45例布鲁菌病患者实验室诊断指标特征

Characteristics of laboratory indexes of 45 cases with Brucellosis

目的分析布鲁菌病患者不同病期实验室指标变化特征,为布鲁菌病诊断及预后评估提供参考。方法对天门市第一人民医院确诊的45例布鲁菌病患者的降钙素原(PCT)、超敏C-反应蛋白(hsCRP)、白细胞(WBC)、血小板(PLT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Crea)、尿微量白蛋白(mALB)和红细胞沉降率(ESR)等指标以及血培养阳性率和试管凝集试验阳性率进行回顾性分析。根据临床分期分组:急性期患者23例,亚急性期患者8例和慢性期患者14例。结果急性期与亚急性期布鲁菌病患者感染性指标WBC、PCT、hsCRP、ALT、Crea和mALB水平差异均无统计学意义(tWBC=2.04、P=0.082,tPCT=1.98、P=0.093,thsCRP=2.18、P=0.081,tALT=0.94、P=0.18,tCrea=2.31、P=0.088,tmALB=2.02、P=0.085)。急性期布鲁菌病患者AST水平显著低于亚急性期患者(t=7.59、P=0.023),且急性期布鲁菌病患者WBC、PCT、hsCRP、ALT、Crea和mALB水平较慢性期患者差异有统计学意义(tWBC=8.43、P=0.021,tPCT=18.36、P=0.013,thsCRP=12.35、P=0.020,tALT=5.38、P=0.024,tCrea=4.81、P=0.036,tmALB=10.87、P=0.020)。亚急性期与慢性期布鲁菌病患者感染性指标WBC、PCT、hsCRP、ALT、Crea和mALB水平差异均无统计学意义(tWBC=1.12、P=0.096,tPCT=2.19、P=0.082,thsCRP=2.03、P=0.084)。随着病期延长,布鲁菌病患者从急性期进展为慢性期,PLT降低、ESR增快、血培养阳性率逐渐降低,但试管凝集试验阳性率一直较高。急性期、亚急性期和慢性期布鲁菌病患者治疗前后PCT和hsCRP差异均有统计学意义(tPCT=7.85、16.31、27.60,P=0.018、0.0023、0.003;thsCRP=9.98、12.14、7.88,P=0.021、0.036、0.031)。结论WBC、PLT、ALT、AST、Crea和ESR等指标变化可反映布鲁菌病患者病情的动态变化,血培养和试管凝集试验阳性为布鲁菌病诊断标准;PCT和hsCRP可作为治疗前后患者病情监测及预后的参考依据。

Objective To analyze the changes of laboratory indexes of patients with brucellosis at different stages, and to provide clinical reference for the diagnosis and prognosis evaluation of brucellosis.Methods Total of 45 patients with brucellosis diagnosed in the First people’s Hospital of Tianmen were enrolled, the levels of calcitonin proto(PCT), hypersensitive C-reactive protein(hsCRP), white blood cell(WBC), platelets(PLT), alanine aminotransferase(ALT), aspartate aminotransferase(AST), creatinine(Crea), urinary microalbumin(mALB), erythrocyte sedimentation rate(ESR) positive rate of blood culture and positive rate of tube agglutination test were detected, retrospectively. According to the clinical stages,45 patients were divided into three groups: acute stage group(23 cases), subacute stage group(8 cases) and chronic stage group(14 cases). Results There was no significant difference of WBC, PCT, hsCRP, ALT,Crea and mALB levels between acute stage group and subacute stage group(tWBC = 2.04, P = 0.082; tPCT =1.98, P = 0.093; thsCRP = 2.18, P = 0.081; tALT = 0.94, P = 0.18; tCrea = 2.31, P = 0.088; tm ALB = 2.02, P = 0.085).The proportion of AST increase in patients with acute stage brucellosis was significantly lower than that of patients with subacute stage brucellosis(t = 7.59, P = 0.023). The levels of WBC, PCT, hsCRP, ALT, Crea and m ALB in patients of acute stage group and chronic stage group were with significant differences(tWBC = 8.43, P =0.021; tPCT = 18.36, P = 0.013; ths CRP = 12.35, P = 0.020; tALT = 5.38, P = 0.024; tCrea = 4.81, P = 0.036; tm ALB = 10.87,P = 0.020). There was no significant difference in WBC, PCT, hsCRP, ALT, Crea and mALB levels between patients with subacute stage group and chronic stage group(tWBC = 1.12, P = 0.096; tPCT = 2.19, P = 0.082; ths CRP = 2.03, P =0.084). With the prolongation of brucellosis, PLT decreased, ESR increased rapidly and the positive rate of blood culture decreased gradually from acute stage to chronic stage, but the positive rate of tube agglutination test was high. The levels of PCT and hsCRP in patients with brucellosis at different stages were significantly different before and after treatment(tPCT = 7.85, 16.31, 27.60; P = 0.018, 0.0023, 0.003. ths CRP = 9.98, 12.14, 7.88; P = 0.021, 0.036,0.031). Conclusions The changes of laboratory indexes such as WBC, PLT, ALT, AST, Crea and ESR could reflect the dynamic changes of brucellosis. Blood culture and tube agglutination test positive are the diagnostic criteria for brucellosis. PCT and hsCRP could be taken as a reference to monitor the condition and prognosis of patients.