115例布鲁菌病临床特点分析
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摘要
目的探索布鲁菌病(布病)患者临床特征及治疗转归情况,为临床诊治提供参考。方法收集并分析115例成人布病患者的人口学和流行病学资料、临床表现、血液学指标及治疗与转归情况。结果布病患者常常伴有发热、乏力、多汗、关节疼痛、肝脾肿大等临床症状,其HGB、红细胞压积(hematocrit, HCT)、嗜酸性粒细胞(eosinophil,EO)、红细胞分布宽度(red blood cell distribution width, RDW)和CRP异常率较高。而WBC、PLT、中性粒细胞计数、淋巴细胞计数、单核细胞计数、平均细胞体积、血小板分布宽度、ESR和降钙素原的异常率较低。治疗上大部分患者[53.04%(61/115)]接受利福平联合多西环素治疗,部分患者尤其是合并骨质侵犯患者常使用三联抗菌素治疗。其中47例并发骨关节痛患者,经规范足疗程治疗后皆好转或痊愈。结论布病患者常伴有发热、乏力、多汗、关节疼痛、肝脾肿大等临床症状,其HGB、HCT、EO、RDW和CRP异常率较高,可作为布病的辅助诊断指标。布病临床表现多样,明确诊断后应尽早给予规范的抗菌治疗,抑制疾病进展,减少并发症发生。
Objective To investigate clinical characteristics and treatment outcome of brucellosis patients and provide a basis for clinical diagnosis and treatment. Methods Demographic and epidemiologic information, clinical manifestation, hematological indicators and treatment and outcomes of 115 diagnosed adult patients with brucellosis were collected and analyzed. Results Clinical manifestations of brucellosis patients included fever, fatigue, sweating, joint pain and hepatosplenomegaly. The abnormal rates of HGB, hematocrit(HCT),eosinophil(EO), red blood cell distribution width(RDW) and CRP were higher in patients with brucellosis. While abnormal rates of WBC,PLT, neutrophil count, lymphocyte count, monocyte count, mean cell volume, platelet distribution width, erythrocyte sedimentation rate and procalcitonin abnormalities were lower in those patients. In terms of treatment, most patients [53.04%(61/115)] received rifampicin plus doxycycline, and some patients, especially those with osteoporosis, were often given triple antibiotics. After full-course standard treatment,47 patients complicated with osteoporosis were improved or healed. Conclusions Brucellosis patients often have fever, fatigue, sweating,joint pain, hepatosplenomegaly and other clinical symptoms, as well as the higher rate of HGB, HCT, EO, RDW and CRP abnormalities,which can be used as an auxiliary diagnostic index for brucellosis. Brucellosis is characterized of diverse clinical manifestations, so standardized antibacterial therapy is given as soon as possible after clear diagnosis to prevent the progression of the disease and reduce the occurrence of complications.
Objective To investigate clinical characteristics and treatment outcome of brucellosis patients and provide a basis for clinical diagnosis and treatment. Methods Demographic and epidemiologic information, clinical manifestation, hematological indicators and treatment and outcomes of 115 diagnosed adult patients with brucellosis were collected and analyzed. Results Clinical manifestations of brucellosis patients included fever, fatigue, sweating, joint pain and hepatosplenomegaly. The abnormal rates of HGB, hematocrit(HCT),eosinophil(EO), red blood cell distribution width(RDW) and CRP were higher in patients with brucellosis. While abnormal rates of WBC,PLT, neutrophil count, lymphocyte count, monocyte count, mean cell volume, platelet distribution width, erythrocyte sedimentation rate and procalcitonin abnormalities were lower in those patients. In terms of treatment, most patients [53.04%(61/115)] received rifampicin plus doxycycline, and some patients, especially those with osteoporosis, were often given triple antibiotics. After full-course standard treatment,47 patients complicated with osteoporosis were improved or healed. Conclusions Brucellosis patients often have fever, fatigue, sweating,joint pain, hepatosplenomegaly and other clinical symptoms, as well as the higher rate of HGB, HCT, EO, RDW and CRP abnormalities,which can be used as an auxiliary diagnostic index for brucellosis. Brucellosis is characterized of diverse clinical manifestations, so standardized antibacterial therapy is given as soon as possible after clear diagnosis to prevent the progression of the disease and reduce the occurrence of complications.
引文
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[13] Mohamed Abdirahman Abdinur. Study of the correlation between red blood cells, platelets parameters in the patients with coronary heart disease and heart failure[D]. Yangzhou:Yangzhou University, 2017.
[14] Ege MR, Acìkgoz S, Zorlu A, et al. Mean platelet volume:an important predictor of coronary collateral development[J]. Platelets, 2013, 24(3):200-204.
[15] Hu CP, Du Y, Zhu Y, et al. Platelet distribution width on admission predicts in-stent restenosis in patients with coronary artery disease and type 2 diabetes mellitus treated with percutaneous coronary intervention[J]. Chin Med J(Engl), 2018, 131(7):757-763.
[16]熊劲芝,张林,袁红霞,等. 42例布鲁氏菌病患者的临床分析[J].医学理论与实践,2017,3(30):325-326.
[17] Mousa N, Besheer T, Abdel-Razik A, et al. Can combined blood neutrophil to lymphocyte ratio and c-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?[J]. Br J Biomed Sci, 2018, 75(2):71-75.
[18]李桂梅,唐中权. 42例布鲁菌病临床误诊个例的综合分析[J/CD].中华实验和临床感染病杂志(电子版),2016,10(4):463-466.
[19]王晓燕,曾兆清,徐清楠,等.山东省96例布鲁菌病患者的临床特点及诊疗分析[J/CD].中华实验和临床感染病杂志(电子版),2014,8(4):548-551.
[2] Hasanjani Roushan MR, Ebrahimpour S. Human brucellosis:an overview[J]. Caspian J Intern Med, 2015, 6(1):46-47.
[3]闫飞,郑文艳,张专才,等.布鲁氏菌种/型鉴别的研究现状[J].传染病信息,2014,27(1):55-59.
[4] Ducrotoy MJ, Ammary K, Ait Lbacha H, et al. Narrative overview of animal and human brucellosis in morocco:Intensification of livestock production as a driver for emergence?[J]. Infect Dis Poverty, 2015, 4:57.
[5] Zwerdling A, Delpino MV, Pasquevich KA, et al. Brucella abortus activates human neutrophils[J]. Microbes Infect, 2009, 11(6-7):689-697.
[6] Musallam II, Abo-Shehada MN, Hegazy YM, et al. Systematic review of brucellosis in the middle east:disease frequency in ruminants and humans and risk factors for human infection[J]. Epidemiol Infect, 2016, 144(4):671-685.
[7] Heidari B, Heidari P. Rheumatologic manifestations of brucellosis[J]. Rheumatol Int, 2011, 31(6):721-724.
[8] Bourantas LK, Pappas G, Kapsali E, et al. Brucellosis-induced autoimmune hemolytic anemia treated with rituximab[J]. Ann Pharmacother, 2010, 44(10):1677-1680.
[9] El-Koumi MA, Afify M, Al-Zahrani SH. A prospective study of brucellosis in children:relative frequency of pancytopenia[J]. Iran J Pediatr, 2014, 24(2):155-160.
[10] F?rhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure:prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state[J]. Am Heart J, 2009, 158(4):659-666.
[11] Jiang X, Gao M, Chen Y, et al. Epo-dependent induction of erythroferrone drives hepcidin suppression and systematic iron absorption under phenylhydrazine-induced hemolytic anemia[J]. Blood Cells Mol Dis, 2016, 58:45-51.
[12] Sevinc F, Sevinc M, Ekici OD, et al. Babesia ovis infections:detailed clinical and laboratory observations in the pre-and post-treatment periods of 97 field cases[J]. Vet Parasitol, 2013, 191(1-2):35-43.
[13] Mohamed Abdirahman Abdinur. Study of the correlation between red blood cells, platelets parameters in the patients with coronary heart disease and heart failure[D]. Yangzhou:Yangzhou University, 2017.
[14] Ege MR, Acìkgoz S, Zorlu A, et al. Mean platelet volume:an important predictor of coronary collateral development[J]. Platelets, 2013, 24(3):200-204.
[15] Hu CP, Du Y, Zhu Y, et al. Platelet distribution width on admission predicts in-stent restenosis in patients with coronary artery disease and type 2 diabetes mellitus treated with percutaneous coronary intervention[J]. Chin Med J(Engl), 2018, 131(7):757-763.
[16]熊劲芝,张林,袁红霞,等. 42例布鲁氏菌病患者的临床分析[J].医学理论与实践,2017,3(30):325-326.
[17] Mousa N, Besheer T, Abdel-Razik A, et al. Can combined blood neutrophil to lymphocyte ratio and c-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?[J]. Br J Biomed Sci, 2018, 75(2):71-75.
[18]李桂梅,唐中权. 42例布鲁菌病临床误诊个例的综合分析[J/CD].中华实验和临床感染病杂志(电子版),2016,10(4):463-466.
[19]王晓燕,曾兆清,徐清楠,等.山东省96例布鲁菌病患者的临床特点及诊疗分析[J/CD].中华实验和临床感染病杂志(电子版),2014,8(4):548-551.