187例布鲁菌病患者的临床特征和感染指标分析

目的分析布鲁杆菌感染的诊断方法、临床特征和感染指标,为布鲁菌病诊断提供依据。方法回顾性分析2012年1月至2019年1月解放军联勤保障部队第九四零医院收治的187例布鲁杆菌病患者病例资料,分析患者的诊断方法、基础疾病和并发症。以200例非细菌感染者作为阴性对照,对187例布鲁杆菌病患者感染指标[降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)和中心粒细胞百分比(N%)]进行ROC曲线分析。结果187例布鲁杆菌病患者中男性152例,女性55例;患者年龄中位数为(49.00±12.23)岁,本地区年发病率为36/100000。诊断方法中病原菌培养、血清学诊断和临床诊断分别为27%(51/187)、44.92%(84/187)和40.46%(76/187),病原菌培养以血培养为主24.6%(47/187),平均培养时间为(80.86±20.46)h,且血培养阳性瓶全部为需氧瓶。入组187例布鲁菌病患者常见基础疾病有糖尿病(8.57%、16/187)、乙型肝炎(9.09%、17/187)和胆囊炎(12.83%、24/187);并发症主要表现为腰椎病变(49.20%、92/187)、颈椎病变(10.70%、20/187)和膝关节病变(8.02%、15/187)。感染组与对照组比较,WBC、NEU%、PCT和CRP ROC曲线下面积分别为0.403、0.444、0.414和0.703;当CRP≥1.965 mg/ml时,敏感性为0.589,特异性为0.676。结论布鲁杆菌感染多发生于中老年男性,可通过临床特征、微生物学培养、血清学检测和CRP检测等手段诊断,常并发骨关节病变,需避免漏诊。

Clinical characteristics and infection biomarkers of 187 patients with Brucellosis

Objective To investigate the diagnosis methods,clinical characteristics and infection biomarkers of Brucella spp infection,and to provide experimental basis for the diagnosis of Brucellosis.Methods Data of 187 cases of Brucellosis in the 940 th Hospital of Joint Logistics Support Force of People’s Liberation Army from January 2012 to January 2019 were analyzed,retrospectively.The clinical diagnostic methods,basic diseases and complications were analyzed,respectively.The infection biomarkers,such as procalcitonin(PCT),C-reactive protein(CRP),white blood cell(WBC)and neutrophil(N%)of the patients were analyzed by receiver operating characteristic curve(ROC),200 cases without bacterial infection were collected as negative control.Results Among the 187 patients with brucellosis,152 cases were men;the median age of the patients was(49.00±12.23)years and the annual incidence in this region was 36/100000.The clinical diagnostic methods included pathogenic bacteria culture,serological diagnosis and clinical diagnosis,which were 27%(51/187),44.92%(84/187)and 40.46%(76/187),respectively.Blood culture was the main pathogenic bacteria culture[24.6%(47/187)],the average blood culture period was(80.86±20.46)h,all the positive bottles were aerobic bottles.The common clinical basic diseases with Brucella spp were mellitus(8.57%,16/187),hepatitis B(9.09%,17/187)and cholecystitis(12.83%,24/187);the main complications of the patients were lumbar spine lesions(49.20%,92/187),cervical spine lesions(10.70%,20/187)and knee joint lesions(8.02%,15/187).ROC analysis of WBC,N%,PCT and CRP of patients with Brucella spp infection showed that,the area under curve were 0.403,0.444,0.414 and 0.703,respectively,which indicated CRP had high sensitivity and specificity for Brucella infection,and when CRP was≥1.965 mg/ml,the sensitivity and specificity were 0.589 and 0.676.Conclusions Brucellosis often occurs in middle-aged and elderly men,which could be diagnosed by clinical features,microbiological culture,serological detection and CRP detection;and also commonly with complications of osteoarthrosis,and missed diagnosis should be avoided.