25例布鲁菌病患者合并三系减少的回顾性分析

发布时间：2018-04-11 18:30

本文选题：出血 + 布鲁菌病　；参考：《中国全科医学》2017年S2期

【摘要】：目的分析吉林大学白求恩第一医院感染科布鲁菌病合并三系减少的特点。方法对吉林大学白求恩第一医院感染科2000年1月—2016年10月住院的25例布鲁菌病合并三系减少患者的症状、体征、实验室检查进行回顾性分析。两组间指标比较采用二样本Mann-Whitney U检验。结果患者的年龄在12~54岁之间,并根据2012年布鲁菌病诊疗指南明确诊断为布鲁菌病,发热为最主要的临床症状,患者20例(80%),存在出血症状的患者3例(12%),其中鼻出血患者1例,牙龈出血、双下肢皮肤出血点1例,便血1例。并对25例患者在住院期间血象改变最明显时的血常规进行统计,同时对患者血象改变情况进行曲线分析,25例患者中21例患者的(每3天复查血常规)血小板较先降低,后白细胞及红细胞逐渐降低,同时对25例患者的凝血常规进行观察,8例患者存在凝血异常,其中血浆凝血酶时间(TT)延长的患者4例,血浆凝血酶原时间(PT)延长的患者5例,活化部分凝血活酶时间(APTT)存在异常的患者2例,患者均根据世界卫生组织(WHO)的推荐方案进行治疗,经过抗布病治疗,三者降至最低点后逐渐恢复,血小板恢复较快,白细胞及红细胞维持低水平的时间较长,经过对25例患者的观察,经过抗布病治疗后,10~30天内血象均恢复正常。且在血象异常组与血象正常组的比较中,血象异常组与血象正常组的年龄、病程、最高体温、热退时间、C反应蛋白、红细胞沉降率方面无明显差异,两者仅在肝功改变方面存在差异,存在三系减少的患者肝功损伤较重(P0.05)。结论临床上常存在布鲁菌病同时合并血象三系减少,三系减少的原因尚未完全明确,症状上除存在发热、乏力、多汗、关节痛等常见症状外,也存在出血症状。本文中记录了3例分别出现了鼻出血、皮肤瘀斑、便血症状的患者,通过对存在三系减少的患者进行抗布病治疗及其他对症支持治疗,短期内患者血象可恢复正常。
[Abstract]:Objective to analyze the characteristics of the decrease of infection in the first hospital of Bai Qiuen in Jilin University.Methods the symptoms, signs and laboratory examinations of 25 patients with brucellosis combined with three departments who were hospitalized from January 2000 to October 2016 in the first Hospital infection Department of Bai Qiuen of Jilin University were retrospectively analyzed.Two samples of Mann-Whitney U test were used to compare the indexes between the two groups.Results the age of the patients ranged from 12 to 54 years. According to the diagnosis and treatment guidelines for brucellosis in 2012, they were clearly diagnosed as brucellosis, with fever as the main clinical symptom, 20 patients with Bleomycetes, and 3 patients with bleeding symptoms, including 1 patient with epistaxis.Gingival bleeding, lower extremity skin bleeding in 1 case, blood in 1 case.At the same time, the blood routine of 25 patients with the most obvious changes in blood image during hospitalization was analyzed by curve analysis. The platelet count of 21 out of 25 patients (blood routine every 3 days) was lower than that of the control group.At the same time, 8 patients with abnormal coagulation were observed, including 4 patients with prolonged plasma thrombin time (TTT), 5 patients with prolonged plasma prothrombin time (PTT), 5 patients with prolonged plasma prothrombin time (PTT), 4 patients with thrombin time prolongation (TTT) and 5 patients with prolonged plasma prothrombin time (PTT).Two patients with abnormal activated partial thromboplastin time (APTT) were treated according to the recommended regimen of World Health Organization (WHO). After anti-brucellosis treatment, the three patients gradually recovered after the lowest point, and the platelet recovered more quickly.White blood cells and red blood cells remained low for a long time. After observation of 25 patients, the blood signs returned to normal within 1030 days after anti-brucellosis treatment.There was no significant difference in age, course of disease, maximum body temperature, heat withdrawal time and erythrocyte sedimentation rate between abnormal group and normal group.There were only differences in liver function changes between the two groups, and the liver function injury in the patients with the decrease of the three systems was more serious than that in the patients with P0.05.Conclusion there are often brucellosis accompanied with the decrease of three blood lines in clinic, and the causes of the decrease of the three lines are not completely clear. Besides the common symptoms of fever, fatigue, sweating and arthralgia, the symptoms are also haemorrhage.Three patients with epistaxis, skin ecchymosis and hematochezia were recorded in this paper.
【作者单位】：吉林大学白求恩第一医院感染科;
【基金】：吉林省重点科技攻关项目(3D515R343428)
【分类号】：R516.7

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