神经型布鲁菌病临床特点和实验室诊断分析

目的总结神经型布鲁菌病（NB）的临床及实验室诊断过程，为提高临床和实验室对该病的认识和早期诊疗提供经验。 方法回顾性分析2015年1月至2017年1月于首都医科大学宣武医院确诊的12例神经型布鲁菌病患者的临床表现、流行病学资料及脑脊液（CSF）培养等病原学检查、影像学表现和其他实验室检查结果，并与非神经型布鲁菌病患者比较平均发病年龄，CSF白细胞数、蛋白含量、氯化物、葡萄糖水平等。 结果12例神经型布鲁菌病患者中男性9例，女性3例，平均年龄为（43 ± 14）岁；10例患者来自流行地区，9例有明确的流行病学接触史，其中3例既往诊断布鲁菌病；12例患者均出现不同程度发热，6例有头痛伴脑膜刺激征表现；3例患者表现为复视、视力下降；伴有听力减退伴步态不稳，肢体麻木无力，精神状态改变者各4例。血清布鲁杆菌凝集试验阳性（100%）较CSF凝集阳性率（58.3%）和CSF培养阳性率（46.1%）对临床诊断神经型布鲁菌病价值较大，差异具有统计学意义（χ² = 52.68、P = 0.005，χ² = 73.79、P = 0.005）；12例NB患者CSF白细胞数（单核为主）和蛋白均不同程度升高，葡萄糖、氯化物正常或减低，与非NB感染者相比，CSF葡萄糖检测具有重要价值（P均< 0.05）。给予多西环素或米诺环素+利福平+头孢曲松治疗后12例患者均预后良好。 结论神经型布鲁菌病临床表现多样，易误诊或漏诊，非疫区医务人员应重视CSF血瓶培养及布鲁杆菌凝集，加强多学科协作交流以及早确诊及早治疗。

Clinical presentions and features of diagnostic examinations of neurobrucellosis

ObjectiveTo investigate the clinical and laboratory diagnosis of neurobrucellosis (NB), and to provide the experience for improving the early diagnosis and treatment of NB in clinical and laboratory practice. MethodsThe clinical manifestations, epidemiological data and cerebrospinal fluid (CSF) culture of 12 patients with NB confirmed in Xuanwu Hospital of Capital Medical University from January 2015 to January 2017 were analyzed, retrospectively. The results of other laboratory examination including average age of patients, level of CSF leukocyte count, protein content, chloride, glucose were examined and compared with patients with non-NB. ResultsAmong the 12 cases of neurobrucellosis, 9 cases were males and 3 cases were femals, with an average age of (43 ± 14) years old. Ten patients came from epidemic areas of brucellosis and 9 had a clear history of epidemiological contact. Three of them had previously been diagnosed as brucellosis. All the 12 cases had fever of different degrees, 6 with headache and meningeal irritation, 3 cases presented diplopia and decreased vision. Hearing loss with gait instability, limbs numbness and mental status changed occured in 4 cases, respectively. The positive rate of Brucella blood agglutination test (100%) was higher than that of CSF agglutination test (58.3%) and CSF culture (46.1%) in clinical diagnosis of NB, with significant differences (χ² = 52.68, P = 0.005; χ² = 73.79, P = 0.005). The count of CSF leukocyte (monocyte) and levels of protein increased in 12 patients with NB. The glucose and chloride levels were normal or decreased. Compared with other non-NB diseases, CSF glucose detection was with great value in patients with NB (P < 0.05). All 12 cases with NB who treated with doxycycline or minocycline + rifampin + ceftriaxone were with a good prognosis. ConclusionsThe clinical presentation of neurobrucellosis are diverse and easy to be misdiagnosed or missed. CSF blood culture and brucellosis agglutination should be emphasized by medical staff in non-endemic areas. In addition, the multidisciplinary cooperation is proved to be helpful for early diagnosis and treatment of neurobrucellosis.