本文關(guān)鍵詞： 布魯氏菌病 流行病學(xué)特征 臨床特征　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景 布魯氏菌病(brucellosis,簡稱布病),是由布魯氏菌(Brucella)通過皮膚粘膜、消化道、呼吸道等多種傳播途徑侵入機(jī)體引起的人畜共患傳染病。該病流行較為廣泛,為全球性疾病。建國以來,我國曾出現(xiàn)兩次流行高峰,經(jīng)大規(guī)模防治后流行得到控制,發(fā)病率下降。但近年研究顯示,我國布病發(fā)病率呈現(xiàn)上升趨勢,波及范圍逐漸擴(kuò)大。而我省1958年以前無布病記載,由于1958年引進(jìn)帶疫種羊后,布病開始扎根我省。90年代初期我省人間布病調(diào)查研究顯示我省布病疫情有上升趨勢,隨即于1999年相繼在我省各州市布病疫情較重地區(qū)設(shè)立了布病重點(diǎn)監(jiān)測縣。目前關(guān)于我省布病疫情的研究主要集中在對監(jiān)測縣的調(diào)查,而關(guān)于監(jiān)測縣以外布病的研究文獻(xiàn)較少。為初步了解我院近年來布病患者的收治情況,本課題將對2008年01月至2014年4月以來昆明醫(yī)科大學(xué)第一附屬醫(yī)院收治的全部28例布病患者進(jìn)行較為詳細(xì)的回顧性分析。 目的 旨在初步了解我院近年來布病的收治情況,分析布病患者的流行病學(xué)及臨床特征,為制定防控措施及早期診斷、治療提供一定的科學(xué)依據(jù)。 方法 對2008年01月至2014年4月昆明醫(yī)科大學(xué)第一附屬醫(yī)院收治的診斷符合診斷標(biāo)準(zhǔn)的布病患者進(jìn)行回顧性分析。 結(jié)果 1.2008年01月至2014年4月昆明醫(yī)科大學(xué)第一附屬醫(yī)院共收治布病病例28例,28例患者均有明確牛、羊接觸史。 2.流行病學(xué)特征：時(shí)間分布：2008-2014年發(fā)病例數(shù)分別為：4例、2例、2例、3例、4例、7例、6例；每年1-12月發(fā)病例數(shù)分別為：5例、4例、2例、6例、2例、1例、1例、2例、2例、0例、3例、0例;人間分布：男性24例,女性4例；≤10歲0例、11-20歲1例、21-30歲0例、31-40歲2例、41-50歲11例、51-60歲8例、61-70歲6例；其中農(nóng)民21例、屠夫2例、個(gè)體2例、工人1例、教師1例、學(xué)生1例；空間分布：各州(市)布病發(fā)病例數(shù)由高到低依次為：曲靖市12例、昆明市11例、紅河州2例、玉溪市2例、昭通市1例。 3.臨床特征：首發(fā)癥狀：發(fā)熱16例(占57.1%)、腰痛5例(占17.9%)、關(guān)節(jié)痛3例(占10.7%)、腹痛3例(占10.7%)、皮疹1例(占3.6%)；主要癥狀、體征：發(fā)熱28例(100%)、乏力28例(100%)、多汗26例(92.9%)、腰痛25例(89.3%)、脾腫大23例(82.1%)、淋巴結(jié)腫大20例(71.4%)、肝腫大10例(35.7%)、關(guān)節(jié)痛5例(17.6%)、皮疹3例(10.7%)、腹痛2例(7.1%)、胸悶1例(3.6%)；其中發(fā)熱以高熱為主,71.4%患者體溫高峰在39.0℃以上。熱型：波狀熱(32.1%)、稽留熱(25%)、不規(guī)則熱(42.9%)。 4.輔助檢查：血常規(guī)：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：膽紅素均正常；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均在正常范圍內(nèi)；體液培養(yǎng)：除1例陰性,其余均為陽性；影像學(xué)檢查：腹部B超：脾腫大23例、肝腫大10例、肝硬化1例；腰椎MRI示：椎體感染性占位病變并椎體破壞者8例、腰椎膨出及退行性變5例；四肢關(guān)節(jié)平片：四肢關(guān)節(jié)炎性改變3例；心臟彩超：感染性心內(nèi)膜炎并心臟瓣膜贅生物2例。 5.治療情況：確診前：營養(yǎng)支持治療3例,其余25例布病患者予頭孢三代加酶抑制劑、喹諾酮類、氨基糖苷類等抗生素單獨(dú)或雙聯(lián)治療后有效20例,無效5例,有效率為80%；確診后：四環(huán)素+利福平：治療4例,有效3例、顯效1例,有效率為100%；多西環(huán)素+利福平：治療24例,有效19例、顯效2例、復(fù)發(fā)3例,有效率為87.5%。 6.并發(fā)癥：28例患者中,出現(xiàn)并發(fā)癥者14例,其中腰椎病變8例,骨關(guān)節(jié)病變3例,胸椎病變2例,感染性心內(nèi)膜炎2例,繼發(fā)性血小板減少癥2例,腹膜炎1例,貧血1例。結(jié)論 1.2008-2014年我院收治布病患者發(fā)病例數(shù)呈現(xiàn)上升趨勢,每年以1-4月份高發(fā)。 2.我院收治的布病患者以男性為主,發(fā)病年齡主要集中在41-70歲,其中農(nóng)民為主要感染人群。各州(市)布病發(fā)病率以曲靖市最高,其他依次為昆明市、紅河州、玉溪市、昭通市,推測上述流行病學(xué)特征與接觸傳染源的幾率大小有關(guān)。 3.發(fā)熱、乏力、多汗、腰痛、關(guān)節(jié)痛是我院布病患者的主要癥狀,同時(shí)可伴有淋巴結(jié)腫大、肝脾腫大、皮疹等癥狀、體征,而繼發(fā)并發(fā)癥患者同時(shí)還會(huì)出現(xiàn)相應(yīng)并發(fā)癥的癥狀、體征。 4.我院收治的布病患者白細(xì)胞總數(shù)變化不明顯,部分患者可出現(xiàn)淋巴細(xì)胞或單核細(xì)胞比例升高,少數(shù)患者可并發(fā)貧血和(或)血小板減少；血生化檢查以轉(zhuǎn)氨酶升高為主要表現(xiàn)；ESR、CRP呈不同程度的升高,與大多數(shù)G-敗血癥不同,布病患者PCT檢查均在正常范圍內(nèi)。 5.我院收治的布病患者經(jīng)頭孢三代加酶抑制劑、喹諾酮類、氨基糖苷類等抗生素治療后普遍有效；確診后,利用WHO標(biāo)準(zhǔn)治療方案治療都比較有效,未見耐藥。 6.我院布病患者亦存在多系統(tǒng)并發(fā)癥,其中腰椎病變最為常見,罕見的是其中1例患者并發(fā)了布魯氏菌性自發(fā)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%).
4.杈呭姪媯，

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