神经型布鲁菌病的临床特征和实验室检查特点分析

Analysis of clinical features and laboratory examination characteristics of neruobrucellosis

目的分析神经型布鲁菌病(neruobrucellosis,NB)的临床特征和实验室检查项目特点,为临床诊治提供依据。方法采用前瞻性设计,以2016年6月至2019年2月黑龙江省农垦总局总医院确诊为NB的住院患者为研究对象。对其一般特征,临床特点,实验室检查结果[全血白细胞计数(WBC)、血红蛋白(Hb)、C-反应蛋白(CRP)、血清谷氨酸-丙酮酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总蛋白(TP)、白蛋白(ALB)、脑脊液常规和生化、试管凝集实验(SAT)、布鲁菌血培养及脑脊液培养],诊断及治疗效果进行分析。结果共有25例患者确诊为NB,其中,男性19例、女性6例;年龄为(41.7±14.2)岁,范围为11~70岁。临床症状以发热、头痛、关节痛、恶心呕吐、多汗为主,分别占92.0%(23/25)、88.0%(22/25)、76.0%(19/25)、64.0%(16/25)、64.0%(16/25)。临床表现中,颈强直阳性和下肢麻木无力各9例(36.0%),神智障碍7例(28.0%)。25例NB患者中,WBC升高5例(20.0%),Hb降低4例(16.0%),CRP升高13例(52.0%),ALT和AST各升高6例(24.0%),TP降低21例(84.0%);SAT均阳性,脑脊液SAT阳性7例(28.0%),血培养阳性2例(8.0%)。脑脊液改变主要表现为氯化物降低14例(56.0%)、葡萄糖降低13例(52.0%)和蛋白升高19例(76.0%)。25例NB患者中,17例用多西环素+利福平+头孢曲松治疗,7例用依替米星+利福平+头孢唑肟治疗,1例用多西环素+利福平+哌拉西林舒巴坦治疗。治疗后随访6~12个月,21例患者恢复良好,4例患者有后遗症。结论NB患者临床表现多样,神经系统症状、脑脊液检查对NB诊断有重要价值。

Objective To analyze the clincial characteristics and laboratory findings of patients with neurobrucellosis(NB).Methods Using retrospective analysis,clinical diagnosed patients with NB from June 2016 to February 2019 in Heilongjiang Agricultural Reclamation Bureau General Hospital were selected to analyze the general characteristics,clinical symptoms,laboratory examination results[white blood cell(WBC),hemoglobin(Hb),c-reactive protein(CRP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total protein(TP),albumin(ALB),cerebrospinal fluid routine and biochemical,serum tube agglutination test(SAT),blood culture and cerebrospinal fluid culture of Brucella],diagnosis and treatment effect.Results A total of 25 patients were diagnosed with NB,including 19 males and 6 females,with an average age of(41.7±14.2)years old,ranged from 11 to 70 years old.The main clinical symptoms were fever,headache,joint pain,vomiting and sweating,which accounted for 92.0%(23/25),88.0%(22/25),76.0%(19/25),64.0%(16/25),and 64.0%(16/25),respectively.Positive neck ankylosis and mumbness of lowerlimbs were both 9 cases(36.0%),and mental disorders were 7 cases(28.0%).In 25 patients with NB,the WBC increased in 5 cases(20.0%),Hb decreased in 4 cases(16.0%),CRP increased in 13 cases(52.0%),ALT and AST both increased in 6 cases(24.0%),TP decreased in 21 cases(84.0%);SAT was positive in 25 cases(100.0%),cerebrospinal fluid SAT positive in 7 cases(28.0%);and blood culture was positive in 2 cases(8.0%).Cerebrospinal fluid changes were mainly manifested in 14 cases(56.0%)of chloride reduction,13 cases(52.0%)of gluose reduction and 19 cases(76.0%)of protein increase.In 25 patients with NB,17 cases were treated with doxycycline+rifampicin+ceftriaxone,7 cases with etimicin+rifampicin+ceftriaxone,and 1 case with doxycycline+rifampicin+piperacillin sulbactam.After 6 to 12 months follow-up,21 cases recovered well,whereas mild sequelae were observed in 4 patients.Conclusion Clinical features of NB are hetorogeneous,and nerurological symptoms and cerebrospinal fluid examination are of great value in the diagnosis of NB.