神经型布鲁菌病的临床特点及诊治分析

The clinical features, diagnostic criteria and treatment analysis of neurobrucellosis

目的探讨神经型布鲁菌病的临床特点、诊断标准及抗菌药物联合治疗方案。方法回顾性分析首都医科大学附属北京地坛医院2008年9月至2014年7月收治的10例神经型布鲁菌病患者的临床资料。结果神经型布鲁菌病以青壮年男性为主,均有明确的流行病学史,临床多表现为脑膜炎和脑膜脑炎等。所有患者血清布鲁杆菌凝集试验阳性,6例患者行脑脊液布鲁杆菌凝集试验,其中4例阳性。所有患者均行腰椎穿刺检查,7例患者脑脊液压力升高,9例白细胞数升高(以单核细胞升高为主),9例患者蛋白升高,5例糖减低。全部病例给予多西环素和利福平基础上联合三代头孢、氨基糖苷类、复方新诺明、喹诺酮类中的一种或两种组成三联或四联初始抗病原治疗,序贯长疗程口服抗菌药物,平均疗程>6个月。结论神经型布鲁氏菌病的临床表现复杂多样,大部分患者预后良好,少数患者可留有后遗症。治疗上不同药理学机制的抗菌药物联合、足量、长疗程治疗有效。

Objective To describe the clinical characteristics, diagnostic criteria and evaluated antibiotic combinations of patients with neurobrucellosis. Methods The clinical data of 10 patients with neurobrucellosis treated in Beijing Ditan Hospital, Capital Medical University from September 2008 to July 2014 were analyzed, retrospectively. Results The majority of the patients with neurobrucellosis were young male. All patients had certain contact history of the source of infection of brucellosis. Meningitis and meningoencephalitis were the main clinical manifestations. Brucella blood serum agglutination test were positive in 10 cases. There were 6 patients underwent Brucella cerebrospinal fluid（CSF） agglutination test, 4 cases were positive. All cases underwent lumbar puncture. Increased CSF pressure were detected in 7 cases. Analysis of CSF revealed increased cell number（mainly for the monocyte） in 9 cases, protein increased in 9 cases and decreased glucose in 5 cases. All patients were given initial therapy and sequential therapy. The initial treatment regimen was composed of triple or quadruple drugs, based on doxycycline and rifampin, combined with one or two components of the three generation cephalosporin, aminoglycosides, trimethoprimsulfamethoxazole and quinolones. Sequential treatment were with long course of doxycycline and rifampin. The average duration were longer than six months. Conclusions The clinical presentation of neurobrucellsis varies greatly. The majority of the patients had favorable prognosis, while fewer patients might have sequel. The combined treatment by antibiotics of different pharmacological mechanisms with full dose and long course is effective.