山东省枣庄市71例急性期布鲁氏菌病患者临床特征分析

Clinical features of 71 patients with acute brucellosis in Zaozhuang City of Shandong Province

目的了解山东省枣庄市急性期布鲁氏菌病(简称布病)患者的流行病学特征及临床表现,以提高对布病的认识。方法回顾性分析2019年1月至2020年12月枣庄市立医院确诊的急性期布病患者的人口学特征、流行病学特征、临床表现、实验室检查结果。结果确诊的71例急性期布病患者中,男性患者居多,男女比例为2.2∶1.0(49∶22),年龄为(53.23±14.12)岁,主要集中在枣庄市峄城区(32.39%,23/71);80.28%(57/71)有流行病学接触史;全年均有发病,主要集中在4-10月(76.06%,54/71);主要症状有发热(100.00%,71/71),肌肉关节疼痛(80.28%,57/71),乏力(54.93%,39/71),多汗(39.44%,28/71),部分有肝脾肿大(18.31%,13/71)和睾丸炎(4.23%,3/71)等。实验室检查结果显示,白细胞降低占12.68%(9/71),红细胞减少占21.13%(15/71),血小板减少占8.45%(6/71),淋巴细胞百分比降低占12.68%(9/71),C-反应蛋白升高占67.61%(48/71),红细胞沉降率加快占50.70%(36/71),部分伴有丙氨酸氨基转移酶升高(50.70%,36/71)和天门冬氨酸氨基转移酶升高(42.25%,30/71),血培养阳性患者57例(80.28%)。结论枣庄市急性期布病患者临床特征不典型,对有流行病学接触史的长期不明原因发热患者,特别是伴有肌肉关节疼痛、肝脾肿大和睾丸炎者,应进行布病筛查。

Objective To analyze the epidemiological characteristics and clinical manifestations of patients with acute brucellosis in Zaozhuang City of Shandong Province,and to improve the understanding of brucellosis.Methods The demographic characteristics,epidemiological characteristics,clinical manifestations and laboratory examination results of patients with acute brucellosis diagnosed in Zaozhuang Municipal Hospital from January 2019 to December 2020 were retrospectively analyzed.Results Most of the 71 patients with acute brucellosis were male,with a male-to-female ratio of 2.2∶1.0(49∶22)and an average age of(53.23±14.12)years old,mainly in Yicheng District(32.39%,23/71);80.28%(57/71)of patients had a history of epidemiological contact;the disease occurred throughout the year,mainly from April to October(76.06%,54/71);the main symptoms were fever(100.00%,71/71),muscle and joint pain(80.28%,57/71),fatigue(54.93%,39/71),hyperhidrosis(39.44%,28/71),hepatosplenomegaly(18.31%,13/71)and orchitis(4.23%,3/71),etc.Laboratory examination results showed that decreased white blood cells accounted for 12.68%(9/71),decreased red blood cells accounted for 21.13%(15/71),thrombocytopenia accounted for 8.45%(6/71),decreased lymphocyte percentage accounted for 12.68%(9/71),increased C-reactive protein accounted for 67.61%(48/71),and accelerated erythrocyte sedimentation rate accounted for 50.70%(36/71).Some patients were accompanied by elevated alanine aminotransferase(50.70%,36/71)and aspartate aminotransferase(42.25%,30/71),57 patients(80.28%)with positive blood culture.Conclusions The clinical manifestations of acute brucellosis are atypical in Zaozhuang City.Brucellosis screening should be carried out for patients with long-term unexplained fever and an epidemiological exposure history,especially those with muscle joint pain,hepatosplenomegaly and orchitis.