布鲁杆菌病患者流行病学及临床特征分析

Epidemiological and Clinical Characteristics of Patients with Brucellosis

目的通过分析布鲁杆菌病患者的流行病学及临床特征,旨在提高临床对布鲁杆菌病的认识,为早期诊断及防止误诊提供依据。方法选取2014—2015年河北医科大学第二医院住院治疗的布鲁杆菌病患者110例为研究对象。查阅患者病历资料,记录患者流行病学特征(性别、年龄、职业、发病时间、感染途径)、临床表现、实验室检查、就诊科室、治疗和转归情况。结果 110例布鲁杆菌病患者中男78例,女32例;年龄10~78岁,以41~60岁(81例,73.6%)、21~30岁(22例,20.0%)为主;职业以农民为主(66例,60.0%)。1~4季度分别有16例(14.6%)、46例(41.8%)、31例(28.2%)、17例(15.4%);有明确羊、牛等动物及污染产品接触史30例(27.3%)。临床表现以发热(100例,90.9%)、关节及肌肉痛(52例,47.3%)、乏力(31例,28.2%)、胃肠道症状(26例,23.6%)为主。实验室检查主要表现为肝功能损害(41例,37.3%)、红细胞沉降率增快(40例,36.4%)、白细胞计数增多或减少(37例,33.6%)、清蛋白水平降低(33例,30.0%)、C反应蛋白水平增高(23例,20.9%)。106例布鲁杆菌抗体阳性,22例血培养阳性,1例关节液培养阳性。布鲁杆菌病患者主要于呼吸内科(31例,28.2%)、全科医疗科(25例,22.7%)、免疫风湿科(17例,15.4%)、消化内科(10例,9.1%)治疗,余患者因不典型临床特征就诊于其他科室。51例(46.4%)应用盐酸多西环素联合利福平,44例(40.0%)应用盐酸多西环素联合链霉素,7例(6.4%)应用盐酸米诺环素联合利福平,3例(2.7%)应用盐酸多西环素联合利福喷汀,3例(2.7%)单独应用盐酸米诺环素,2例(1.8%)单独应用盐酸多西环素。1例患者出现脓毒症、感染性休克,余患者预后良好。结论布鲁杆菌病患者临床表现复杂多变,通过早期诊断和规范化治疗,可迅速缓解患者症状,避免慢性化、降低致残率。

Objective To analyze the epidemiological and clinical characteristics of patients with brucellosis,so as to improve the clinical awareness of brucellosis,provide basis for early diagnosis and prevention of misdiagnosis.Methods A total of 110 brucellosis patients hospitalized in the Second Hospital of Hebei Medical University from 2014 to 2015 were selected as the research objects.Referring to the medical records of patients,epidemiological characteristics of the patients（ including gender,age,professional title, disease time and route of infection）, clinical symptoms, laboratory inspection, visited department,treatment and outcome conditions were recorded.Results Among the 110 patients with,there were 78 males and 32 females;the patients were aged from 10 to 78 years old,and the majority was between 41 and 60 years old（ 81 patients,73.6%）,and between 21 and 30 years old（ 22 patients,20.0%）; most of their occupations were farmers（ 66 patients,60.0%）.Each quarter the number of patients was 16（ 14.6%）,46（ 41.8%）,31（ 28.2%）,and 17（ 15.4%） respectively; There were30 patients（ 27.3%） who had clear contact history of animals such as cattle and sheep,and polluted products.Fever（ 100 patients,90.9%）,joint and muscle pain（ 52 patients,47.3%）,fatigue（ 31 patients,28.2%）,gastrointestinal symptoms（ 26 patients,23.6%） were the main clinical manifestations.Hepatic function damage（ 41 patients,37.3%）,increased erythrocyte sedimentation rate（ 40 patients,36.4%）,increased or reduced white blood cell count（ 37 patients,33.6%）,reduced albumin level（ 33 patients,30.0%）,and increased C- reactive protein level（ 23 patients,20.9%） were the main presentation of laboratory inspections.The brucella antibodies of 106 cases were positive,22 cases blood culture were positive,the blood culture of three cases was positive, and the joint fluid culture of one case was positive.Patients with brucellosis received treatment mainly in respiratory medicine（ 31 patients,28.2%）,general medical department（ 25 patients,22.7%）,immune rheumatology department（ 17 patients,15.4%） and digestive system department（ 10 patients,9.1%）,the others were admitted to other departments due to atypical clinical features.There were 51（ 46.4%） patients using doxycycline hydrochloride combined with rifampicin,44（ 40.0%） using doxycycline hydrochloride combined with streptomycin, seven（ 6.4%） receiving minocycline hydrochloride combined with rifampicin, three（ 2.7%） using doxycycline hydrochloride combined with rifapentini,three（ 2.7%） receiving minocycline hydrochloride alone,and two（ 1.8%） receiving doxycycline hydrochloride alone.One patient developed sepsis and septic shock,the rest had good prognosis.Conclusion The clinical manifestations of patients with brucellosis are complicated and changing.Early diagnosis and normalized therapy can quickly relieve symptoms of patients,avoid chronicity,and reduce disability rate.