布鲁菌病相关主动脉感染性疾病诊治现状  

Current status of diagnosis and treatment of brucellosis related aortic infectious diseases

作　　者：王雷[1] 王嘉谊 辛世杰[1] WANG Lei;WANG Jia-yi;XIN Shi-jie(Department of Vascular Surgery,the First Hospital of China Medical University,Regenerative Medicine Research Center,China Medical University,Key Laboratory of Etiology and Prevention of Arterial Diseases of Liaoning Province,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院血管外科中国医科大学再生医学研究中心辽宁省动脉瘤疾病病因及防治研究重点实验室,辽宁沈阳110001

出　　处：《中国实用外科杂志》2024年第12期1362-1366,共5页Chinese Journal of Practical Surgery

基　　金：辽宁省科学计划项目(No.2023JH2/101700088,No.2022JH1/10400002)。

摘　　要：布鲁菌病是一种由家畜传染给人类的传染病,常累及骨关节、脊柱等器官,心血管系统的并发症虽然罕见,但布鲁菌病累及主动脉时,病情发展迅速且具有较高的死亡率。布鲁菌病相关的主动脉感染性疾病,主要表现为主动脉的感染性血管炎,可能进展为感染性主动脉瘤。布鲁菌病相关主动脉感染性疾病的致病因素是布鲁菌,该病菌通过皮肤或黏膜进入人体,最终通过淋巴系统扩散至全身,导致主动脉感染的发生。动脉壁的炎症改变及基质金属蛋白酶的上调是其主要的发病机制。布鲁菌病相关主动脉感染性疾病的诊断依赖于血清学检查、影像学检查及临床表现的综合评估。影像学检查如CT、MRI及超声能帮助确诊布鲁菌病相关的主动脉瘤,CT和18氟-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET/CT)在显示病变进展方面具有较高的敏感度。临床表现通常包括腹痛、腰痛等,但这些症状缺乏特异性,因此需要结合血清学和影像学检查进一步确诊。布鲁菌病相关感染性主动脉疾病的治疗主要包括抗生素治疗和手术治疗。抗生素治疗应早期、广谱使用,结合利福平和多西环素,治疗通常持续6个月。腔内修复术已成为治疗主动脉感染性疾病的首选方案,相较传统开放手术,腔内修复创伤较小、恢复更快,且短期效果良好。开放手术仍在一些复杂病例中占主导地位,尤其是当腔内治疗无法有效解决问题时。术后抗感染治疗和长期随访对于改善病人的预后至关重要。布鲁菌病相关主动脉感染性疾病的治疗方案应根据具体病情进行选择,腔内治疗已显示出良好的临床效果。Brucellosis is a zoonotic infectious disease transmitted from livestock to humans,commonly affecting the bones,joints,and spine.While cardiovascular complications are rare,brucellosis involving the aorta progresses rapidly and is associated with high mortality.Brucellosis-related aortic infectious diseases primarily manifest as infectious aortitis,which may progress to an infectious aortic aneurysm.The causative agent is Brucella,which enters the human body through the skin or mucosa and disseminates systemically via the lymphatic system,leading to aortic infection.The primary pathogenesis involves inflammatory changes in the arterial wall and upregulation of matrix metalloproteinases.The diagnosis of brucellosis-related aortic infectious diseases relies on a combination of serological tests,imaging studies,and clinical presentations.Imaging modalities such as CT,MRI,and ultrasound aid in confirming brucellosis-related aortic aneurysms.CT and18F-FDG PET/CT exhibit high sensitivity in detecting disease progression.Clinical presentations often include abdominal pain and back pain,which are nonspecific,necessitating further confirmation through serological and imaging assessments.The treatment of brucellosis-related aortic infectious diseases primarily involves antibiotic therapy and surgical intervention.Early and broad-spectrum antibiotic therapy combining rifampin and doxycycline is recommended,with a typical treatment duration of six months.Endovascular repair has become the preferred treatment modality for aortic infectious diseases,offering advantages over traditional open surgery,including reduced invasiveness,faster recovery,and favorable short-term outcomes.Open surgery remains dominant in managing complex cases,particularly when endovascular therapy is insufficient to address the condition effectively.Postoperative anti-infective therapy and long-term follow-up are crucial for improving patient prognosis.Treatment strategies for brucellosis-related aortic infectious diseases should be tailored to individua

关 键 词：布鲁菌病 主动脉感染性疾病 感染性主动脉瘤 血管内治疗 开放手术 CT MRI 18氟-脱氧葡萄糖正电子发射计算机断层扫描(^(18)F-FDG PET/CT) 

分 类 号：R6[医药卫生—外科学]