本文選題：布魯菌病 + 兒童布魯菌病�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)兒童與成人布魯菌病人口學(xué)特點(diǎn)、實(shí)驗(yàn)室檢查、臨床特點(diǎn)等進(jìn)行差異性分析,提高臨床醫(yī)師對(duì)兒童布魯菌病臨床特點(diǎn)的認(rèn)識(shí),減少誤診、漏診的情況發(fā)生,并探討兒童布魯菌病抗生素的選擇。材料與方法:1.研究對(duì)象2010年12月-2016年12月吉大一院感染科住院的362例布魯菌病患者,根據(jù)年齡分為成人組和兒童組,兒童組(0-14歲)36例患者,成年人組(14歲)326例。2.總結(jié)兩組患者的人口學(xué)特點(diǎn)、臨床特點(diǎn)及血液生化檢查。比較分析兩組間患者的人口學(xué)、臨床特點(diǎn)及血液生化檢查的差異。總結(jié)兒童布魯菌病治療方案。3.統(tǒng)計(jì)學(xué)方法:應(yīng)用IBM SPSS statistics 23.0軟件對(duì)統(tǒng)計(jì)結(jié)果進(jìn)行分析,P0.05定義為具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.人口學(xué)特點(diǎn):兒童布魯菌病發(fā)病率8.84%。兒童組患兒中位年齡8.0(5.25,11.75)歲,成人組患者中位年齡43.5(34.0,53.0)歲。兒童組患者男童24例,女童12例,男女比例:2:1。成人組男性258例,女性68例,男女比例3.79:1。兒童組與成年人組牛、羊接觸史、性別比例無(wú)顯著差異;兒童組中有9例患兒家庭成員確診布魯菌病,成人組患者38例家庭成員患布魯菌病,兩組家庭成員患病率比較差異具有統(tǒng)計(jì)學(xué)意義。2.一般臨床表現(xiàn):兒童組患者出現(xiàn)發(fā)熱34例、多汗10例、乏力15例、寒戰(zhàn)12例、關(guān)節(jié)疼痛12例、肝腫大8例、脾腫大11例,成年人組患者發(fā)熱242例、多汗91例、乏力59例、寒戰(zhàn)122例、關(guān)節(jié)疼痛135例、肝腫大57例、脾腫大55例。兒童組與成年組患者臨床資料比較,發(fā)熱、乏力、脾腫大等癥狀明顯;骨關(guān)節(jié)疼痛較成人組少;多汗、寒顫、肝腫大兩組比較均無(wú)顯著性差異。3.實(shí)驗(yàn)室檢查:兒童組患者血紅蛋白減少較成年人組明顯。白細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、肝功酶學(xué)、膽紅素、CRP、ESR、血培養(yǎng)陽(yáng)性率差異比較無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者試管凝集試驗(yàn)均集中在1:100和1:200。4.并發(fā)癥:兒童組骨關(guān)節(jié)并發(fā)癥14例,主要累及膝關(guān)節(jié)、踝關(guān)節(jié)及外周小關(guān)節(jié);血液系統(tǒng)受累21例,患兒可出現(xiàn)白細(xì)胞減少、貧血、血小板減少及全血細(xì)胞減少;神經(jīng)型布魯菌病5例,包括腦膜炎2例,腦膜腦炎3例;肝損害21例;附睪睪丸炎3例。成年人組骨關(guān)節(jié)受累135例,主要累及腰椎、骶髂關(guān)節(jié)、髖關(guān)節(jié)且可累及多處關(guān)節(jié);神經(jīng)型布魯菌病4例,包括腰部脊髓神經(jīng)根病變2例,腦膜炎1例,腦膜腦炎1例;肝損害198例;附睪睪丸炎9例。兒童組患者神經(jīng)系統(tǒng)、血液系統(tǒng)受累較成人組明顯,差異有統(tǒng)計(jì)學(xué)意義;兩組患者骨關(guān)節(jié)受累、泌尿生殖系統(tǒng)及肝臟實(shí)質(zhì)受損差異無(wú)統(tǒng)計(jì)學(xué)意義。兒童組有4名患者心肌普酶升高,心臟彩超未見(jiàn)異常,成年組患者中1例心臟彩超可見(jiàn)主動(dòng)脈瓣膜贅生物,且血培養(yǎng)布魯菌陽(yáng)性。兩組患者均未見(jiàn)明確的呼吸系統(tǒng)受累及。5.治療:36例患兒均為初治,4種治療方案治療均有效,患兒平均退熱天數(shù)3.9(1-11)天,隨訪6-24個(gè)月不等,僅有1例合并神經(jīng)系統(tǒng)病變的患兒治療失敗。結(jié)論:1、布魯菌病可發(fā)生于各個(gè)年齡階段,包括嬰幼兒及老年人,兒童好發(fā)于8-12歲的學(xué)齡期兒童,成年人好發(fā)于中青年,男性患者患病率高于女性。兒童布魯菌病是人類布魯菌病的重要組成部分。2、家庭成員患病的兒童患布魯菌病的風(fēng)險(xiǎn)增加。3、兒童組與成人組實(shí)驗(yàn)室檢查及一般癥狀無(wú)顯著差異。4、兒布魯菌病患者較易累及血液系統(tǒng)骨關(guān)節(jié)系統(tǒng)、中樞神經(jīng)系統(tǒng)、泌尿生殖系統(tǒng),需與上述系統(tǒng)疾病相鑒別。5、四種治療方案治療均安全有效,但抗菌方案的選擇及治療時(shí)間應(yīng)依據(jù)患兒年齡、經(jīng)濟(jì)條件、并發(fā)癥、依從性及藥物的副作用等綜合考慮,個(gè)體化應(yīng)用,規(guī)范化治療。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.1

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