35例布鲁菌病患者临床特征分析

Brucellosis： clinical analysis of 35 cases

目的 分析布鲁菌病（简称布病）患者的临床特征和实验室检查结果，提高临床医师对布病的认识和诊治水平，减少误诊漏诊。方法 收集北京大学第三医院1994年1月至2016年12月急性期布病患者的临床资料，回顾性分析患者的科室分布、人口学特征、流行病学史、临床表现、实验室检查和诊疗经过等。结果35例布病患者，男27例，女8例，年龄（46 ± 14）岁。布病患者分布在医院多个科室；职业以农民、牧民为主（23例，65.7%）；居住于北京市远郊区13例（37.1%），外省市19例（54.3%）；有明确羊、牛、猪接触史者18例（51.4%）。主要症状为发热（35例，100.0%），最高体温（39.42 ± 0.66）℃；其他症状主要包括肌肉关节痛（22例，62.9%）、乏力（16例，45.7%）、多汗（13例，37.1%）、肝脾肿大（15例，42.9%）、淋巴结肿大（13例，37.1%）。血清凝集试验阳性率为62.9%（22／35），血培养阳性率为65.7%（23／35）。病程30 d以上者24例（68.6%）。确诊前多使用多种药物治疗，确诊后多采用多西环素、利福平为基础的治疗，部分联合喹诺酮／头孢曲松的二联、三联、四联方案。治疗4（1 - 6）d后体温正常，疗程为4（2 - 12）个月。对25例患者进行随访，23例无复发。结论 布病患者分布在医院多个科室，临床表现缺乏特异性且无明确流行病学史，诊治过程曲折，容易漏诊误诊，要提高医生对布病的认识，提高诊治水平。

Objective To analyze the clinical and laboratory data of brucellosis patients in Peking University Third Hospital, and to promote clinician＇s understanding and diagnosis and treatment of brucellosis, and to reduce misdiagnosis and missed diagnosis. Methods The clinical characteristics of patients with acute brucellosis in Peking University Third Hospital from January 1994 to December 2016 were retrospectively analyzed, including departments division, demographic characteristics, epidemiology, clinical manifestation, laboratory examination, diagnosis and treatment. Results There were 35 patients, 27 males and 8 females, with an average age of （46 ± 14） years. Patients with brucellosis were distributed in multiple departments of the hospital. There were 23 cases （65.7%） whose occupation were farmers or herdsmen, and 13 cases （37.1%） that lived in the outer suburbs of Beijing, and 19 cases in other provinces （54.3%）. There were 18 cases having sheep （cattle） and pig contact history （51.4%）. The main symptoms were fever in 35 cases （100.0%）, the highest temperature was （39.42 ± 0.66）℃, other symptoms including muscle and joint pain （22, 62.9%）, fatigue （16, 45.7%）, sweating （13, 37.1%）, hepatosplenomegaly （15, 42.9%） and lymphadenopathy （13, 37.1%）. The positive rate of serum agglutination test was 62.9% （22/35）, and the positive rate of blood culture was 65.7% （23/35）. The course of disease was more than 30 d in 24 cases （68.6%）. Multi-drug treatment was common before diagnosis; the cases were treated with doxycycline and rifampicin based, combined quinolone/ceftriaxone two, triple and quadruple therapy. After treatment for 4 days （1 - 6 days）, the body temperature was returned to normal and the total course of treatment was 4 months （2 - 12 months）. Twenty-five patients were followed up, and 23 cases had no recurrence. Conclusions In general hospital, brucellosis patients distributed in a number of departments, the conditions are relatively complex, a considerable number of patients do not have a clear epidemiological history, lack of specific clinical manifestations, the process of diagnosis and treatment is tortuous, and easily misdiagnosed. Doctors＇ understanding of brucellosis needs to be improved, in order to improve their level of diagnosis and treatment.