2015年陕西省绥德县布鲁菌病患者临床诊断情况回顾性调查

A retrospective study of clinical diagnosis of brucellosis patients in Suide County of Shaanxi Province in 2015

目的了解2015年陕西省绥德县布鲁菌病（以下称布病）患者就诊经过，为制定精准防控策略提供科学依据。方法通过个案调查问卷对绥德县2015年1月1日至12月31日发病且在该县居住的所有确诊为布病的病例进行回顾性调查，包括基本情况、就医过程、流行病学接触史，采用SPSS18．0软件进行描述性统计分析。结果2015年，绥德县确诊布病75例，发放问卷75份，调查完整的合格问卷53份。调查对象平均年龄为（49±14）岁，其中84．9％（45／53）为男性，农民占94.3％（50／53），除1例是由绥德县疾病预防控制中心主动监测阳性后就诊，其余均是发病后主动到医疗机构就诊。52例患者中，最少经过1次就诊得到确诊的占25．0％（13／52），最多经过4次就诊才得到确诊的占3．8％（2／52）。省级医院累计确诊率为1／3，疾病预防控制机构为92．7％（51／55），市级医院、县级医院、乡镇卫生院、村卫生室及个人诊所均无确诊病例。首诊原因中．65．4％（34／52）是由于发热或伴多汗、乏力、关节痛、腰腿疼就诊；首次，第2、3、4次就诊发病一就诊间隔天数的中位数分别为15、18、27、45d；发病一确诊时间间隔中位数是21d，范围是2～182d。84．9％（45／53）的布病患者有动物接触史，其中97．8％（44／45）有羊接触史。结论绥德县布病患者以成年男性农民为主，市级以下医院布病诊断率低，应加强高危人群的健康干预和提高基层医务人员诊疗水平。

Objective To learn the diagnosis and treatment of brucellosis patients in Suide County of Shaanxi Province in 2015, and to provide a scientific basis for making accurate prevention and control measures. Methods All the cases diagnosed as brucellosis in Suide County from January 1 to December 31 in 2015 and lived in this county were retrospectively investigated by case questionnaire survey, including basic information, medical procedures, and epidemiological contacts. Descriptive statistical analysis was performed using SPSS 18.0 software. Results In 2015, 75 cases of brucellosis were diagnosed in Suide County, 75 questionnaires were distributed, with 53 completed questionnaires returned. The average age of respondents was （49 ~ 14） years old, of which 84.9% （45/53） were male and 94.3% （50/53） were farmers, except one case was actively monitored by Suide County Centre for Disease Control and Prevention then treated, the rest of the patients were treated after the onset of the disease. Of the 52 patients, one patient was diagnosed after one visit, accounting for 25.0% （13/52）; one patient was diagnosed after at least 4 visits, accounting for 3.8% （2/52）. The cumulative diagnosis rate at provincial-level hospitals was 1/3 and that at disease prevention and control institutions was 92.7% （51/55）, there were no confirmed cases in municipal hospitals, county hospitals, township hospitals, village clinics and individual clinics. For the first reason to see a doctor, 65.4% （34/52） of the patients were fever or accompanied by sweating, fatigue, arthralgia and waist and leg pain. The medians from onset to treatment between the first diagnosis, and 2, 3, 4 visits were 15, 18, 27, 45 days, respectively; the median from onset to diagnosis was 21 days, ranging from 2 to 182 days. Totally 84.9% （45/53） patients had a history of exposure to animals, of which 97.8% （44/45） had contacted the sheep. Conclusions The cases in Suide County are mainly adult male farmers, and the diagnosis rate at hospitals below municipal level is low. It is recommended to strengthen the health intervention of high-risk groups and improve the level of diagnosis and treatment of primary medical staff.