布氏杆菌性脊柱炎的流行病学分析

Epidemiological analysis of brucellar spondylitis

目的 分析布氏杆菌性脊柱炎(BS)的发病特点和临床特征。方法 收集BS患者201例,分析人口学、临床表现、实验室检查、侵袭部位的特点。结果 患者男女比例为2.41∶1,40~69岁为发病高峰(84.58%),职业分布以农牧民居多,共149例(74.13%),有明确牛羊接触史者139例(69.15%)。BS患者临床表现复杂多样,多以腰背部剧烈疼痛为主,部分患者可伴有发热、乏力、大汗、寒战等症状及神经受损体征。201例患者布氏杆菌凝集试验(SAT)均为阳性,77例患者布氏杆菌血培养阳性21例,阳性率为27.27%;红细胞沉降率(ESR)阳性率为81.87%(158/193),超敏C反应蛋白(hs-CRP)阳性率为91.79%(179/195)。腰椎受累最常见(74.30%),颈椎、胸椎、骶椎次之,病变以单节段感染为主(78.60%),多节段、跨节段及单个椎体感染较少(21.40%)。结论 BS患者男性多于女性,发病高峰年龄为40~69岁,以农牧民为主,常有家畜及畜产品接触史;常见侵袭部位以腰椎、单节段感染居多,患者多以腰背部剧烈疼痛症状就诊。对于符合布氏杆菌病流行病史的患者,需要完善SAT、ESR、hs-CRP及影像学检查以进一步明确诊断。

Objective To explore the characteristics and clinical features of brucellar spondylitis(BS).Methods 201 patients with BS were collected.The characteristics of demography, clinical manifestation, laboratory examination and the invasive site were analyzed.Results The ratio of male to female was 2.41∶1,the peak incidence was between 40 and 69 years old(84.58%).149 cases(74.13%)of the patients were farmers and herdsmen, and 139 cases(69.15%)had a clear history of contact with cattle and sheep.The clinical manifestations of BS patients were complex and diverse, most of which were severe pain in the waist and back.Some patients were accompanied by the symptoms such as fever, fatigue, sweating, chills, and signs of nerve damage.The brucella agglutination test(SAT)of 201 patients were all positive, the positive rate of blood culture test in 77 cases was 27.27%,the positive rate of erythrocyte sedimentation rate(ESR)was 81.87%(158/193),and the positive rate of hypersensitivity C-reactive protein(hs-CRP)was 91.79%(179/195).Lumbar vertebrae was the most common involvement site(74.30%),followed by cervical vertebrae, thoracic vertebrae and sacral vertebrae.The lesions were mainly single-segment infection(78.60%),the cross-segments and single vertebrae infection were less(21.40%).Conclusion The patients with BS are more male than female, and the peak age of onset was 40~69 years old, mainly farmers and herdsmen, and often have a history of contact with livestock and livestock products;The common invasive site is lumbar vertebrae and single-segment infection.Patients are mostly treated with severe pain in the lumbar and back.For patients with an epidemiological history of brucellosis, SAT,ESR,hs-CRP and imaging tests should be perfected to further confirm the diagnosis.