布鲁菌病患者骨关节系统损伤的临床特征分析

Clinical features of brucellosis complicated with osteoarticular damage

目的探讨布鲁菌病（简称布病）患者骨关节系统损伤的临床特点，提高临床医师对布病的认识。方法采用回顾性分析方法，收集2011年1月至2014年4月济南市传染病医院住院的265例布病患者作为调查对象，按照影像学检查结果，排除其他原因引起的骨关节损伤，将研究对象分为骨关节损伤组和无骨关节损伤组。调查分析患者性别、年龄、临床表现及实验室检查等资料。结果265例布病患者中，存在骨关节损伤者为46例，占17．36％。所有损伤中以脊椎关节炎[50．00％（23／46）]最多，其次是骶髂关节炎[41．30％（19／46）]和外周关节炎[26．09％（12／46）]。女性患者以骶髂关节炎[21．74％（10／46）]居多，男性患者以脊椎关节炎[36．96％（17／46）]居多；≤17岁组患者以外周关节炎居多[4．35％（2／46）]，18～60岁年龄组患者以骶髂关节炎居多[23．91％（11／46）]；〉160岁年龄组患者以脊柱关节炎居多[30．43％（14／46）]。骨关节损伤组与无骨关节损伤组比较从发病到确诊的时间间隔长（45比30d，Z=5．74，P〈0．05）。结论布病患者骨关节损伤临床表现呈多样性，因此，对于长期发热伴关节疼痛的患者．应仔细询问病史．结合流行病学资料及影像学检查，早诊断、早治疗。

Objective To evaluate the clinical features of osteoarticular damage of patients with brucellosis, and to enhance the knowledge of clinical doctors. Methods The demographic characteristics, clinical presentations, accessory examination of 265 patients with brucellosis admitted from January 2011 to April 2014 in Ji＇nan Infectious Diseases Hospital were retrospectively analyzed. Patients were classified into two groups： Patients with osteoarticular complications and patients without osteoartieular complications. Results Of the 265 patients, forty-six patients （17.36%） had osteoartieular complications. Spondylitis was the most common complication [50.00% （23/46）], followed by sacroiliitis [41.30% （19/46）] and peripheral arthritis [26.09% （12/46）]. Saeroiliitis was more common than other types of osteoarticular damage in females [21.74% （10/46）], whereas in males spondylitis was more common [36.96% （17/46）]. Peripheral arthritis was more common in individuals under the age of 17 years old [4.35% （2/46）], and saeroiliitis were more common in the ages of 18 - 60 years old group [23.91% （11/46）] and spondylitis were more common in over 60-year age group [30.43% （14/46）]. Patients with osteoartieular complications showed longer duration of illness from the onset of the symptoms to its diagnosis （median 45 days）, compared to those non-osteoartieular brucellosis （median 30 days, Z = 5.74, P 〈 0.05）. Conclusion Due to diversity of osteoartieular damage in patients with brucellosis, in case of a patient with long-term fever and osteoarticular symptoms, medical and epidemiologiea] history should be inquired so as to strengthen early diagnosis and treatment of the disease based on combination with radiological findings.