布鲁杆菌病患者流行病学及临床特征分析

发布时间：2018-04-19 04:17

本文选题：布鲁杆菌病 + 体征和症状　；参考：《中国全科医学》2017年08期

【摘要】：目的通过分析布鲁杆菌病患者的流行病学及临床特征,旨在提高临床对布鲁杆菌病的认识,为早期诊断及防止误诊提供依据。方法选取2014—2015年河北医科大学第二医院住院治疗的布鲁杆菌病患者110例为研究对象。查阅患者病历资料,记录患者流行病学特征(性别、年龄、职业、发病时间、感染途径)、临床表现、实验室检查、就诊科室、治疗和转归情况。结果 110例布鲁杆菌病患者中男78例,女32例;年龄10~78岁,以41~60岁(81例,73.6%)、21~30岁(22例,20.0%)为主;职业以农民为主(66例,60.0%)。1~4季度分别有16例(14.6%)、46例(41.8%)、31例(28.2%)、17例(15.4%);有明确羊、牛等动物及污染产品接触史30例(27.3%)。临床表现以发热(100例,90.9%)、关节及肌肉痛(52例,47.3%)、乏力(31例,28.2%)、胃肠道症状(26例,23.6%)为主。实验室检查主要表现为肝功能损害(41例,37.3%)、红细胞沉降率增快(40例,36.4%)、白细胞计数增多或减少(37例,33.6%)、清蛋白水平降低(33例,30.0%)、C反应蛋白水平增高(23例,20.9%)。106例布鲁杆菌抗体阳性,22例血培养阳性,1例关节液培养阳性。布鲁杆菌病患者主要于呼吸内科(31例,28.2%)、全科医疗科(25例,22.7%)、免疫风湿科(17例,15.4%)、消化内科(10例,9.1%)治疗,余患者因不典型临床特征就诊于其他科室。51例(46.4%)应用盐酸多西环素联合利福平,44例(40.0%)应用盐酸多西环素联合链霉素,7例(6.4%)应用盐酸米诺环素联合利福平,3例(2.7%)应用盐酸多西环素联合利福喷汀,3例(2.7%)单独应用盐酸米诺环素,2例(1.8%)单独应用盐酸多西环素。1例患者出现脓毒症、感染性休克,余患者预后良好。结论布鲁杆菌病患者临床表现复杂多变,通过早期诊断和规范化治疗,可迅速缓解患者症状,避免慢性化、降低致残率。
[Abstract]:Objective to analyze the epidemiological and clinical characteristics of brucellosis in order to improve the clinical understanding of brucellosis and to provide evidence for early diagnosis and prevention of misdiagnosis.Methods 110 patients with brucellosis were selected from the second Hospital of Hebei Medical University in 2014-2015.The epidemiological characteristics (sex, age, occupation, time of onset, route of infection, clinical manifestation, laboratory examination, department of consultation, treatment and outcome) were recorded.Results among the 110 patients with brucellosis, 78 were males and 32 females, aged 1078 years, 81 patients were 41660 years old and 22 patients were 20. 0 years old. In 66 cases of brucellosis, 66 cases were mainly farmers. In the fourth quarter, there were 16 cases with 14. 660 cases of brucellosis and 46 cases with 41.831 cases with 28. 22 cases of Rhizoma japonica.Exposure history of cattle and other animals and contaminated products in 30 cases.The main clinical manifestations were fever in 100 cases (90.9%), joint and muscle pain in 52 cases (47.3%), fatigue in 31 cases (28. 2%) and gastrointestinal symptoms in 26 cases (23. 6%).Laboratory examination mainly showed liver function damage in 41 cases, erythrocyte sedimentation rate in 40 cases, leukocyte count increased or decreased in 37 cases (33. 6%), albumin level decreased in 33 cases (30. 0%) and C reactive protein level increased in 23 cases (20. 9%). 106 cases with brucellae antibody were found in laboratory examination, which showed liver function damage in 41 cases, erythrocyte sedimentation rate increased in 40 cases, leukocyte count increased or decreased in 37 cases, serum protein level decreased in 33 cases, and the level of C reactive protein increased in 23 cases.22 cases were positive for blood culture and 1 case was positive for joint fluid culture.Brucellosis was mainly treated in 31 cases of respiratory medicine, 25 cases of general medical department, 17 cases of immune rheumatism, 10 cases of stomach and stomach.The remaining patients were treated with doxycycline hydrochloride combined with rifampicin in 44 cases with doxycycline hydrochloride and rifamycin in 44 cases due to their atypical clinical features.) doxycycline hydrochloride combined with streptomycin hydrochloride was applied in 7 cases.) minocycline hydrochloride combined with rifampicin hydrochloride was used in 3 cases with rifampicin.Doxycycline hydrochloride combined with rifopentine hydrochloride (3 cases, 2 cases) minocycline hydrochloride (2 cases, 1.8%) doxycycline hydrochloride (1 case) appeared sepsis.Septic shock, the remaining patients with good prognosis.Conclusion the clinical manifestations of patients with brucellosis are complicated and changeable. Early diagnosis and standardized treatment can relieve the symptoms of the patients quickly, avoid chronic disease and reduce the rate of disability.
【作者单位】：河北医科大学第二医院全科医疗科;
【基金】：河北省卫生计生委医学科学研究重点课题计划(20160562)
【分类号】：R516.7;R181.3

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