细菌培养阳性的人布鲁菌病27例的临床及流行病学分析

Clinical and epidemic characteristics of 27 cases with Brucellosis confirmed by bacterial culture

目的分析本院布鲁菌病患者的临床特点及流行病学特征，提高诊治水平。方法回顾性分析2007年至2016年间本院确诊的27例布鲁菌病患者的流行病学特征及临床表现。结果全部患者均依据临床表现及细菌培养结果确诊。男19例（70．4％），女8例（29．6％）。2012年至2016年的病例数分别为1例、1例、6例、4例及15例。27例患者中与羊密切接触者10例（37．0％），羊肉销售及加工者7例（25．9％），屠宰及销售牛肉者1例，可疑实验室感染1例，另有8例（29．6％）无明确接触史。临床表现主要有发热、腰痛／关节酸痛、乏力、多汗，其发生率分别为81．5％、55．6％、33．3％、22．2％。实验室检查示血白细胞正常者20例（74．1％），减低者6例（22．2％）；血红蛋白降低者20例（74．1％），血小板降低者4例（14．8％）。谷丙转氨酶、谷草转氨酶、乳酸脱氢酶升高比例分别为32．0％、48．0％及100％；23例（92．0％）血清白蛋白降低。ESR、C反应蛋白、血清铁蛋白升高的比例分别为75．0％、82．3％、77．8％，12例（85．7％）血清降钙素原〈0．5ng／L。所有患者治疗后痊愈。结论本院收治的布鲁菌病病例近年有增多的趋势，掌握其流行病学特点及临床表现对提高布鲁菌病的诊治能力具有重要意义。

Objective To improve the diagnostic and therapeutic ability of Brucellosis by analyzing the epidemic and clinical characteristics. Methods A retrospective analysis was done on the data of Bru- cellosis patients treated in our hospital from 2007 to 2016. Results Since the first case was diagnosed in 2012, 27 patients [ 19 male and 8 female, mean age （44.4 ±16. 9）years] were confirmed by clinical manifestations and positive bacterial cultures results. The annual number of cases from 2012 to 2016 was 1, 1, 6, 4 and 15. Among them, 10 cases （37. 0% ） had a history of close contact with goat, 7 cases （25.9%） with raw mutton, 1 ease （3.7%） with raw beef and 1 ease （3.7%） with suspicious laboratory contamination while 8 cases （29. 6% ） had no evident risk factors for Brucellosis. The common clinical manifestation included fever （81.5%）, lumbago/joint pain （55.6%）, fatigue （33.3%） and hyperhidrosis （22. 2% ）. The white blood cell count was normal among 20 cases （74. 1% ） while 6 cases （22. 2% ） with leukopenia. Mild to moderate anemia in 20 cases （74. 1% ） and decreased platelet number in 4 case （ 14. 8% ）. The percentage of elevated alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase was 32. 0% , 48.0% and 100% , respectively. Decreased albumin level was found in 23 cases （92.0%）. The percentage of elevated erythrocyte sedimentation rate （ESR） , C-reactive protein and serum ferritin 75.0% ,82. 3% and 77.8% , respectively, while 12 cases （85.7%） with procalcitonin level below 0. 5 ng/L. According to follow-up for at least half year, all the cases were cured by active medical management. Concluslons The number of Brucellosis cases is rapidly increasing in our hospital. It＇s of great significance to know the epidemic and clinical characteristics of Brucellosis.