28例布鲁氏菌病患者流行病学及临床特征分析

发布时间：2018-01-25 18:02

  本文关键词： 布鲁氏菌病 流行病学特征 临床特征　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景 布鲁氏菌病(brucellosis,简称布病),是由布鲁氏菌(Brucella)通过皮肤粘膜、消化道、呼吸道等多种传播途径侵入机体引起的人畜共患传染病。该病流行较为广泛,为全球性疾病。建国以来,我国曾出现两次流行高峰,经大规模防治后流行得到控制,发病率下降。但近年研究显示,我国布病发病率呈现上升趋势,波及范围逐渐扩大。而我省1958年以前无布病记载,由于1958年引进带疫种羊后,布病开始扎根我省。90年代初期我省人间布病调查研究显示我省布病疫情有上升趋势,随即于1999年相继在我省各州市布病疫情较重地区设立了布病重点监测县。目前关于我省布病疫情的研究主要集中在对监测县的调查,而关于监测县以外布病的研究文献较少。为初步了解我院近年来布病患者的收治情况,本课题将对2008年01月至2014年4月以来昆明医科大学第一附属医院收治的全部28例布病患者进行较为详细的回顾性分析。 目的 旨在初步了解我院近年来布病的收治情况,分析布病患者的流行病学及临床特征,为制定防控措施及早期诊断、治疗提供一定的科学依据。 方法 对2008年01月至2014年4月昆明医科大学第一附属医院收治的诊断符合诊断标准的布病患者进行回顾性分析。 结果 1.2008年01月至2014年4月昆明医科大学第一附属医院共收治布病病例28例,28例患者均有明确牛、羊接触史。 2.流行病学特征：时间分布：2008-2014年发病例数分别为：4例、2例、2例、3例、4例、7例、6例；每年1-12月发病例数分别为：5例、4例、2例、6例、2例、1例、1例、2例、2例、0例、3例、0例;人间分布：男性24例,女性4例；≤10岁0例、11-20岁1例、21-30岁0例、31-40岁2例、41-50岁11例、51-60岁8例、61-70岁6例；其中农民21例、屠夫2例、个体2例、工人1例、教师1例、学生1例；空间分布：各州(市)布病发病例数由高到低依次为：曲靖市12例、昆明市11例、红河州2例、玉溪市2例、昭通市1例。 3.临床特征：首发症状：发热16例(占57.1%)、腰痛5例(占17.9%)、关节痛3例(占10.7%)、腹痛3例(占10.7%)、皮疹1例(占3.6%)；主要症状、体征：发热28例(100%)、乏力28例(100%)、多汗26例(92.9%)、腰痛25例(89.3%)、脾肿大23例(82.1%)、淋巴结肿大20例(71.4%)、肝肿大10例(35.7%)、关节痛5例(17.6%)、皮疹3例(10.7%)、腹痛2例(7.1%)、胸闷1例(3.6%)；其中发热以高热为主,71.4%患者体温高峰在39.0℃以上。热型：波状热(32.1%)、稽留热(25%)、不规则热(42.9%)。 4.辅助检查：血常规：WBC：降低6例；GR%：升高4例、降低7例；LY%：升高7例、降低5例；M0%：升高9例、降低1例；RBC：降低4例；HGB：降低6例；PLT：升高6例、降低4例；肝功能：胆红素均正常；ALB：降低9例；GLOB：升高10例；ALT：升高15例；AST：升高者14例；GGT：升高者22例；ALP：升高者6例；血沉：升高27例；CRP均升高,PCT均在正常范围内；体液培养：除1例阴性,其余均为阳性；影像学检查：腹部B超：脾肿大23例、肝肿大10例、肝硬化1例；腰椎MRI示：椎体感染性占位病变并椎体破坏者8例、腰椎膨出及退行性变5例；四肢关节平片：四肢关节炎性改变3例；心脏彩超：感染性心内膜炎并心脏瓣膜赘生物2例。 5.治疗情况：确诊前：营养支持治疗3例,其余25例布病患者予头孢三代加酶抑制剂、喹诺酮类、氨基糖苷类等抗生素单独或双联治疗后有效20例,无效5例,有效率为80%；确诊后：四环素+利福平：治疗4例,有效3例、显效1例,有效率为100%；多西环素+利福平：治疗24例,有效19例、显效2例、复发3例,有效率为87.5%。 6.并发症：28例患者中,出现并发症者14例,其中腰椎病变8例,骨关节病变3例,胸椎病变2例,感染性心内膜炎2例,继发性血小板减少症2例,腹膜炎1例,贫血1例。结论 1.2008-2014年我院收治布病患者发病例数呈现上升趋势,每年以1-4月份高发。 2.我院收治的布病患者以男性为主,发病年龄主要集中在41-70岁,其中农民为主要感染人群。各州(市)布病发病率以曲靖市最高,其他依次为昆明市、红河州、玉溪市、昭通市,推测上述流行病学特征与接触传染源的几率大小有关。 3.发热、乏力、多汗、腰痛、关节痛是我院布病患者的主要症状,同时可伴有淋巴结肿大、肝脾肿大、皮疹等症状、体征,而继发并发症患者同时还会出现相应并发症的症状、体征。 4.我院收治的布病患者白细胞总数变化不明显,部分患者可出现淋巴细胞或单核细胞比例升高,少数患者可并发贫血和(或)血小板减少；血生化检查以转氨酶升高为主要表现；ESR、CRP呈不同程度的升高,与大多数G-败血症不同,布病患者PCT检查均在正常范围内。 5.我院收治的布病患者经头孢三代加酶抑制剂、喹诺酮类、氨基糖苷类等抗生素治疗后普遍有效；确诊后,利用WHO标准治疗方案治疗都比较有效,未见耐药。 6.我院布病患者亦存在多系统并发症,其中腰椎病变最为常见,罕见的是其中1例患者并发了布鲁氏菌性自发性腹膜炎。
[Abstract]:background
Brucellosis (brucellosis, referred to as brucellosis), by Brucella (Brucella) through skin and mucosa, gastrointestinal, respiratory and other ways to invade the body caused by the spread of zoonotic infectious diseases. The disease is widespread, as a global disease. Since the founding of new China, our country has had two peaks, the large scale control after the epidemic under control, the incidence rate decreased. But recent studies have shown that the incidence of brucellosis in China showed a rising trend, and gradually expanding the scope of the province before 1958. No brucellosis records, since 1958 the introduction of sheep with the epidemic of brucellosis in our province, began to take root in the early.90 province was investigated in human brucellosis brucellosis epidemic has increased my show then in 1999, has been in the trend of brucellosis epidemic in our province is the city areas set up monitoring county. Current research focus of brucellosis in our province on the brucellosis epidemic mainly focus on monitoring County The investigation and research literature is less about brucellosis monitoring outside the county. A preliminary understanding of our hospital cases of patients with brucellosis in recent years, the topic will be on 01 2008 to April 2014 since the First Affiliated Hospital of Kunming Medical University. All 28 cases of brucellosis patients were retrospectively analyzed in details.
objective
In order to understand our hospital situation of brucellosis in recent years, epidemiological and clinical characteristics of patients with brucellosis, for the prevention and early diagnosis, provide a scientific basis for treatment.
Method
Meet the diagnostic criteria of 2008 01 months to the First Affiliated Hospital of Kunming Medical University in April 2014 for the diagnosis of brucellosis patients were retrospectively analyzed.
Result
1.2008 years 01 months to the First Affiliated Hospital of Kunming Medical University in April 2014 were treated 28 cases of brucellosis cases, 28 cases had clear contact history of cattle, sheep.
2.: the epidemiological characteristics of time distribution of 2008-2014 cases were 4 cases, 2 cases, 2 cases, 3 cases, 4 cases, 7 cases, 6 cases; 1-12 months each year the number of cases were 5 cases, 4 cases, 2 cases, 6 cases, 2 cases, 1 cases, 1 cases, 2 cases, 2 cases, 0 cases, 3 cases, 0 cases of human; distribution: male 24 cases, female 4 cases; less than 10 years old in 0 cases, 11-20 1 cases, 21-30 0 cases, 31-40 years old in 2 cases, 11 cases 41-50 years old and 51-60 years old in 8 cases, 6 cases of 61-70 years old the farmers; in 21 cases, 2 cases of butcher, 2 individuals, 1 cases of workers, 1 teachers, 1 cases of students; the spatial distribution of states (city) brucellosis cases from high to low: 12 cases in Qujing City, Kunming City, 11 cases, 2 cases of 2 cases of Honghe Prefecture, Yuxi city. 1 cases in Zhaotong city.
3. clinical features: first symptom: 16 cases of fever (57.1%), 5 cases of low back pain (17.9%), 3 cases of joint pain (10.7%), 3 cases of abdominal pain (10.7%), 1 cases of skin rash (3.6%); the main symptoms and signs of fever in 28 cases (100%), fatigue (28 cases 100%), 26 cases (92.9%), hyperhidrosis, 25 cases of low back pain (89.3%), splenomegaly in 23 cases (82.1%), lymphadenopathy in 20 cases (71.4%), 10 cases (35.7%), 5 cases with hepatomegaly joint pain (17.6%), 3 cases of skin rash (10.7%), 2 cases (7.1%), 1 cases of abdominal pain the chest (3.6%); the 71.4% patients with high fever fever, temperature peak at 39 DEG. Heat type: undulant fever (32.1%), (25%), irregular enecia heat (42.9%).
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