27例神经型布鲁菌病患者临床分析  

Clinical analysis of 27 neurobrucellosis patients

作　　者：苏艳 赵世刚[2] 何涛 廖雅丽[2] 任彩云[2] Su Yan;Zhao Shigang;He Tao;Liao Yali;Ren Caiyun(Department of Emergency Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010020 ,China;Department of Neurology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010 ,China)

机构地区：[1]内蒙古自治区人民医院急诊内科,呼和浩特010020 [2]内蒙古医科大学附属医院神经内科,呼和浩特010010

出　　处：《中华传染病杂志》2019年第2期88-92,共5页Chinese Journal of Infectious Diseases

摘　　要：目的分析神经型布鲁菌病(neurobrucellosis,NB)的临床特点及预后。方法收集2016年1月至2016年12月就诊于内蒙古自治区CDC及内蒙古医科大学附属医院的27例NB患者,并完善临床资料并总结其临床特征。结果27例患者中24例(88.89%)有牛羊接触史。发热24例(88.89%),大汗18例(66.67%),头痛16例(59.26%);神经系统症状伴有脑膜炎和脑膜脑炎14例(51.85%),听神经损害4例(14.81%),脊髓损害3例(11.11%)。白细胞计数升高2例(7.41%),血清C反应蛋白升高3例(11.11%),降钙素原升高2例(7.41%),ESR升高15例(55.56%)。27例行腰椎穿刺脑脊液均有异常,蛋白升高17例(62.96%),单核细胞比例升高14例(51.85%),压力升高14例(51.85%),氯化物降低14例(51.85%),糖降低6例(22.22%),脑脊液培养阳性1例(3.70%)。白质损害8例(29.63%),脑膜强化5例(18.52%),脊髓病变3例(11.11%),脑水肿2例(7.41%),脑脓肿2例(7.41%)。四肢感觉神经受损10例(37.04%),听神经损害4例(14.81%),运动神经损害2例(7.41%)。所有患者经抗布鲁杆菌治疗6周,疗程结束后均随访1年(每3个月1次)。痊愈19例(70.37%),遗留后遗症7例(25.93%),死亡1例(3.70%)。结论NB临床特点多样,脑脊液检查,影像学检查结合神经电生理检测对NB的诊断有重要价值。Objective To analyze the clinical characteristics and prognosis of neurobrucellosis (NB). Methods Twenty-seven cases of NB patients who received treatment in Disease Prevention and Control Center of Inner Mongolia Autonomous Region and Inner Mongolia Medical University Hospital from January to December in 2016 were collected. The clinical data of these patients were recorded and systematically analyzed. Results Twenty-four cases (88.89%) had a history of exposure to cattle and sheep. Twenty-four cases (88.89%) were admitted with fever, 18(66.67%) cases with sweat, 16 cases(59.26%) with headache, 14 cases (51.85%) with neurological symptoms of meningitis and meningoencephalitis, 4 cases (14.81%) with auditory nerve damage and 3 cases (11.11%) with spinal cord damage. Elevated white blood cells were found in 2 cases (7.41%), elevated serum C-reactive protein in 3 cases (11.11%), elevated procalcitonin in 2 cases (7.41%) and elevated erythrocyte sedimentation rate in 15 cases (55.56%). All the 27 patients underwent lumbar puncture and the cerebrospinal fluid test results were abnormal, of which increased protein levels in 17 cases (62.96%), increased mononuclear cell ratio 14 cases (51.85%), increased pressure in 14 cases (51.85%), and reduced chloride levels in 14 cases (51.85%), and reduced glucose levels in 6 cases (22.22%). Positive cerebrospinal fluid culture (CSF) was found in 1 case (3.70%). There were 8 cases (29.63%) with white matter damage, 5 cases (18.52%) with meningeal enhancement, 3 cases (11.11%) with spinal cord lesions, 2 cases (7.41%) with cerebral edema and 2 cases (7.41%) with brain abscess. There were 10 cases (37.04%) with sensory nerve damage in the extremities, 4 cases (14.81%) with auditory nerve damage and 2 cases (7.41%) with motor nerve damage. All patients were treated with regular anti-Berg′s disease for 6 weeks and were followed up for 1 year (every 3 months) after the treatment. Nineteen patients (70.37%) were cured, 7 patients (25.93%) developed sequelae and 1(3.70%) patient died.

关 键 词：神经型布鲁杆菌病 临床特点 脑脊液特点 神经影像 神经电生理 

分 类 号：R516.7[医药卫生—内科学]