布鲁菌病骨关节损害影像学分析及临床特点

Clinical and imaging characteristics of bone and joint damage derived from brucellosis

目的 分析布鲁菌病致骨关节损害的临床及影像学特征，为早期诊断提供数据支撑。方法 收集济南市传染病医院2013年12月至2014年12月收治的布鲁菌病患者中经影像学证实有骨关节损害患者的临床资料，通过回顾性分析对其流行病学、临床特点、CT及核磁共振（MRI）特征、治疗与转归进行总结。结果 46例患者中，有明确布鲁菌病接触史的占97.8%（45／46），从事家畜养殖者最多，占67.4%（31／46）。发病时间多集中在7 - 10月，占58.7%（27／46）。临床主要表现为关节疼痛、肿胀及活动障碍。CT图像可见明显骨质破坏，表现为多个类圆形或大面积低密度虫蚀样斑点，边缘有硬化灶或有骨赘生成，椎体变形不明显，偶可见椎小关节损伤，椎旁软组织受累肿胀。MRI显示为椎旁韧带、软组织破坏，或椎体边缘骨质增生，椎骨骨质虫蚀样破坏，T1W1略长或长短T2W1异常信号，FS-T1W1呈高信号，FS-T2W1呈略高信号。CT、MRI及CT联合MRI对布鲁菌病致骨关节损害的诊出率分别为76.1%（35／46）、84.8%（39／46）及91.3%（42／46）。病例的主要治疗药物为多西环素与利福平，有效率为91.3%（42／46）。结论 布鲁菌病致椎骨关节损害的流行病学特点、CT和MRI特征较为典型，综合诊断利于提高准确性。

Objective To provide data evidence for early diagnosis of bone and joint damage derived from brucellosis by analyzing its clinical and imaging characteristics. Methods Patients with brucellosis accepted in Ji＇nan Infectious Disease Hospital form December 2013 to December 2014 were selected. Patients with bone and joint damage confirmed through imaging were further studied, their epidemiological and clinical characters, CT and MRI characteristics, treatment and outcome were summarized. Results Total of 97.8% （45/46） patients had a clear contact history, most of them worked in poultry farming, taking up to 67.4% （31/46）. July to October was its peak time for attacking, taking up to 58.7% （27/46）. The clinical manifestations of patients were joint pain, swelling and activities obstacles. In the CT images, there was obvious bony destruction, characterized by multiple round or large areas of low density insect damage sample spots. There was osteosclerotic bone lesions or osteophyte formatted in edge. The paravertebral soft tissue was swelling, and the vertebral body deformation was not obvious, and there was vertebra small joint damage occasionally. In the MRI images, there was vertebral ligaments damage, or soft tissue damage, or osteoproliferation at the edge of the vertebral bodies. There was abnormal signal T1W1 or T2W1 signal, and FS-T1W1 showed high signal, while FS-T2W1 showed slightly high signal. The diagnosis rate of CT, MRI and CT combined MRI for bone and joint damage derived from brucellosis was 76.1% （35/46）, 84.8% （39/46） and 91.3% （42/46）, respectively. The main therapeutic drugs were doxycycline and rifampicin, and the clinical effective rate was 91.3% （42/46）. Conclusion The epidemiological characters, CT and MRI characteristics of bone and joint damage derived from brucellosis have certain representativeness, and the comprehensive investigation is beneficial for clinical diagnosis.