445例合并骨关节痛的布鲁杆菌病临床病例分析
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摘要
目的了解并分析布鲁杆菌病合并骨关节痛患者的流行病学特征、临床特征以及实验室检查情况,为临床医生诊断和鉴别提供科学依据。方法收集2015年1月1日至2016年12月31日间沈阳某医院收治的布病合并骨关节痛患者的病例资料,计量资料采用均数±标准差以及中位数(四分位数间距)来进行统计描述;计数资料的描述采用构成比和率。结果平均年龄为49.16±12.47岁,41～60岁人数所占比例最高(60.56%);男女性别比为2.56:1;汉族人口最多,占79.78%;职业以农民居多,占58.20%;动物接触史以接触羊者居多(63.82%),接触方式主要为饲养或放牧家畜(63.15%);临床分期以急性期(77.08%)为主;临床症状主要为发热(72.58%)、乏力(68.76%)、多汗(42.92%)等;关节受累以脊柱(68.99%)为主。布鲁菌属分离率为33.86%;心肌指标中,乳酸脱氢酶升高117例(26.29%);炎症指标中,67.64%患者CRP升高,43.16%患者PCT升高。肝功能指标中,ALT升高占比24.94%。结论布病合并骨关节痛患者男性多于女性,以中老年为主,多为农民。动物接触史主要为羊,其次为牛,接触方式以饲养或放牧为主。临床症状多为发热、乏力、多汗等,骨关节痛情况以脊柱受累严重,同时伴有一定程度的肝损伤。
Objective To understand and analyze the epidemiological characteristics, the clinical features and laboratoryexamination.The aim of this study is providing the scientific basis for diagnosis and identification.Methods The data of patients with brucellosis complicated with joint pain admitted to a hospital in Shenyang from January 1, 2015 to December 31,2016 were collected. Measured data were statistically described using the mean ± standard deviation and the median(interquartile range); the count data were described using the composition ratio and rate. Results The average agewas 49.16±12.47 years old, and the proportion of 41-60 years old was the highest(60.56%); the male to female sex ratio was 2.56:1;the ethnic group was Han population, accounting for 79.78%.Most of the occupations were farmers, accounting for 58.20%;most people were exposed to sheep(63.82%), and the main contact methods were feeding or grazing livestock(63.15%).The clinical stage was mainly in the acute phase(77.08%);the mainclinicalsymptomswerefever(72.58%),fatigue(68.76%),hyperhidrosis(42.92%),etc. Joint pain was mainly caused by spinal pain(68.99%).All the RBPT tests were positive, 97.75% of the patients had positive SAT test.The isolation rate of Brucella was 33.86%.Among the myocardial indexes, 117 cases(26.29%) had increased lactate dehydrogenase(LDH).Among the inflammatory markers, 67.64% patients had increased CRP and 43.16% patients had increased PCT.Among the indexes of liver function, the percentage of ALT was 24.94%,and the decrease of ALB was 50.56%.Conclusion There are more males than females in brucellosis with osteoarthritis, mainly middle-aged and older, mostly farmers. The history of animal contact was mainly sheep, followed by cattle, the mode of contact was mainly feeding or grazing. The clinical symptoms are mostly fever, fatigue, etc. joint pain is severely affected by the spine and is accompanied by a certain degree of liver damage.
Objective To understand and analyze the epidemiological characteristics, the clinical features and laboratoryexamination.The aim of this study is providing the scientific basis for diagnosis and identification.Methods The data of patients with brucellosis complicated with joint pain admitted to a hospital in Shenyang from January 1, 2015 to December 31,2016 were collected. Measured data were statistically described using the mean ± standard deviation and the median(interquartile range); the count data were described using the composition ratio and rate. Results The average agewas 49.16±12.47 years old, and the proportion of 41-60 years old was the highest(60.56%); the male to female sex ratio was 2.56:1;the ethnic group was Han population, accounting for 79.78%.Most of the occupations were farmers, accounting for 58.20%;most people were exposed to sheep(63.82%), and the main contact methods were feeding or grazing livestock(63.15%).The clinical stage was mainly in the acute phase(77.08%);the mainclinicalsymptomswerefever(72.58%),fatigue(68.76%),hyperhidrosis(42.92%),etc. Joint pain was mainly caused by spinal pain(68.99%).All the RBPT tests were positive, 97.75% of the patients had positive SAT test.The isolation rate of Brucella was 33.86%.Among the myocardial indexes, 117 cases(26.29%) had increased lactate dehydrogenase(LDH).Among the inflammatory markers, 67.64% patients had increased CRP and 43.16% patients had increased PCT.Among the indexes of liver function, the percentage of ALT was 24.94%,and the decrease of ALB was 50.56%.Conclusion There are more males than females in brucellosis with osteoarthritis, mainly middle-aged and older, mostly farmers. The history of animal contact was mainly sheep, followed by cattle, the mode of contact was mainly feeding or grazing. The clinical symptoms are mostly fever, fatigue, etc. joint pain is severely affected by the spine and is accompanied by a certain degree of liver damage.
引文
[1] 李伟,李欣容,赵明,等.2008年郑州市人间布鲁杆菌病疫情分析[J].中国地方病防治杂志,2010(2):141-142.
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[7] NavarroMartínez A,Solera J ,Corredoira J ,et al.Epididymoorchitis due to Brucella mellitensis:a retrospective study of 59 patients.[J].Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America,2001,33(12):2017.
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[10] 张鹏,张明香,杨军研,刘洪艳,宋继业,戴越.133例布鲁杆菌病脊柱炎的影像学研究[J].辽宁医学杂志,2018,32(04):42-46.
[11] 姚慧臣,窦月玲.布鲁氏菌感染致微血管病性溶血性贫血1例[J].中国小儿血液与肿瘤杂志,1998(3).
[12] 翟雪.急性布氏杆菌病治疗过程中血清白介素 17、内毒素、超敏 C 反应蛋白及降钙素原的变化[D].宁夏医科大学,2017.
[13] 王仲秋,王季秋.布鲁氏杆菌性脊柱炎的诊断和鉴别诊断[J].中国地方病防治杂志,2010,25(5):339-340.
[14] 赵旭春,刘颖翰,曹文智,等.急性布氏菌病患者血C 反应蛋白测定[J].中华实验和临床感染病杂志(电子版),2010,4(01):39-42.
[15] 赵旭春,刘颖翰,王玮,曹文智,常桂红,武永平,张剑平,田志新,宋雪冬.125例成人急性布鲁杆菌病患者的肝功能异常分析[J].肝脏,2009,14(04):284-286.
[16] 张立波.607例布鲁菌病患者的临床特点及实验室检查分析[D].吉林大学,2017.
[2] Mangalgi S S ,Sajjan A G ,Mohite S T ,et al.Brucellosis in Occupationally Exposed Groups[J].Journal of Clinical & Diagnostic Research Jcdr,2016,10(4):DC24.
[3] Dahouk S A,N ? ckler K,Hensel A,et al.Human brucellosis in a nonendemic country:a report from Germany,2002 and 2003[J].European Journal of Clinical Microbiology & Infectious Diseases,2005,24(7):450-456.
[4] 李悦,王宇枢,王锐,et al.97例布鲁杆菌病病例临床分析[J].中国地方病防治杂志,2015(2):147-147.
[5] Karahocagil,Mustafa Kas ?m,Irmak H ,Baran A I ,et al.Clinical manifestations and complications in 1028 cases of brucellosis:a retrospective evaluation and review of the literature.[J].International Journal of Infectious Diseases,2010,14(6):e469-e478.
[6] 解英波,贾恩厚,康耀霞,et al.166例布鲁菌病例流行病学及临床特征的分析研究[J].疾病监测与控制,2016(11):14-15.
[7] NavarroMartínez A,Solera J ,Corredoira J ,et al.Epididymoorchitis due to Brucella mellitensis:a retrospective study of 59 patients.[J].Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America,2001,33(12):2017.
[8] 杨新明,王耀一,石蔚,等.布鲁杆菌病性脊椎炎的影像学分型及临床意义.中国骨与关节外科[J].2014,7(2),122-127.
[9] 张治,杨新明,王耀一,等.建立布鲁杆菌病性脊椎炎的影像学分型及临床意义[J].河北医药,2014,36(16):2426-2430.
[10] 张鹏,张明香,杨军研,刘洪艳,宋继业,戴越.133例布鲁杆菌病脊柱炎的影像学研究[J].辽宁医学杂志,2018,32(04):42-46.
[11] 姚慧臣,窦月玲.布鲁氏菌感染致微血管病性溶血性贫血1例[J].中国小儿血液与肿瘤杂志,1998(3).
[12] 翟雪.急性布氏杆菌病治疗过程中血清白介素 17、内毒素、超敏 C 反应蛋白及降钙素原的变化[D].宁夏医科大学,2017.
[13] 王仲秋,王季秋.布鲁氏杆菌性脊柱炎的诊断和鉴别诊断[J].中国地方病防治杂志,2010,25(5):339-340.
[14] 赵旭春,刘颖翰,曹文智,等.急性布氏菌病患者血C 反应蛋白测定[J].中华实验和临床感染病杂志(电子版),2010,4(01):39-42.
[15] 赵旭春,刘颖翰,王玮,曹文智,常桂红,武永平,张剑平,田志新,宋雪冬.125例成人急性布鲁杆菌病患者的肝功能异常分析[J].肝脏,2009,14(04):284-286.
[16] 张立波.607例布鲁菌病患者的临床特点及实验室检查分析[D].吉林大学,2017.