神经型布氏杆菌病30例临床分析

Neurobrucellosis： a clinical analysis of 30 cases

目的 探讨神经型布氏杆菌病（NB）的临床特点,提高诊治水平.方法 对首都医科大学宣武医院神经内科2013年4月至2016年10月收治的30例NB患者的流行病学、临床表现、实验室及影像学资料进行回顾性分析.结果 30例NB患者的男女比例为23：7,平均年龄为43岁.既往有明确布氏杆菌病史者6例,有牛羊或其奶制品接触史者24例.伴有脑膜炎或脑膜脑炎表现者29例,伴脊髓损害者20例,伴听神经损害者18例,这些均为NB的常见临床表现.29例患者的脑脊液化验白细胞数升高[（10 ～599）×106/L],30例蛋白水平升高（0.5 ～4.0 g/L）,29例葡萄糖水平下降（0.8 ～2.6 mmol/L）.17例患者的头颅MRI显示有白质病变.大部分患者应用多西环素、利福平及头孢曲松3种药物联合治疗,多数患者预后良好.结论 NB在临床上并不少见,其临床表现多样,以脑膜炎或脑膜脑炎最为多见,脊髓损害和听神经损害也很常见.来自布氏杆菌病流行区的患者表现为原因不明的神经系统症状时,需考虑与NB相鉴别.

Objective To investigate the clinical features of neurobrucellosis and improve the diagnosis and treatment of the disease.Methods The epidemiological information,clinical manifestation,laboratory examination,and imaging characteristics of 30 cases with neurobrucellosis were summarized retrospectively.Results There were 23 men,seven women in this group of cases.The mean age was 43 years.There were six cases with definite history of brucellosis,24 with exposure history of cattle and sheep or their diary products.Brucella blood serum agglutination tests were all positive in 30 cases.Meningitis or meningoencephalitis （29 cases）,spinal cord lesion （20 cases） and auditory nerve＇s damage （18 cases） were the most common forms of neurobrucellosis in these patients.In the cerebral spinal fluid inspection tests,there were 29 cases with increasing leukocyte （（10-599） × 106/L）,30 cases with elevated protein （0.5-4.0 g/L）,29 cases with decreased glucose （0.8-2.6 mmol/L） in this group of patients.There were 17 cases with white matter lesion on cranial magnetic imaging.The combinations of doxycycline,rifampin and ceftriaxone sodium were given to most cases.The prognosis was good in most cases.Conclusions Neurobrucellosis is not unusual clinically,clinical presentation of which varies greatly.The most common form is meningitis or meningoencephalitis,whereas spinal cord damage and hearing damage are also common.Patients who come from epidemic area and develop unexplained neurological symptoms should be screened and distinguished with neurobrucellosis.