒別 華支睪吸蟲(chóng)卵與異形科、其他后睪以及次睪吸蟲(chóng)卵，往往難以鑒別，需要驅(qū)蟲(chóng)定種。鐮刀星隙前腸異形貓后睪麝貓后睪異形異形臺(tái)灣棘帶橫川后殖

15、高橋后殖75 76 豬絳蟲(chóng)-成蟲(chóng)乳白色，扁長(zhǎng)如帶。略透明，體長(zhǎng)2-4米牛帶絳蟲(chóng)77 牛帶絳蟲(chóng)-成蟲(chóng)乳白色，扁長(zhǎng)如帶。略透明，體長(zhǎng)4-8米78 在豬肉中的豬囊尾蚴（米豬肉）豬囊尾蚴寄生在心肌79 豬帶子宮分支不整齊 牛帶子宮分支較整齊 每側(cè)為713支 每側(cè)為1530支孕節(jié)80 帶絳蟲(chóng)卵卵殼脫落帶絳蟲(chóng)卵帶有卵殼81 在Kato-Katz厚涂片中 1)蟲(chóng)卵形態(tài)變化不大，而且由于透明液的作用，六鉤蚴特別清楚。 2)透明過(guò)度時(shí): 帶絳蟲(chóng)卵的胚膜易破裂; 短膜殼絳蟲(chóng)卵有時(shí)可消失;長(zhǎng)膜殼和克氏假裸頭絳蟲(chóng)卵容易扭曲變形或破裂。帶絳蟲(chóng)卵短膜殼絳蟲(chóng)卵短膜殼絳蟲(chóng)卵長(zhǎng)膜殼絳蟲(chóng)卵克氏假裸頭絳蟲(chóng)卵82 常見(jiàn)假葉目絳蟲(chóng)卵:闊節(jié)裂頭絳蟲(chóng)卵曼氏迭宮絳蟲(chóng)卵大復(fù)殖孔絳蟲(chóng)卵1. 直接涂片中:2. Kato-Katz厚涂片曼氏