38例儿童布鲁菌病临床特点分析

Clinical features of 38 children with brucellosis

目的探讨38例儿童布鲁菌病（简称布病）患者的临床特征和实验室检查等特点，为其临床诊治提供理论依据。方法采用回顾性分析方法，收集2011年1月至2015年12月呼伦贝尔市人民医院布病科收治门诊和住院的儿童布病患者的临床资料，分析儿童布病患者的流行病学、临床特征、实验室检查、治疗以及疗效等情况。结果共收集38例儿童布病患者，其中男性24例，女性14例，36例有明确的流行病学史，发病季节以夏、秋季为主。儿童布病患者发热33例（86．8％），食欲减退21例（55.3％），关节肌肉疼痛17例（44．7％），肝肿大5例（13.2％），脾肿大11例（28．9％），淋巴结肿大10例（263％）。实验室检查异常以炎症指标异常为主，其中C反应蛋白升高27例（71．1％），红细胞沉降率增高24例（63.2％）。37例布病儿童虎红平板凝集试验和试管凝集试验（SAT）阳性，1例阴性但血培养阳性。所有儿童布病患者经过至少12周的联合、足量、规范治疗后，近期疗效为治愈30例，好转8例，布病血清学转阴3例，总有效率达100．0％。结论在布病疫区，儿童存在长期发热、关节痛、肝脾肿大等特征，临床医师应高度怀疑布病，做到早期诊断和治疗，降低疾病的慢性化。

Objective To analyze clinical and laboratory results of 38 children with brucellosis ibr providing theoretical basis for its clinical diagnosis and treatment. Methods The epidemiology, clinical features, laboratory characteristics and therapeutic effect of pediatric patients at HulunBuir People＇s Hospital from January 2011 to December 2015, were retrospectively evaluated. Results Totally there were 38 child patients with brucellosis, 24 males and 14 females, 36 children had directly contacted with animals, and onset seasons were mainly in Summer and Autumn. The dominant manifestations were fever in 33 （86.8%）, anorexia in 21 （55.3%）, arthralgiaand Inyalgia in 17 （44.7%）, hepatomegaly in 5 （13.2%）, splenomegaly in 11 （28.9%）, and lymph nodes enlargement in 10 （26.3%）. Abnormal laboratory findings included elevated C-reactive protein （CRP） level in 27 （71.1%） and erythrocyte sedimentation rates （ESR） in 24 （63.2%）. Both the Rose Bengal test and serum agglutination test （SAT） were positive in 37 patients, only one patient was negative but the blood culture was positive. After at least 12 weeks of combined, adequate and standardized treatment, there were 30 pediatric brucellosis patients cured, improved in 8 cases, the total effective rate was 100.0%. Conclusions In endemic regions, the presence of persistent fever, joint pain and hepatosplenomegaly should alert clinicians the possibility of brucellosis. Early diagnosis and treatment will reduce the incidence of complications.