徐州地区30例布鲁菌病的临床特征分析

The Clinical Analysis of 30 Cases of Brucellosis

目的:分析徐州地区布鲁菌病的流行情况、临床症状、体征、化验检查及治疗情况。方法:回顾分析徐州医学院附属医院2011年1月-2014年7月收治的30例布鲁菌病病例的临床资料,包括一般资料、主要临床表现、实验室检查、用药情况及疗效。结果:本地区布鲁菌病发病例数逐年增加,以冬春季节多见;发病人群以中青年男性为主,多有羊接触史;临床主要表现为发热(100%)、骨关节疼痛(73.3%)、多汗(53.3%)及乏力(40.0%),部分患者可出现肌肉疼痛(26.7%)、淋巴结肿大(20.0%)、败血症(16.7%)、肺炎(13.3%)、肝脾肿大(10.0%)、胸腔积液(10.0%)、皮疹(6.7%)。典型波状热仅有11例(36.7%)。多数患者血常规、肝功能无明显异常,血沉增快23例(76.7%),影像学检查证实骨关节病变8例(36.4%)。只有2例(6.7%)首诊得到确诊。治疗主要采用多西环素、利福平及左氧氟沙星联合,27例在2周内体温恢复正常。结论:徐州地区布鲁菌病散发病例有逐年增多的趋势,临床表现不典型,易误诊,应重视流行病学线索,加强对布鲁菌病的认识。采用多西环素、利福平及左氧氟沙星联合治疗效果较好。

Objective：To investigate the epidemiological,clinical,laboratory and treatment data of brucellosis in Xuzhou.Method：The prevalence,symptoms and signs,laboratory,treatment and outcome data of 30 brucellosis patients admitted in affiliated hospital of Xuzhou Medical College from January 2011 to July 2014 were retrospectively analyzed.Result：The cases of brucellosis were increased gradually in Xuzhou,which were more frequent in winter and spring.The patients were mainly middle-aged males,and most of them had a history of close contact with sheep.The main clinical manifestations were fever（100%）,arthralgia（73.3%）,sweating（53.3%） and fatigue（40.0%）.Some patients had myalgia（26.7%）,sepsis（16.7%）,pneumonia（13.3%）,hepatomegaly and splenomegaly（10.0%）,pleural effusion（10.0%） and rash（6.7%）.Only 11 cases（36.7%） had the typical abortus fever.Blood routine and liver functions were normal in most patients,while ESR was increased in 23 cases（76.7%）,and osteoarthropathy was comfirmed by radiograph in 8 cases（36.4%）.Only 2 cases were confirmed the diagnosis during the first visit.The combinational treatment with Doxycycline,Rifampin and Levofloxacin were effective,with the result that 27 cases had their fever dropped to normal in 2 weeks.Conclusion：Sporadic cases of brucellosis in Xuzhou increas gradually in recent years,which usually have atypical clinical manifestations.Epidemiological clues should be kept in mind in order to avoid misdiagnosis.The combinational therapy of Doxycycline,Rifampin and Levofloxacin are effective against brucellosis.