布鲁菌病37例临床分析

Clinical analysis of 37 cases of Brucellosis

目的 了解南京地区布鲁菌病的流行病学和临床特征,为相关部门制定布鲁菌病的防治策略提供参考依据。方法 回顾性分析南京医科大学第一附属医院感染科2011年1月至2019年1月收治的37例布鲁菌病患者的临床资料。结果 37例患者中,男23例(62.16%),女14例(37.84%),以41~60岁居多(15例,占40.54%)。每年1~6月为发病高峰期,主要临床表现为发热(35例,94.59%)、关节痛(23例,62.16%)、畏寒(21例,56.75%)、多汗(10例,27.02%)、乏力(7例,18.91%)。血C反应蛋白(CRP)升高28例(75.76%),降钙素原(PCT)升高27例(72.97%)、谷丙转氨酶(ALT)升高17例(45.94%),谷草转氨酶(AST)升高22例(59.45%)、红细胞沉降率(ESR)升高22例(59.50%)。并发症以骨关节炎、脊柱炎和肝损害多见。曾被误诊为上呼吸道感染13例,腰椎间盘突出7例,肺部感染和药物性肝炎2例,关节炎、颈椎病、病毒感染和风湿病1例。结论 南京地区布鲁菌病以中年男性患者居多,每年1~6月为发病高峰期。临床上遇到不明原因发热,抗感染治疗无效或效果不显著者,并发骨关节炎、脊柱炎和肝损害等疾病时,应提高对本病的警惕性,以免误诊漏治。

Objective To understand the epidemiological and clinical characteristics of Brucellosis in Nanjing,and to provide reference for relevant departments to establish prevention and control strategies of Brucellosis.Methods A total of37 cases of Brucellosis diagnosed in the first affiliated hospital of Nanjing medical university from January 2011 to January2019 were collected to analysis the epidemiological and clinical characteristics of Brucellosis.Results There were 23 males(62.16%)and 14 females(37.84%).The patients in the age range of 41~60 years had the highest incidence(41%).The onset time was mainly from january to june of the year.The main clinical manifestations were fever(35 cases,94.59%),arthralgia(23 cases,62.16%),cold fear(21 cases,56.75%),hypersweat(10 cases,27.02%)and fatigue(7 cases,18.91%).Serum C-reactive protein(CRP)increased in 28 cases(75.76%),procalcitonin(PCT)increased in 27 cases(72.97%),glutamicpyruvic transaminase(ALT)increased in 17 cases(45.94%),glutamic oxaloacetic transaminase(AST)increased in 22 cases(59.45%),Erythrocyte sedimentation rate(ESR)increased in 22 cases(59.50%).Osteoarthritis,spondylitis and liver damage were the most common complications.13 cases were misdiagnosed as upper respiratory tract infection,7 cases as lumbar disc protrusion,2 cases as pulmonary infection and drug hepatitis,1 case as arthritis,cervical spondylosis,virus infection and rheumatism.Conclusion The Brucellosis patients of Nanjing are mainly middle-aged males,and the peak incidence is from January to June.Clinicians should be more vigilant in order to avoid misdiagnosed and missed treatment if patients encounter fever without causes accompanied with osteoarthritis,spondylitis,and/or liver damage and the antiinfection treatment did not work.