儿童布鲁菌病临床特点分析及治疗

发布时间：2018-05-25 07:01

本文选题：布鲁菌病 + 儿童布鲁菌病　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:对儿童与成人布鲁菌病人口学特点、实验室检查、临床特点等进行差异性分析,提高临床医师对儿童布鲁菌病临床特点的认识,减少误诊、漏诊的情况发生,并探讨儿童布鲁菌病抗生素的选择。材料与方法:1.研究对象2010年12月-2016年12月吉大一院感染科住院的362例布鲁菌病患者,根据年龄分为成人组和儿童组,儿童组(0-14岁)36例患者,成年人组(14岁)326例。2.总结两组患者的人口学特点、临床特点及血液生化检查。比较分析两组间患者的人口学、临床特点及血液生化检查的差异。总结儿童布鲁菌病治疗方案。3.统计学方法:应用IBM SPSS statistics 23.0软件对统计结果进行分析,P0.05定义为具有统计学意义。结果:1.人口学特点:儿童布鲁菌病发病率8.84%。儿童组患儿中位年龄8.0(5.25,11.75)岁,成人组患者中位年龄43.5(34.0,53.0)岁。儿童组患者男童24例,女童12例,男女比例:2:1。成人组男性258例,女性68例,男女比例3.79:1。儿童组与成年人组牛、羊接触史、性别比例无显著差异;儿童组中有9例患儿家庭成员确诊布鲁菌病,成人组患者38例家庭成员患布鲁菌病,两组家庭成员患病率比较差异具有统计学意义。2.一般临床表现:儿童组患者出现发热34例、多汗10例、乏力15例、寒战12例、关节疼痛12例、肝肿大8例、脾肿大11例,成年人组患者发热242例、多汗91例、乏力59例、寒战122例、关节疼痛135例、肝肿大57例、脾肿大55例。儿童组与成年组患者临床资料比较,发热、乏力、脾肿大等症状明显;骨关节疼痛较成人组少;多汗、寒颤、肝肿大两组比较均无显著性差异。3.实验室检查:儿童组患者血红蛋白减少较成年人组明显。白细胞计数、血小板计数、肝功酶学、胆红素、CRP、ESR、血培养阳性率差异比较无统计学意义。两组患者试管凝集试验均集中在1:100和1:200。4.并发症:儿童组骨关节并发症14例,主要累及膝关节、踝关节及外周小关节;血液系统受累21例,患儿可出现白细胞减少、贫血、血小板减少及全血细胞减少;神经型布鲁菌病5例,包括脑膜炎2例,脑膜脑炎3例;肝损害21例;附睾睾丸炎3例。成年人组骨关节受累135例,主要累及腰椎、骶髂关节、髋关节且可累及多处关节;神经型布鲁菌病4例,包括腰部脊髓神经根病变2例,脑膜炎1例,脑膜脑炎1例;肝损害198例;附睾睾丸炎9例。儿童组患者神经系统、血液系统受累较成人组明显,差异有统计学意义;两组患者骨关节受累、泌尿生殖系统及肝脏实质受损差异无统计学意义。儿童组有4名患者心肌普酶升高,心脏彩超未见异常,成年组患者中1例心脏彩超可见主动脉瓣膜赘生物,且血培养布鲁菌阳性。两组患者均未见明确的呼吸系统受累及。5.治疗:36例患儿均为初治,4种治疗方案治疗均有效,患儿平均退热天数3.9(1-11)天,随访6-24个月不等,仅有1例合并神经系统病变的患儿治疗失败。结论:1、布鲁菌病可发生于各个年龄阶段,包括婴幼儿及老年人,儿童好发于8-12岁的学龄期儿童,成年人好发于中青年,男性患者患病率高于女性。儿童布鲁菌病是人类布鲁菌病的重要组成部分。2、家庭成员患病的儿童患布鲁菌病的风险增加。3、儿童组与成人组实验室检查及一般症状无显著差异。4、儿布鲁菌病患者较易累及血液系统骨关节系统、中枢神经系统、泌尿生殖系统,需与上述系统疾病相鉴别。5、四种治疗方案治疗均安全有效,但抗菌方案的选择及治疗时间应依据患儿年龄、经济条件、并发症、依从性及药物的副作用等综合考虑,个体化应用,规范化治疗。
[Abstract]:Objective: to analyze the oral characteristics, laboratory examination and clinical characteristics of Brucella in children and adults, to improve the understanding of clinical characteristics of brucellosis in children, to reduce misdiagnosis and missed diagnosis, and to explore the selection of antibiotics for brucellosis in children. 1. -2016 1 in December 2010. In February, 362 cases of brucellosis hospitalized in the Department of infection were divided into adult group and children group, 36 cases of children (0-14 years old), 326 cases of adult (14 years old) (14 years old).2. summary two groups of demographic characteristics, clinical characteristics and blood biochemical examination. Compare and analyze the demology, clinical characteristics and blood biochemical examination of two groups of patients. .3. statistical methods: IBM SPSS statistics 23 software was used to analyze the statistical results of children brucellosis. P0.05 was defined as statistical significance. Results: 1. demographic characteristics: the median age of children with brucellosis children's incidence of brucellosis children was 8 (5.25,11.75) age 8 (5.25,11.75), and middle age of adult patients. 43.5 (34.0,53.0) years old. There were 24 boys and 12 girls in the children's group. The proportion of male and female: 258 cases of male and 68 women in 2:1. adult group. There was no significant difference in sex ratio between male and female 3.79:1. children group and adult group of cattle and sheep. In children, 9 cases of family members confirmed brucellosis, and 38 family members in adult group had Brucella. The incidence of disease in the two groups had a statistically significant difference in general clinical manifestations: 34 cases of fever, 10 cases of hyperhidrosis, 15 cases of hyperhidrosis, 12 cases of arthralgia, 12 cases of joint pain, 8 cases of hepatomegaly, 11 cases of splenomegaly, 242 cases of fever in adult group, 91 cases of hyperhidrosis, 59 cases of fatigue, 135 cases of joint pain, 135 cases of joint pain, hepatomegaly 5. 7 cases, splenomegaly in 55 cases, children group and adult patients compared with the clinical data, fever, fatigue, splenomegaly and other symptoms are obvious; bone and joint pain less than the adult group; hyperhidrosis, shivering, hepatomegaly, two groups have no significant difference.3. laboratory examination: Children's blood red egg white decreased compared with the adult group, white blood count, platelet count, There was no significant difference in the positive rate of liver function enzyme, bilirubin, CRP, ESR, and blood culture. The two groups of test tube agglutination tests were concentrated in the complications of 1:100 and 1:200.4.: 14 cases of bone and joint complications in the children group, mainly the knee joint, the ankle joint and the peripheral joint; the blood system was involved in 21 cases, and the children could have leukocyte reduction, anaemic anaemia, and small blood. 5 cases of neuro brucellosis, including 2 cases of brucellosis, 3 cases of meningitis, 3 cases of meningitis, 21 cases of liver damage, 3 cases of epididymis with epididymis, 135 cases of bone and joint involvement in adult group, mainly involving the lumbar spine, sacroiliac joint, hip joint and multiple joints; 4 cases of nerve brucellosis, including 2 cases of lumbar spinal nerve root lesions, meningeal meninges. There were 1 cases of inflammation, 1 cases of meningoencephalitis, 198 cases of liver damage and 9 cases of epididymis with epididymis. The nervous system and blood system in the children group were more obvious than those in the adult group. The difference was statistically significant in the two groups of patients with bone and joint involvement, and the difference between the genitourinary system and the liver parenchyma was not statistically significant. In the children's group, there were 4 patients with cardiac enzyme elevation and heart color Doppler ultrasound. In the adult patients, 1 cases of cardiac color Doppler ultrasound showed aortic valve neoplasm and Brucella positive in blood. The two groups had no definite respiratory system involvement and.5. treatment: 36 cases were all primary treatment, 4 treatments were all effective, the average fever rate of 3.9 (1-11) days in children was 3.9 (1-11) days, and the follow-up was 6-24 months, only 1 cases combined with God. Conclusion: 1, brucellosis can occur at all ages, including infants and old people. Children are well sent to 8-12 year old school age children, adults are good at middle and young adults, and the prevalence rate of male patients is higher than that of women. Children brucellosis is an important part of brucellosis of human.2, family members suffer from the disease. The risk of brucellosis in the sick children increased by.3. There was no significant difference in the laboratory examination and general symptoms between the children and the adult group.4. The patients with brucellosis were easily involved in the blood system bone and joint system, the central nervous system, the urogenital system, and the.5 of the above system diseases. The four treatments were safe and effective, but the antiseptic treatment was effective. The choice of the scheme and the time of treatment should be based on the age, economic conditions, complications, compliance and side effects of the drug. Individualized application and standardized treatment should be considered.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

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