血小板减少的21例布鲁菌病患者临床特征分析

Clinical characteristics of 21 brucellosis patients with thrombocytopenia

目的了解布鲁菌病合并血小板减少症患者的临床特征。方法采用回顾性分析,收集2012年1月至2018年12月新疆医科大学第一附属医院感染科诊断的布鲁菌病合并血小板减少症(血小板计数<100×109个/L)患者的临床资料,分析患者的人口学特征、临床特征、实验室检查、治疗方法和预后情况。结果共纳入21例患者,均为男性,年龄为(47.3±12.2)岁,其中维吾尔族3例,汉族14例,哈萨克族4例;职业以农牧民为主,共16例;11例患者有牛、羊密切接触史,5例患者从事屠宰、羊毛加工行业,5例患者为不明原因感染。患者有发热(21例)、多汗(17例)、乏力(16例)、关节肌肉疼痛(7例)、体质量下降(5例)症状。血培养羊种布鲁菌阳性12例;血清试管凝集试验阳性16例,滴度为1∶200~1∶800;白细胞计数正常[(4~10)×109个/L]3例,减少18例。16例患者口服利福平胶囊联合多西环素片治疗,3例患者口服拜复乐片联合多西环素片治疗,2例患者口服拜复乐片联合利福平胶囊治疗;血小板计数<10×109个/L的3例患者同时给予糖皮质激素、丙种球蛋白及血小板输注治疗。治疗结束后随访6个月,19例患者血小板恢复正常,2例患者血小板略低于正常水平。结论布鲁菌病合并血小板减少症患者主要临床特征为发热、多汗、乏力、关节肌肉疼痛、体质量下降及白细胞降低,经治疗后患者预后较好。

Objective To investigate the clinical features of brucellosis with thrombocytopenia.Methods The clinical data of patients with brucellosis complicated with thrombocytopenia(platelet count<100×109/L)diagnosed by the Department of Infection Disease,the First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2018 were collected retrospectively,and the demographic characteristics,clinical characteristics,laboratory examinations,treatment and prognosis of the patients were analyzed.Results All the 21 patients were male and their age was(47.3±12.2)years old,including 3 Uygur,14 Han and 4 Kazak.Their occupation was dominated by farmers and herdsmen,a total of 16 patients;11 patients had a history of close contact with cattle and sheep,5 patients were engaged in slaughter and wool processing industries,and 5 patients were infected for unknown reason.All the 21 patients had fever,hyperhidrosis in 17 patients,fatigue in 16 patients,joint and muscle pain in 7 patients,and decreased body mass in 5 patients.Sheep Brucella blood culture were positive in 12 patients;serum tube agglutination test was positive in 16 patients,titer was 1∶200-1∶800;white blood cell count was normal[(4-10)×109/L]in 3 patients,white blood cell count reduced in 18 patients.Sixteen patients were treated by orally taking rifampin capsules combined with doxycycline tablets,3 patients were treated by orally taking baifule tablets combined with doxycycline tablets,and 2 patients were treated by orally taking baifule tablets combined with rifampin capsules;three patients with platelet count<10×109/L were treated with glucocorticoid,gamma globulin and platelet transfusion.After 6 months of follow-up after treatment,19 patients returned to normal platelet levels,and 2 patients had slightly lower platelet levels.Conclusions The main clinical features of brucellosis with thrombocytopenia are fever,hyperhidrosis,fatigue,joint and muscle pain,decreased body mass,and reduced white blood cell count.Their prognosis is better after treatment.