2016—2022年非牧区布鲁氏菌病的临床特征及其实验室诊断  

Clinical characteristics laboratory diagnosis of brucellosis in non-pastoral areas from 2016 to 2022

作　　者：杨慧 韩雪 张婷[2] 郑国军[1] YANG Hui;HAN Xue;ZHANG Ting;ZHENG Guo-jun(The Third People's Hospital of Changzhou,Changzhou,Jiangsu 213000,China)

机构地区：[1]常州市第三人民医院检验科,江苏常州213000 [2]常州市第三人民医院感染科,江苏常州213000

出　　处：《中华医院感染学杂志》2024年第6期816-820,共5页Chinese Journal of Nosocomiology

基　　金：常州市科技计划资助项目(CJ20230075);常州市第三人民医院科学基金(SY202206)常州市第三人民医院重点人才工程基金资助项目(YCRC23QM04)。

摘　　要：目的 探讨非牧区布鲁氏菌病的临床特征、诊断方法和布鲁氏菌培养特点。方法 选择常州市第三人民医院2016—2022年收治的36例布鲁氏菌病患者为研究对象,分别分析细菌培养特性、临床特征及防治,采用受试者工作特征(ROC)曲线分析布鲁氏菌病的感染生物标志物。结果 36例布鲁氏菌病患者中,以男性和中老年患者为主。患者有明确的牛羊接触史流行病学特征。36例患者,发热伴夜间大汗淋漓为主要临床症状,其次为关节酸痛,主要以膝关节酸痛为主。患者睾丸疼痛罕见。腰椎骨质破坏是最常见的并发症,其次并发布鲁氏菌脑炎。实验室结果显示,主要有C-反应蛋白(CRP)升高和淀粉样蛋白A(SAA)升高。白细胞计数、降钙素原(PCT)均正常。28例患者血培养均在需氧瓶中报阳生长,均鉴定为羊布鲁氏菌。18例患者布鲁氏菌抗体阳性,1例仅有二代测序为羊布鲁氏菌。治疗以多西环素和利福平联合用药最常见。35例患者治愈、好转,1例患者放弃治疗。ROC分析表明当CRP的临界值为4.81 mg/L时,敏感性和特异性分别为93.30%和89.50%。结论 布鲁氏菌病临床表现多样,实验室检测无特异性。对于不明原因发热患者结合流行病学史加强布鲁氏菌实验室检测。OBJECTIVE To explore the clinical characteristics and diagnostic methods of brucellosis in non-pastoral areas and observe the characteristics of culture of Brucella.METHODS A total of 36 patients with brucellosis who were treated in the Third People's Hospital of Changzhou from 2016 to 2022 were recruited as the research sub-jects.The characteristics of bacterial culture,clinical characteristics,prevention and treatment were respectively analyzed.The biomarkers for the brucellosis were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The male and middle-aged patients were dominant among the 36 patients with brucellosis.The patients had a clear epidemiological contact history of contact with cattle and sheep.Among the 36 patients,fever complicated with night sweating was the major clinical symptom,followed by joint sore,with the knee-joint sore dominant.Testicular pain was rare.Lumbar vertebra bone destruction was the most common complication,fol-lowed by Brucella encephalitis.The result of clinical laboratory test showed that the levels of C-reactive protein(CRP)and serum amyloid A(SAA)were elevated.Both white blood cell counts and procalcitonin(PCT)were normal.The blood culture of 28 patients was reported for positive growth in aerobic bottle,and all were identified as Brucella ovis.18 patients were tested positive for Brucella antibody,1 of whom was identified as Brucella ovis by the next generation sequencing.Doxycycline combined with rifampicin was the most common drug therapy.To-tally 35 patients were cured and improved,and 1 patient abandoned the drug therapy.ROC curve analysis indica-ted that when the critical value of CRP was 4.81 mg/L,the sensitivity and specificity were 93.30%and 89.50%,respectively.CONCLUSION The brucellosis shows diversified clinical manifestations,there is no specificity in the clinical laboratory test.It is necessary to strengthen the clinical laboratory test of Brucella and combine with the epidemiological history for the patients with unknown origin.

关 键 词：布鲁氏菌病 非牧区 临床表现 血流感染 感染生物标志物 实验室诊断 

分 类 号：R516.7[医药卫生—内科学]