119例布鲁菌病患者的流行病学特征和临床分析

The epidemiological features and clinical analysis of 119 brucellosis cases

目的分析布鲁杆菌感染者的流行病学特征、临床表现、诊断及治疗效果，为布鲁菌病在临床治疗和预防两方面提供实践基础和经验。方法收集2011年1月1日至2016年7月30日兰州大学第一医院收治的119例住院布鲁菌病患者的性别、年龄、牛羊接触史，以及发热、出汗、关节肌肉疼痛等临床表现，诊断及临床治疗效果等相关资料，对上述流行病学特征和临床表现等资料进行总结分析。结果患者以中年男性居多，男性病例数是女性病例数2.5倍（85比34）。全年均有发病，多集中于5至7月；78例有明确动物接触史，其中接触牛、羊者53例（44.54%）；主要临床表现有发热84例（70.59%），肌肉、关节痛93例（78.15%） ，多汗52例（43.70%），全身乏力29例（24.37%），以骨关节、肌肉疼痛症状最为常见。25例（21.01%）患者中性粒细胞下降，34例（28.57%）红细胞沉降率增快，30例（25.21%）凝血功能出现障碍；ALT升高37例（31.09%）、AST升高43例（36.13%）。其他检查显示，脾肿大28例（23.52%），肝脏弥漫性病变22例（18.49%）；最常用药物前3位分别为多西环素79例（66.39%），利福平60例（50.42%），头孢类50（42.02%），其中利福平联用多西环素常见，有45例（37.82%），多西环素联用利福喷丁或头孢类31例（26.05%）；患者治愈、好转112例（94.12%）。结论布鲁菌病患者以男性多见，临床表现多样，临床医师应加强辨别，防止误诊，并根据患者情况进行及时、有效的治疗；同时相关部门也应加强布鲁菌病监管和宣教。

ObjectiveTo analyze the epidemiological characteristics, clinical manifestations, diagnosis and treatment effect of brucella in=nfection, and to provide practical foundation and valuable experience for clinical treatment and prevention of brucellosis.MethodsOne hundred and nineteen patients with brucella infection hospitalized at the First Hospital of Lanzhou University from January 1st 2011 to July 30th 2011 were enrolled. Clinical data including gender, age, contact history with bovine and clinical manifestations such as fever, sweating and joint and muscle pain were extracted. Diagnosis and treatment effect of these patients were all recorded. The epidemiological characteristics and clinical manifestations were analyzed.ResultsThe majority of patients were middle-aged male, and the number of male cases were 2.5 times of female cases. The brucella infections were observed all seasons in Lanzhou, while most cases were observed between May and July. A total of 78 cases had clear animal contact history. Among them, 53 cases （44.54%） had contact history with bovine. Main clinical manifestations included fever （n=84, 70.59%）, muscle and joint pain （n=93, 78.15%）, sweating （n=52, 43.70%）, fatigue （n=29, 24.37%）, and the most common clinical symptoms was joint and muscle pain. Blood routine test showed neutropenia （n=25, 21.01%）, increase in blood sedimentation （n=34, 28.57%） and blood coagulation dysfunction （n=30, 25.21%）. Liver function examination showed increase in ALT （n=37, 31.09%） and AST （n=43, 36.13%）. Other examination showed that splenomegaly （n=28, 23.52%） was the most common finding, and liver diffuse lesions （n=22, 18.49%） ranked second. The most common drugs were doxycycline （n=79, 66.39%）, rifampin （n=60, 50.42%） and cephalosporins （n=50, 42.02%）. Among them, 45 cases （37.82%） were treated with combination therapy of rifampin and doxycycline, and 31 cases were treated with combination therapy of doxycycline and rifapentine or cephalosporins. Totally 112 cases （94.12%） recovered.ConclusionsThe majority of patients with brucellosis are male. The clinical manifestations of brucellosis are varied. Clinicians should pay attention to identify and prevent misdiagnosis. The timely and effective treatment should be provided according to patients’ conditions. The relevant departments should also strengthen supervision and education of brucellosis.