儿童布鲁菌病临床研究

Clinical research of brucellosis in children

目的探讨儿童布鲁菌病的临床发病特点，以提高对本病的认识及早期诊断。方法对2012年9月至2015年9月5例儿童布鲁菌病患儿的临床资料进行研究，包括临床表现、常规实验室检验、检查结果及诊断过程。结果5例患儿中，男3例，女2例，年龄1～5岁；5例患儿均有羊接触史或有食用羊肉病史。临床表现：均有发热，热程持续约8～13d，热峰37．5—39．8℃，1例患儿表现为弛张热，其余为不规则热；1例膝关节疼痛；1例发现皮肤散在出血点；2例肝脾大。常规实验室检查：C-反应蛋白、降钙素原、白细胞介素-6水平，血沉有不同程度改变，病毒抗体系列多为IgG阳性，丙氨酸氨基转移酶有1例轻度升高，血培养阴性，血小板减少1例。5例布氏杆菌凝集实验均为阳性，5例患儿入院到确诊时间为7—10d。结论儿童布鲁菌病发病特点多样化，常规实验室检查无特异性，临床医师应行详细的病史问诊，尤其是当地流行病史，尽早行特异性检查，尽可能做到早期诊断和治疗。

Objective To investigate the clinical characteristics of brucellosis in children, in order to imporve the understanding of brucellosis and early diagnosis. Methods From September 2012 to September 2015, the clinical manifestation, laboratory tests results and diagnosis of five cases of brucellosis in children were analyzed. Results Among the five cases, three boys and two girls, aged one to five years . They all had a history of exposure to lamb or consuming infected lamb. The main clinical manifestation was fever in all cases and the peak body temperature was 37.5 to 39. 8 ℃. The fever course was 8 to 13 days. The fever type was irregular fever except one case whose fever type was intefmittent. Joint pain existed in one case, thromboeytopenia in one case, hepatosplenomegaly in two eases. The laboratory test results were the inpaired liverfunction in one case, CRP, PCT, IL-6 higher in two cases, ESR higher in one case, ALT higher in one case. The Brucella agglutination test was positive in five cases. The period between admitted to the hospital to diagnose time was 7 to 10 days. Conclusions The clinical manifestation of brucellosis in children are various, and the regular laboratory test is unspecifical. More attention should be paid to the medical history, especially the epedimic history and take the tests associated with brucellosis and diagnose earlier.