607例布鲁菌病患者的临床回顾性分析

Brucellosis： a retrospective evaluation of 607 cases

目的 分析布鲁菌病（简称布病）患者临床、实验室检测结果和流行病学特点。方法 以2000 - 2016年在吉林大学第一医院感染科住院的布病患者（经2012年《布鲁菌病诊疗指南》确诊）作为调查对象，收集病历中临床症状、体征，实验室检查结果等数据，回顾性分析患者临床特点和流行病学分布特症。根据病情分为急性期和慢性期，另根据病变部位分为局灶病变组和非局灶病变组，进行组间数据的对比分析。结果 共调查607例患者，其中男性489例、女性118例；年龄2 ~ 80岁；急性期570例（93.9%）、慢性期37例（6.1%）；局灶病变组患者418例（68.9%），其中急性期382例，慢性期36例。急性期患者丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）中位数较慢性期明显增高（U／L：47.2比26.7，44.5比24.0，Z = - 3.684、 - 3.754，P均 〈 0.05）。局灶病变组患者白细胞、血小板、C反应蛋白、血沉中位数明显高于非局灶病变组（ × 103／mm3：7.3比5.4、211比176；mg／L：56.0比30.5；mm／h：37比28，Z = - 4.407、 - 2.709、 - 2.334、 - 2.137，P均 〈 0.05），而ALT、AST中位数明显低于非局灶病变组（U／L：33.3比53.9、30.2比48.1，Z = - 4.102、 - 3.730，P均 〈 0.05）。局灶病变组外周关节损伤最为常见，达317例，其中最常见的是膝关节炎，112例，占外周关节损伤的35.3%。有80例患者规律回访1年，其中78例（97.5%）治疗有效，但16例（20.0%）患者复发；有2例（2.5%）患者治疗无效，症状持续存在，且1例患者明确诊断为神经型布病，经过抗布病治疗1个月后无效死亡。结论 对于疼痛局限、白细胞升高的布病患者，应考虑存在局灶性病变的可能。

Objective To analyze the clinical and laboratory results and epidemiological characteristics of brucellosis. Methods The clinical and laboratory characteristics brucellosis cases （confirmed by Brucellosis Guidelines 2012） at the Department of Infectious Disease of the First Hospital of Jilin University between 2000 and 2016, were retrospectively evaluated. The patients were divided into two groups according to acute and chronic stages. According to the range of lesions, the lesions were divided into two groups, and comparative analysis of data between groups was done. Results The ages of the 607 patients （489 males, 118 females） were ranged from 2 to 80 years. Among the 607 patients, 570 （93.9%） were diagnosed with acute brucellosis, 37 （6.1%） with chronic brucellosis. Focal involvement was found in 418 （68.9%） patients. Among them, 382 patients were in acute stage, and the other in chronic phase （36）. Acute patients＇ alanine aminotransferase （ALT） and aspartate transaminase （AST） were higher than those of chronic brucellosis （U/L： 47.2 vs 26.7, 44.5 vs 24.0, Z = - 3.684, - 3.754, all P 〈 0.05）. Although the white blood cell count, platelet values, C-reactive protein, and blood sedimentation were higher in patients with focal involvement （ × 103/mm3： 7.3 vs 5.4, 211 vs 176; mg/L： 56.0 vs 30.5; mm/h： 37 vs 28, Z = - 4.407, - 2.709, - 2.334, - 2.137, all P 〈 0.05）, patients without focal involvement had higher ALT and AST （U/L： 33.3 vs 53.9, 30.2 vs 48.1, Z = - 4.102, - 3.730, all P 〈 0.05）. Peripheral arthritis was the most common type of osteoarticular involvement in 317 patients with focal involvement, and peripheral arthritis was found to be the most frequently identified in the knee joint, 112 patients （35.3%）. Totally 80 patients were followed up, the relapse rate was 20.0% （16/80）, 2 patients treatment failure, only 1 patient died after 1 month of treatment who was diagnosed neuropathic brucellosis. Conclusions Focal involvement should be investigated in the presence of leucocytosis, and pain of a certain part.