2010-2018年承德地区340例布鲁菌病患者临床诊疗情况分析研究

Human Brucellosis in Chengde District from 2010 to 2018:Clinical Analysis of 340 Cases

背景布鲁菌病属于严重危害社会公共卫生安全的法定乙类传染病,其发病率高,分布范围广,病程较长、临床表现复杂。因此,临床诊断困难,误诊率、复发率、致残率高,需要临床医生早期诊断、正确选择抗生素种类和疗程。目的调查承德地区布鲁菌病患者流行病学、临床特点、实验室检查资料、抗生素使用情况和预后及复发情况等临床资料,为布鲁菌病的防治提供指导。方法选取承德市第三医院2010年1月-2018年8月就诊的340例布鲁菌病患者,收集同期进行健康体检的血液样品100份作为对照者。回顾性分析患者的人口学和流行病学资料、临床特点、实验室检查、治疗方案以及预后情况等资料。结果340例患者中有布鲁菌病明确接触史322例(94.7%),无明确接触史18例(5.3%),其中以饲养牛羊、流产或病死牛羊接触者和屠宰、皮毛加工者感染率较高,分别为59.2%、20.5%和5.1%;主要症状和体征以发热(81.5%)、乏力(71.5%)和关节痛、腰腿痛(65.3%)为主要表现。布鲁菌病患者白细胞计数(WBC)、中性粒细胞计数(NRU)低于对照者,淋巴细胞计数(LYM)、降钙素原、C反应蛋白高于对照者(P<0.05)。布鲁菌病治疗共可采用7种治疗方案,其中方案1为157例,方案2为141例,方案3为36例,方案4为3例,方案5为2例,方案6为1例,方案7为0例。340例患者总痊愈率为94.7%(322/340)。其中,方案1痊愈率为96.2%(151/157),肝损伤、胃肠道反应及粒细胞缺乏症发生率分别为5.1%(8/157)、7.6%(12/157)和1.3%(2/157);方案2痊愈率为95.0%(134/141),肝损伤、胃肠道反应及粒细胞缺乏症发生率分别为3.5%(5/141)、4.3%(6/141)和0.7%(1/141);方案3痊愈率为86.1%(31/36),肝损伤、胃肠道反应发生率分别为5.6%(2/36)和8.3%(3/36)。方案1痊愈率高于方案3(χ^2=4.92,P=0.026);方案1与方案2、方案2与方案3痊愈率比较,差异均无统计学意义(χ^2=0.38、3.09,P=0.53、0.08)。方案1、方案2、方案3不良反应发生率比较,差异无统计学意义(χ^2=2.22,P=0.14)。方案4、5、6痊愈率为100%,仅1例发生不良反应,由于病例数较少,未进行统计学处理。结论布鲁菌病的诊断需要依赖牛羊接触史等流行病学资料、复杂多样的临床表现和特异性实验室检查,但由于缺乏临床特异性,涉及各器官系统且并发症多,需要临床医生加强对本病的认识。布鲁菌病的治疗共可采用7种治疗方案,可依据患者具体情况选择治疗方案。

Background Brucellosis belongs to the category B infectious disease which seriously endangers the public health safety in China's law on the prevention and control of infectious diseases.It has a high incidence rate,wide distribution,long duration and complex clinical manifestations.Therefore,the clinical diagnosis is difficult,the misdiagnosis rate,recurrence rate and disability rate are high,so it is necessary for clinicians to make early diagnosis and correctly select the type and course of antibiotics.Objective To investigate epidemiology,clinical characteristics,laboratory examination,use of antibiotics,prognosis and recurrence in patients with brucellosis in Chengde,in order to provide guidance for the diagnosis and treatment of brucellosis.Methods The demographic data,epidemiological data,clinical characteristics,laboratory results,treatment programs and prognosis of 340 patients suffering from brucellosis from the Third Hospital of Chengde from January 2010 to August 2018 were analyzed retrospectively.Meanwhile,100 blood samples of health examinees were collected during the same period.Results Among the 340 cases,322(94.7%)had a definite history of contacting with infected sheep,and other 18(5.3%)had not.Higher rates of infecting with brucellosis were found in those raising cattle and sheep(59.2%),contacting with aborted or decreased cattle and sheep(20.5%),and engaging in slaughtering and fur processing(5.1%).Main symptoms and signs included fever(81.5%),fatigue(71.5%),and joint pain,low back pain and leg pain(65.3%).Compared with the control group,patients with brucellosis had lower mean white blood cell count,and neutrophil count and higher mean procalcitonin and C-reactive protein(P<0.05).There are seven options that can be adopted for the treatment of brucellosis.Specifically,options 1,2,3,4,5,6,7 were used in 157,141,36,3,2,1,0,cases,respectively.The overall cure rate was 94.7%(322/340).The cure rates for the used 6 options were 96.2%(151/157),95.0%(134/141),86.1%(31/36),100%,100%,100%,respectively.Option 1 achieved higher cure rate than option 3(χ^2=4.92,P=0.026).There were no significant difference in terms of cure rate between options 1 and 2(χ^2=0.38,P=0.53),and between options 2 and 3(χ^2=3.09,P=0.08).The adverse reactions of option 1 were liver injury〔5.1%(8/157)〕,gastrointestinal reactions〔7.6%(12/157)〕and agranulocytosis〔1.3%(2/157)〕.And those of option 2 were liver injury〔3.5%(5/141)〕,gastrointestinal reactions〔4.3%(6/141)〕and agranulocytosis〔0.7%(1/141)〕.Option 3 yielded adverse reactions such as liver injury〔5.6%(2/36)〕and gastrointestinal reactions〔8.3%(3/36)〕.Options 1,2,and 3 had no significant difference in the incidence of adverse reactions(χ^2=2.22,P=0.14).Conclusion The diagnosis of brucellosis depends on epidemiological data(history of contacting with infected cattle and sheep and so on),complicated and diverse clinical manifestations,and specific laboratory examinations.However,due to lack of typical clinical features,involving various organ systems and yielding many complications,clinicians should increase their understanding of this disease.There are 7 therapeutic schemes for brucellosis,which can be selected according to the specific situation of patients.