摘要
目的分析布鲁菌病(简称布病)患者临床表现、实验室检查特征,为临床诊断提供帮助。方法收集2015-2019年在昆明市第三人民医院住院的布病确诊患者病历(n=81),回顾性分析患者的职业、接触史、临床表现、实验室检查结果和治疗情况。结果81例布病患者,职业以农民为主(64例),多有养羊或羊粪、羊分泌物等接触史(71例)。临床主要表现为发热(68例)、腰背痛(42例)、关节疼痛(22例),其中急性期患者72例、慢性期患者9例。实验室检查中,肝功能指标总胆红素(TB)和直接胆红素(DB)大致正常,约半数患者天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)有不同程度升高;感染性指标,有80%以上患者超敏C反应蛋白(HsCRP)、降钙素原(PCT)、白细胞介素6(IL-6)和血清淀粉样蛋白A(SAA)升高,有64.6%(42/65)患者血沉(ESR)升高。以多西环素+利福平为一线治疗方案。结论布病患者临床表现多样且不典型,临床遇到发热等临床表现不特异患者,应结合其职业、接触史和感染性指标检测结果,及时进行血培养检查以明确诊断,对肝功能异常的患者要注意询问职业、接触史等,以减少布病误诊误治。
Objective To analyze the clinical manifestations and laboratory features of brucellosis patients in order to provide help for clinical diagnosis.Methods The medical records of confirmed brucellosis patients(n=81)in Kunming Third People's Hospital from 2015 to 2019 were collected.The occupation,contact history,clinical manifestations,laboratory examination characteristics and treatment of the patients were retrospectively analyzed.Results The 81 cases of brucellosis were mainly farmers(64 cases),most of who had a history of raising sheep or contacting sheep manure or secretions(71 cases).The clinical manifestations were fever(68 cases),low back pain(42 cases),joint pain(22 cases),including 72 cases in acute stage and 9 cases in chronic stage.Laboratory examination showed that liver function index total bilirubin(TB)and direct bilirubin(DB)were generally normal,aspartate aminotransferase(AST),alanine aminotransferase(ALT)and gamma glutamyltransferase(GGT)were increased in about half of the patients;high sensitivity C-reactive protein(HsCRP),procalcitonin(PCT),interleukin-6(IL-6)and serum amyloid A(SAA)were increased in more than 80%of the patients,and erythrocyte sedimentation rate(ESR)was increased in 64.6%(42/65)of the patients.Doxycycline plus rifampicin was the first-line treatment program.Conclusion The clinical manifestations of patients with brucellosis are diverse and atypical,and patients with nonspecific clinical manifestations such as fever should be combined with their occupation,contact history,indicators of infection detection,timely blood culture examination to make a clear diagnosis,and patients with abnormal liver function should pay attention to asking about occupation and contact history,so as to reduce misdiagnosis and mistreatment of brucellosis.
作者
苏俊华
普珏
钱绍丽
李永琦
刘红伟
张建瑞
Su Junhua;Pu Jue;Qian Shaoli;Li Yongqi;Liu Hongwei;Zhang Jianrui(Department of Clinical Laboratory,Kunming Third People's Hospital,Kunming 650041,China;Emergency Department,Kunming Third People's Hospital,Kunming 650041,China)
出处
《中华地方病学杂志》
CAS
北大核心
2021年第6期493-496,共4页
Chinese Journal of Endemiology
关键词
布鲁杆菌病
临床表现
肝功能
感染性指标
血培养
Brucellosis
Clinical manifestations
Liver function
Indicators of infection
Blood culture
