2018—2019年黑龙江省328例布鲁菌病患者流行病学特征和临床特点

Epidemiological and clinical characteristics of 328 patients with brucellosis in Heilongjiang Province from 2018 to 2019

目的分析黑龙江省328例布鲁菌病(布病)患者流行病学特征和临床特点,为布病的防治策略提供依据。方法对黑龙江省农垦总局总医院2018年1月—2019年9月治疗的328例布病确诊患者做回顾性研究,健康体检者112例作为对照组。结果328例布病患者中男女比例为4.56∶1;40~<60岁组(53.35%)及4—6月(40.24%)为高发年龄和季节;居住在哈尔滨及其周边最多(31.10%),其次为绥化(21.65%);长期与牛羊接触的农牧民最易感染(70.12%)。急性期、亚急性期、慢性期分别占34.76%、14.33%、50.91%。除常规临床表现外,在有关节痛患者中,髋关节痛(18.60%)、膝关节痛(35.37%)最常见,胸锁关节痛(0.30%)和骶髂关节痛(1.22%)最少见。在有骨骼肌肉痛患者中腰椎疼痛(54.88%)最常见,锁骨痛(0.30%)、肩胛骨痛(0.30%)最少见。与对照组相比,布病组25-羟基总维生素D(25-OH-VD,88例)、血清总蛋白(176例)、血清白蛋白(160例)指标降低,差异有统计学意义(χ^(2)=4.415、83.444、76.088,P<0.05)。超敏C-反应蛋白(hsCRP,135例)、C-反应蛋白(CRP,119例)、单核细胞(143例)、谷丙转氨酶(128例)、谷草转移酶(103例)、γ-谷氨酰转移酶(144例)、乳酸脱氢酶(107例)、碱性磷酸酶(50例)、α-羟丁酸脱氢酶(67例)、肌酸激酶同工酶(19例)指标升高,差异有统计学意义(χ^(2)=28.647、41.757、41.868、39.738、32.713、31.648、28.076、19.262、21.941、4.620,P<0.05)。hsCRP升高(急性期71例、亚急性期15例、慢性期49例)、CRP升高(急性期57例、亚急性期18例、慢性期44例)患者中处于急性期最多,而25-OH-VD降低(急性期29例,亚急性期7例,慢性期52例)处于慢性期最多。结论黑龙江省328例布病患者中慢性期最多,需加强宣教防延误病情。25-OH-VD、CRP、hsCRP应作为布病患者除血常规、肝功、心肌酶常规检测之后的又一重要检测项目,应定期监测以指导临床诊疗。

Objective To provide basis for the prevention and treatment of brucellosis by analyzing epidemiological and clinical characteristics of 328 patients with brucellosis in Heilongjiang.Methods A retrospective study was conducted on 328 patients with confirmed brucellosis treated from January 2018 to September 2019 in Heilongjiang General Hospital of the General Administration of Land Reclamation,and 112 subjects in the physical examination were included in the control group.Results The male-to-female ratio of 328 patients with brucellosis was 4.56∶1,40-<60 years old group(53.35%)and the season from April to June.(40.24%)were the most frequent ages and season respectively,the most cases were patients living in and nearby Harbin(31.10%),followed by Suihua(21.65%).Farmers and herdsmen in long-term contact with cattle and sheep were the most susceptible(70.12%).Acute stage,sub-acute stage and chronic stage accounted for 34.76%,14.33%and 50.91%respectively.The hip joint pain(18.60%)and knee joint pain(35.37%)were the most common among the related cases in addition to routine clinical manifestations,while sternoclavicular joint pain(0.30%)and sacroiliac joint pain(1.22%)were the least common.Lumbar pain(54.88%)was the most common in the patients suffering from skeletal muscle,while collarbone pain(0.30%)and scapula pain(0.30%)were the least common in patients with skeletal muscle pain.The indexes of 25-hydroxyl vitamin D(25-OH-VD,88 cases),serum total protein(176 cases)and serum albumin(160 cases)in brucellosis group were lower when compared to the control group,and the differences were statistically significant(χ^(2)=4.415,83.444,76.088,P<0.05).The indexes of hypersensitive C-reactive protein(hsCRP,135 cases),C-reactive protein(119 cases),monocyte(143 cases),alanine transaminase(128 cases),glutamic oxalacetic transaminase(103 cases),γ-glutamyltransferase(144 cases),lactate dehydrogenase(107 cases),alkaline phosphatase(50 cases),hydroxybutyrate dehydrogenase(67 cases)and creatine kinase isoenzyme(19 cases)were significantly increased,and the differences were statistically significant(χ^(2)=28.647,41.757,41.868,39.738,32.713,31.648,28.076,19.262,21.941,4.620,P<0.05).The increase of hsCRP(71 cases in acute stage,15 cases in sub-acute stage and 49 cases in chronic stage)and CRP(57 cases in acute stage,18 cases in sub-acute stage and 44 cases in chronic stage)rise were the most in acute stage,the decrease of 25-OH-VD(29 cases in acute stage,7 cases in sub-acute stage and 52 cases in chronic stage)was the most in chronic stage.Conclusion The chronic period of cases of brucellosis in Heilongjiang 328 cases,and it is required to strengthen the publicity to prevent delay the treatment of disease.The examination on 25-OH-VD,CRP and hsCRP should be taken as another important items upon routine examinations of blood routine,liver function and myocardial enzyme in brucellosis patients and should be monitored regularly to guide clinical diagnosis and treatment.