辽宁省82例布鲁菌病患者临床特点

Clinical features of 82 patients with brucellosis in Liaoning Province

目的分析辽宁省布鲁菌病的临床特点，以期提高对该病的诊断水平。方法收集中国医科大学附属第一医院2011年至2015年最终确诊为布鲁菌病的82例住院患者的流行病学、临床特征、实验室检查及诊断等资料，进行回顾性分析。结果82例布鲁菌病患者中男性52例（63．4％），45～59岁39例（47．6％）；以发热（90．2％），肌肉、关节痛（61．0％），肝、脾大（36．6％），淋巴结肿大（24．4％）、体质量下降（32．9％）为主要临床表现；外周血白细胞计数正常多见（70．7％）；大部分C反应蛋白（81．3％）、降钙素原（81．8％）、红细胞沉降率（64．2％）均升高。67例患者行试管凝集试验，均为阳性。60例行病原体分离实验，49例布鲁杆菌阳性，35例分离鉴定为马耳他羊布鲁杆菌。90．2％（74／82）的患者以不明原因发热收入院。误诊率为52．4％（43／82）。结论对不明原因发热且肌肉、关节痛，肝、脾大等临床表现的患者，应仔细询问牛、羊接触史，并尽早行病原分离、试管凝集试验等特异性检查，有助于早期诊断。

Objective To identify the clinical features of patients with brucellosis in Liaoning Province in recent 5 years, and to improve the diagnostic level of the disease. Methods The clinical data including epidemiology, clinical features, laboratory data and diagnosis of 82 hospitalized patients who were diagnosed with brucellosis in the First Affiliated Hospital of China Medical University from 2011 to 2015 were collected and reviewed retrospectively. Results The majority of the 82 patients were middle- aged （45-59 years old） （47. 6%） and male gender （63. 4%）. Fever （90. 2%）, muscle and joint pain （61, 0%）, hepatosplenomegaly （36.6%）, lymphadenopathy （24.4%） and weight lose （32.9%） were the main complaints. The peripheral leucocyte counts were usually normal （70. 7%）. C-reactive protein （81.3 % ）, procalcitonin （81.80%） and erythrocyte sedimentation rate （64.2 % ） increased in most cases. The results of the serum agglutination test in 67 patients were all positive （100. 0%）. The pathogen isolation was conducted in 60 patients and 49 patients were positive for Brucella species. Among them, 35（71.3%） isolates were identified as Brucella melitensis. A total of 90. 2% （74/82） cases were firstly diagnosed with fever of unknown origin and were hospitalized. Misdiagnosis accounted for 52. 4 （43/ 82） %. Conclusions Contact history with cow and sheep should be inquired thoroughly in patients with clinical manifestations of fever, muscle and joint pain and hepatosplenomegaly. Pathogen isolation, agglutination test and other specific tests should be performed as soon as possible to diagnose the disease early.