153例急性期和慢性期布鲁氏菌病患者临床表现、实验室特征及治疗比较

Comparison of clinical manifestations, laboratory characteristics and treatment of 153 patients with acute and chronic brucellosis

目的了解急性期和慢性期布鲁氏菌病(简称布病)患者的临床表现、实验室特征及治疗情况。方法回顾性收集2012-2022年广州医科大学附属市八医院收治的153例布病患者临床资料,包括一般资料、流行病学特征、临床表现、实验室检查结果、影像学检查结果、治疗及预后情况。按病程<180 d和≥180 d分为急性期组和慢性期组,对比分析两组患者临床资料。结果共纳入布病患者153例,其中急性期组119例、慢性期组34例。年龄为(46.2±13.8)岁,男性115例(75.2%)、女性38例(24.8%),85例(55.6%)患者为职业接触。90例(58.8%)患者出现并发症,慢性期组并发症发生率高于急性期组[76.5%(26/34)比53.8%(64/119),χ^(2)=5.62,P=0.018]。临床表现主要为发热和关节痛,分别有128例(83.7%)和124例(81.0%)。急性期组发热发生率高于慢性期组[87.4%(104/119)比70.6%(24/34),χ^(2)=5.46,P=0.019],而关节痛发生率低于慢性期组[77.3%(92/119)比94.1%(32/34),χ^(2)=4.83,P=0.027]。实验室检查中,血培养阳性率为59.5%(91/153),急性期组血培养阳性率高于慢性期组[67.2%(80/119)比32.4%(11/34),P<0.05];急性期组降钙素原(PCT)升高发生率[58.6%(58/99)比24.1%(7/29),χ^(2)=10.65,P=0.001]和肝功能异常发生率均高于慢性期组[33.9%(40/118)比15.2%(5/33),χ^(2)=4.33,P=0.037]。影像学检查中,61例(39.9%)患者发生骨质破坏,慢性期组骨质破坏发生率高于急性期组[55.9%(19/34)比35.3%(42/119),χ^(2)=4.68,P=0.031]。所有患者均使用抗生素治疗,急性期、慢性期组使用抗生素种类的中位数分别为3、4种。总体药物不良反应发生率为5.2%(8/153),治疗后65例(42.5%)痊愈、70例(45.8%)好转、18例(11.8%)未愈。结论布病患者的主要临床表现为发热和关节痛,并发症发生率较高,均采用联合抗感染治疗。急性期患者发热、血培养阳性、PCT升高、肝功能异常发生率较高,慢性期患者并发症、关节痛、骨质破坏发生率较高。

Objective To learn about the clinical manifestations,laboratory characteristics and treatment of patients with acute and chronic brucellosis.Methods Clinical data of 153 brucellosis patients admitted to the Guangzhou Eighth People's Hospital,Guangzhou Medical University from 2012 to 2022 were retrospectively collected,including general information,epidemiological characteristics,clinical manifestations,laboratory test results,imaging examination results,treatment and prognosis.According to the course of disease<180 d and≥180 d,these patients were divided into acute brucellosis group and chronic brucellosis group,and the clinical data of the two groups of patients were compared and analyzed.Results A total of 153 patients with brucellosis were included,including 119 in the acute brucellosis group and 34 in the chronic brucellosis group.The age was(46.2±13.8)years old,with 115 males(75.2%)and 38 females(24.8%),and 85 patients(55.6%)were occupational exposed.Complications occurred in 90 patients(58.8%),and the incidence of complications in the acute brucellosis group was lower than that in the chronic brucellosis group[76.5%(26/34)vs 53.8%(64/119),χ^(2)=5.62,P=0.018].The most common clinical manifestations were fever and arthralgia,with 128 cases(83.7%)and 124 cases(81.0%),respectively.The incidence of fever in the acute brucellosis group was higher than that in the chronic brucellosis group[87.4%(104/119)vs 70.6%(24/34),χ^(2)=5.46,P=0.019],while the incidence of arthralgia was lower than that in the chronic brucellosis group[77.3%(92/119)vs 94.1%(32/34),χ^(2)=4.83,P=0.027].In laboratory tests,the positive rate of blood culture was 59.5%(91/153),and it was higher in the acute brucellosis group than that in the chronic brucellosis group[67.2%(80/119)vs 32.4%(11/34),P<0.05].The incidence of elevated procalcitonin[PCT,58.6%(58/99)vs 24.1%(7/29),χ^(2)=10.65,P=0.001]and the incidence of liver dysfunction[33.9%(40/118)vs 15.2%(5/33),χ^(2)=4.33,P=0.037]in the acute brucellosis group were higher than those in the chronic brucellosis group.In the imaging examination,61 patients(39.9%)experienced bone destruction,and the incidence of bone destruction in the chronic brucellosis group was higher than that in the acute brucellosis group[55.9%(19/34)vs 35.3%(42/119),χ^(2)=4.68,P=0.031].All patients were treated with antibiotics,with a median of 3 and 4 types of antibiotics used in the acute and chronic brucellosis groups,respectively.The overall incidence of adverse drug reactions was 5.2%(8/153).After treatment,65 cases(42.5%)recovered,70 cases(45.8%)improved,and 18 cases(11.8%)did not recover.Conclusions The main clinical manifestations of brucellosis patients are fever and arthralgia,with a high incidence of complications.All patients are treated with combined antibiotics therapy.Patients in acute brucellosis group have a higher incidence of fever,positive blood culture,elevated PCT and abnormal liver function,while patients in chronic brucellosis group have a higher incidence of complications,arthralgia and bone destruction.