布鲁氏杆菌与结核分枝杆菌共同感染38例临床分析  

Clinical analysis of 38 cases of Brucella and Mycobacterium tuberculosis co-infection

作　　者：钱彩霞 盛银花[1] 杨小平 高峰[1] 冯鲜妮[1] 宋庆润 孙强 邓海蓉 张有龙 程涛 QIAN Caixia;SHENG Yinhua;YANG Xiaoping;GAO Feng;FENG Xianni;SONG Qingrun;SUN Qiang;DENG Hairong;ZHANG Youlong;CHENG Tao(Department of Infection,Jiuquan People’s Hospital,Jiuquan Gansu 735000;Department of Orthopedics,Jiuquan People’s Hospital,Jiuquan Gansu 735000;Gansu Jinyu Medical Laboratory Co.,LTD.,Lanzhou Gansu 730000)

机构地区：[1]酒泉市人民医院感染科,甘肃酒泉735000 [2]酒泉市人民医院骨科,甘肃酒泉735000 [3]甘肃金域医学检验所有限公司,甘肃兰州730000

出　　处：《当代医药论丛》2023年第3期85-88,共4页

摘　　要：目的:回顾性分析患者的临床资料,探讨人布鲁氏杆菌和结核分枝杆菌共同感染的诊断和治疗。方法:根据酒泉市人民医院送往甘肃金域检验化验的布鲁氏杆菌抗体三项中至少两项阳性,且γ-干扰素释放试验阳性者的资料,追溯医院HIS系统和病案扫描系统中的病历资料,分析汇总布鲁氏杆菌和结核分枝杆菌共同感染者的临床诊疗情况。结果:研究周期内(2019年1月至2021年12月间)送检布鲁氏杆菌抗体三项723例中,按照布鲁氏杆菌抗体IgG、虎红平板试验、试管凝集试验滴度>1:100者且升高的顺序阳性率递减,但高达72.5%的患者试管凝集试验≤1:25;行γ-干扰素释放试验2534例的阳性检出率为39.3%,其中符合布鲁氏杆菌抗体三项中至少两项阳性且γ-干扰素释放试验阳性者共38例。38例患者中,同时行抗结核和抗布鲁氏菌病治疗者8例,其中抗结核治疗采用肺结核2-3HRZE/4-6HR(E)方案、骨结核2SHRZE/HRZE/15HRE方案,单纯性布鲁氏菌病治疗以多西环素、利福平为基础。结论:布鲁氏杆菌与结核分枝杆菌共同感染者并不少见,抗布鲁氏菌病治疗前应常规行γ-干扰素释放试验等,以明确有无结核分枝杆菌感染,一旦确定两者共同感染,则应同时行抗结核和抗布鲁氏菌病治疗,患者对HRZE抗结核方案联合多西环素治疗的耐受性良好。Objective:To retrospectively analyze the clinical data of patients,and to explore the diagnosis and treatment of human brucella and Mycobacterium tuberculosis co-infection.Methods:According to the data of at least two of the three brucella antibodies positive in Gansu Golden Field test sent by Jiuquan People’s Hospital and positive in gamma-interferon release test,the medical records in HIS system and medical record scanning system of the hospital were traced,and the clinical diagnosis and treatment of brucella and mycobacterium tuberculosis co-infected patients were analyzed and summarized.Results:In the study period(January 2019 to December 2021),723 cases of brucella antibody were tested.According to the titer of Brucella antibody IgG,tiger red plate test and tube agglutination test>1:100,the positive rate decreased,but as high as 72.5%of the patients with tube agglutination test≤1:25.The positive detection rate of 2534 cases by gamma interferon release test was 39.3%,among which 38 cases were positive for at least two of three Brucella antibodies and gamma interferon release test.Among the 38 patients,8 patients received anti-tuberculosis and antibrucellosis treatment at the same time,among which the anti-tuberculosis treatment used tuberculosis 2-3HRZE/4-6HR(E)regimen and bone tuberculosis 2SHRZE/HRZE/15HRE regimen.The treatment of simple brucellosis was based on doxycycline and rifampicin.Conclusions:Co-infection of brucellosis and Mycobacterium tuberculosis is not uncommon.Before anti-brucellosis treatment,routine gamma-interferon release test should be performed to determine whether there is mycobacterium tuberculosis infection.Once the coinfection is confirmed,anti-tuberculosis and anti-brucellosis treatment should be performed simultaneously.

关 键 词：布鲁氏杆菌 结核分枝杆菌 感染 诊断 治疗 

分 类 号：R516.7[医药卫生—内科学]