深圳14例布鲁菌病患者临床特点与实验室分析

Clinical feature and laboratory analysis of 14 cases of human brucellosis in Shenzhen

目的分析布鲁菌病(布病)病例临床及相关实验室检查结果,为布病的临床及实验室鉴别诊断提供依据。方法采用回顾性分析方法,选择2015年12月至2019年8月深圳市人民医院检验科微生物室检测确诊的布病病例作为调查对象,收集调查对象的临床资料,包括流行病学特征、临床表现、实验室检测结果、治疗及预后,进行评价分析。结果14例患者中男性9例,女性5例,年龄中位数(范围)为42(23~62)岁。患者的首诊时间集中在4-9月,占78.6%(11/14)。有明确生牛羊猪肉、羊胎盘接触史占78.6%(11/14)。发热和关节肿痛为主要临床症状,分别占100.0%(14/14),42.9%(6/14)。关节炎是最常见的并发症,占3/7。实验室结果显示,白细胞计数均不升高,C反应蛋白升高者9例,肝功能异常者9例,血沉升高者8例,血培养阳性报警时间中位数(范围)为69(48~110)h。14例患者中,7例预后良好,4例因并发症多次住院治疗,2例预后不明,1例确诊前已死亡。结论布病临床表现复杂,实验室检查无特异性,需血培养确诊。在临床诊断过程中应详细询问流行病学资料,避免误诊及漏诊。微生物检验人员应掌握布鲁菌的微生物学特征,提高鉴别能力。

Objective To analyze the clinical manifestations and test results of brucellosis cases,provide basis for clinical and laboratory differential diagnosis of brucellosis.Methods Using retrospective analysis method,the cases of brucellosis confirmed by the Microbiology Laboratory of the Laboratory of Shenzhen People's Hospital from December 2015 to August 2019 were selected as the survey subjects,and the clinical data of the survey subjects were collected,including epidemiological characteristics,clinical manifestations,laboratory test results,treatment and prognosis.Results Of the 14 patients,9 were males and 5 were females.The median age of the patients was 42 years old(ranged 23-62 years old).Seventy-eight point six percent(11/14)of the patients were firstly diagnosed from April to September;78.6%(11/14)of the patients had a history of contact with raw beef,mutton,pork and sheep placenta.The main clinical symptoms of brucellosis were fever(100.0%,14/14)and arthralgia(42.9%,6/14).The most common complication was arthritis(3/7).Laboratory results showed that the white blood cell count in all patients was not increased.However,many patients presented with high C-reactive protein level(9 cases),abnormal liver function(9 cases)and high erythrocyte sedimentation rate(8 cases).The median detection time of positive blood culture was 69 h(ranged 48-110 h).Seven patients had good prognosis,4 patients continued to receive treatment due to complications,2 patients failed to follow-up,and 1 patient died before the diagnosis was confirmed of the 14 patients.Conclusions The clinical manifestations of brucellosis are complex,and detailed epidemiological history should be documented during clinical diagnosis to avoid misdiagnosis or missed diagnosis.Microbiologists should master the microbiological characteristics of Brucella,and improve differential diagnosis capabilities.