实验室检查对儿童布氏杆菌病的诊断价值

Diagnostic role of laboratory test results in childhood brucellosis

目的评价血常规血培养等常见实验室检测项目在儿童布氏杆菌病诊断中的应用价值。方法回顾性分析西安市儿童医院2016—2019年间39例布氏杆菌感染患儿(病例组)的临床资料及实验室常规检验项目结果,所有患儿均取得布鲁氏杆菌血培养阳性和血清抗体阳性证据。将病例组的各项实验室检查结果与39例儿保科正常儿童(正常组)体检结果进行比较。结果病例组临床主要以发热或膝、髋关节疼痛收入院,部分患儿有肝、脾、淋巴结肿大;实验室检查患儿血培养布氏杆菌阳性率为100%(39/39),报警时间集中于2~3 d,其中7例患儿同时行骨髓培养,布氏杆菌阳性率为43%(3/7);与正常组儿童比较,儿童布氏杆菌感染者常伴有贫血、血小板计数(PLT)减低、C反应蛋白(CRP)和血沉升高、中性粒细胞与淋巴细胞的比值(NLR)减小,差异均有统计学意义(P<0.05)。结论儿童布氏杆菌感染与多种疾病临床表现相似,易出现漏诊或误诊。血培养在该病阳性率高,是诊断该病的金标准。由于该菌生长缓慢,培养耗时较长,可与抗体凝集试验联合送检,提高该病检出率的同时缩短检测时间。血常规、CRP、NLR、血沉检测可辅助诊断布氏杆菌病。

Objective To evaluate the value of routine blood culture and other common laboratory test items in the diagnosis of childhood brucellosis. Methods The medical records of 39 patients who were diagnosed and treated for brucellosis(positive results in blood culture and serum antibody detection) in Xi’an Children Hospital between 2016 and 2019 were evaluated(the study group). The laboratory test items of the children with brucellosis were compared with those of 39 healthy children(the control group). Results Fever, arthralgia were the main clinical manifestations of brucellosis. A few children with brucellosis had hepatomegaly, splenomegaly, and enlargement of lymph nodes. The positive rate of Brucella in blood culture was 100%(39/39), and the alarm time was 2~3 days. Meanwhile, 7 patients had bone marrow culture and the positive rate was 43%(3/7). Laboratory examinations showed that children with brucellosis often had anemia, decrease of platelet count(PLT), increase of C-reactive protein(CRP) and ESR, decrease of erythrocyte sedimentation rate(NLR), compared with the healthy children(P<0.05). Conclusion Childhood brucellosis is easily to be misdiagnosed, because it has similar clinical manifestations with other diseases. Blood culture has high accuracy in the diagnosis of this disease, and blood culture combined with antibody agglutination test can improve the detection rate and shorten the detection time. Changes in hematological parameters, such as routine blood test, CRP, ESR,NLR can be used as inflammatory markers for the auxiliary diagnosis of brucellosis.