应用羧化胶乳凝集试验诊断人、畜布鲁氏菌病的研究

应用以化学交联法制备的布鲁氏菌１６Ｍ抗原－羧化胶乳制剂的羧化胶乳凝集试验（ＬＡＴ）、试管凝集试验（ＳＡＴ）、虎红平板凝集试验（ＲＢＰＴ）以及酶联免疫吸附试验（ＥＬＩＳＡ）、半胱氨酸凝集试验（ＣＹＴ），对在四省布鲁氏菌病疫区收集的部分人、畜血清中布氏菌抗体进行对比检测。结果表明，ＬＡＴ较之ＲＢＰＴ具有更高的特异性；与ＳＡＴ相比，无论阳性或阴性符合率均较一致。另外，ＬＡＴ可检测血清中ＩｇＧ、ＩｇＭ两类布氏菌特异性抗体。因而本试验对人、畜布病的诊断具有特异、敏感和简便的优点，更宜在基层推广应用。     

2008-2018年云南省人间布鲁菌病流行特征及灰色GM(1,1)模型预测

目的分析云南省布鲁菌病(简称布病)流行特征,建立灰色GM(1,1)模型,预测云南省布病病情。方法收集中国疾病预防控制信息系统和云南省统计局2008-2018年云南省布病疫情数据和人口资料,分析布病流行病学特征(包括时间、地区、人群分布),并以灰色GM(1,1)模型进行建模,预测2019、2020年云南省布病发病率。结果2008-2018年云南省共报告布病病例1216例,年均发病率为0.2374/10万,呈逐年递增趋势(χ²趋势=843.34,P<0.01)。病例报告主要集中在3-9月份,占总病例数的69.41%(844/1216)。病例报告数居前5位的州市分别为红河州(289例)、曲靖市(264例)、昆明市(258例)、大理州(160例)、玉溪市(134例),占总病例数的90.87%(1105/1216)。职业以农民为主,占79.03%(961/1216)。建立灰色GM(1,1)模型预测2019、2020年云南省布病发病率分别为0.4876/10万和0.4817/10万。结论云南省布病发病较以往上升,应对重点地区、重点人群进行针对性防控,并对预测结果进行前瞻性评价,逐步完善云南省布病预测模型。     

Association of antiviral prophylaxis and rituximab use with posttransplant lymphoproliferative disorders (PTLDs): A nationwide cohort study

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation (SOT). Most PTLD cases are associated with Epstein–Barr virus (EBV) infection. The role of antiviral prophylaxis or rituximab therapy for prevention of PTLD in SOT recipients is controversial. In a nationwide cohort, we assessed the incidence, presentation, and outcome of histologically proven PTLD. We included 4765 patients with a follow-up duration of 23 807 person-years (py). Fifty-seven PTLD cases were identified; 39 (68%) were EBV positive (EBV+ PTLD). Incidence rates for EBV+ PTLD at 1, 2, and 3 years posttransplant were 3.51, 2.24, and 1.75/1000 py and 0.44, 0.25, and 0.29/1000 py for EBV− PTLD. We did not find an effect of antiviral prophylaxis on early and late EBV+ PTLD occurrence (early EBV+ PTLD: SHR 0.535 [95% CI 0.199–1.436], p = .264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751–6.521], p = .150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but 57 of 4574 patients without rituximab induction developed PTLD. In an adjusted restricted mean survival time model, PTLD-free survival was significantly longer (0.104 years [95% CI 0.077–0.131]) in patients receiving rituximab as induction treatment. This study provides novel data on the association of rituximab induction and reduced risk for PTLD.     

21例布氏杆菌性脊柱炎的诊断及综合治疗疗效观察

目的 探讨布氏杆菌性脊柱炎临床表现及影像学特点,以提高对该病的鉴别诊断水平.观察药物与手术综合治疗的效果.方法 回顾性分析我科收治21例布氏杆菌性脊柱炎患者的临床表现、体征、影像学特点、实验室及病理检查等情况.采用利福平和四环素及链霉素联合药物治疗的同时,均采取一期病灶清除植骨融合术,其中3例加内固定治疗.结果 (1) 21例均有与羊、羊皮、羊肉接触史.本组病例均有发热,多为典型波浪热.腰部疼痛7例,脊柱,四肢大关节及肌肉痛14例,经治疗后均遗有位置固定的腰痛;均有乏力,多汗,食欲减退,消瘦.(2)布氏杆菌性脊柱炎病灶除1例为T11～12,余均分布于腰椎.骨破坏灶小而多发,多局限于椎体边缘,病灶周围明显硬化、增生,新生骨组织中有新破坏灶形成.椎间隙变窄较结核轻,少或无椎旁脓肿形成,无死骨形成.(3)化验布氏杆菌试管凝集试验均为阳性,虎红平板凝集试验15例+++、4例++、2例+.血沉增快21例,为35～110mm/h.(4)超声检查见肝脾肿大6例,腹腔间隙积液3例.(5)病灶清除后均留标本送病理检查符合布氏杆菌性脊柱炎之诊断.(6)对初治6例和复治15例均采用利福平、四环素,链霉素药物治疗的同时行病灶清除植骨融合或植骨融合内固定术,术后疼痛即刻缓减,2周疼痛消失,血沉开始下降.2～3个疗程血沉恢复正常,布氏杆菌试管凝集试验和虎红平板凝集试验转为阴性.结论 布氏菌杆性脊柱炎可以通过接触史、典型的临床表现、影像特点、特殊的实验室检查及病理检查明确诊断,采用利福平、四环素、链霉素联合治疗的同时手术综合治疗可以取得满意的效果.     

近10年国内针灸临床试验研究病种计量分析

为了解近年来国内针灸临床试验研究中涉及的病种情况,并且与之前国外针灸临床试验研究的结果进行对比,本研究采用文献计量的方法,通过对中国中医药期刊文献数据库收录的近10年(2003年至2012年)的针灸临床试验研究的文献进行调研,得出有关中西医疾病病名的主题词1187个,并列举其中排名前100位的高频词。与国内外前期的研究报道进行比较,认为国内针灸临床研究涉及的疾病种类远远超过国外,并且在不断扩充。     

EVALUATION OF BRAINSTEM AUDITORY POTENTIAL IN BRUCELLOSIS PATIENTS WITH AND WITHOUT NEUROLOGICAL INVOLVEMENT

This study investigated the changes in brainstem auditory evoked potentials (BAEPs) in acute phase of brucellosis. Twenty-two patients with brucellosis without neurologic involvement and seven patients with neurobrucellosis were included. BAEPs were evaluated before treatment. No patient had a symptom of hearing loss. Patients who had neurologic involvement did not show any abnormalities in their BAEPs recording. This study suggests that patients with brucellosis who are in the acute phase of the disease with or without neurological involvement may have normal BAEPs. BAEPs do not seem to be a sensitive method for central nervous system involvement of brucella patients in the acute phase of the disease.     

Genetic stability of Brucella abortus S19 and RB51 vaccine strains by multiple locus variable number tandem repeat analysis (MLVA16)

The aims of the present study were (i) to assess the in vitro genetic stability of S19 and RB51 Brucella abortus vaccines strains and (ii) to evaluate the ability of multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA) as a tool to be used in the quality control of live vaccines against brucellosis. Sixty-three batches of commercial S19 (n = 53) and RB51 (n = 10) vaccines, produced between 2006 and 2009, were used in this study. S19 and RB51 vaccines were obtained from, respectively, seven and two different manufacturers. Ten in vitro serial passages were performed on reference strains and on selected batches of commercial vaccines. All batches, reference strains and strains of serial passages were typed by the MLVA16. The results demonstrated that B. abortus S19 and RB51 vaccine strains are genetically stable and very homogeneous in their respective groups. Anyway, batches of S19 from one manufacturer and batches of RB51 from another presented genotypes distincts from the reference vaccine strains. In both cases, differences were found on locus Bruce07, which had addition of one repeat unit in the case of S19 batches and the deletion of one repeat unit in the case of RB51 batches. In summary, MLVA16 proved to be a molecular tool capable of discriminating small genomic variations and should be included in in vitro official tests.     

布鲁杆菌病职业人群高危行为习惯调查及健康教育效果评价

目的 调查辽西地区布鲁杆菌病(简称布病)职业人群的高危行为习惯,评估健康教育干预效果.方法 采取分层随机整群抽样的方法,2008-2010年对辽西地区与牛羊等牲畜有密切接触的职业人群高危行为习惯进行现况调查,从中抽取凌海市职业人群作为干预组,实施为期3个月的布病高危行为习惯健康教育,其余职业人群作为对照组.在健康教育基线期和终末期问卷调查干预组和对照组布病高危行为习惯情况.结果 基线期共调查916名观察对象,其中干预组499人,对照组417人.布病高危行为习惯(接触流产牲畜时防护、病畜及时扑杀、病畜深埋处理、不贩卖加工病畜、不吃病死畜肉、不喝生奶、不吃未熟乳肉制品、对饲养牲畜进行免疫)正确率干预组分别为70.9%(354/499)、64.3%(321/499)、53.8%(268/499)、92.2%(460/499)、82.2%(410/499)、87.5%(437/499)、93.6%(467/499)、56.2%(280/499),对照组分别为68.8%(287/417)、59.2%(247/417)、54.7%(228/417)、89.2%(372/417)、85.6%(360/417)、88.5%(369/417)、94.0%(392/417)、55.9%(233/417),组间比较差异无统计学意义(P均＞0.05).终末期共调查908名观察对象,其中干预组499人,对照组409人;干预组上述8种布病高危行为习惯正确率分别为85.4%(426/499)、79.0%(394/499)、69.9%(349/499)、96.4%(481/499)、94.3%(471/499)、94.9%(474/499)、94.0%(469/499)、99.4%(496/499),对照组分别为66.8%(273/409)、57.3%(234/409)、50.1%(205/409)、85.3%(349/409)、88.8%(363/409)、89.5%(366/409)、90.1%(369/409)、57.2%(234/409),组间比较差异有统计学意义(x2值分别为43.991、49.833、37.111、35.032、9.537、9.826、4.485、253.808,P均＜0.05).干预组在基线期除不吃未熟乳肉制品外,其他7种布病高危行为习惯正确率与终末期比较,差异有统计学意义(x2值分别为30.426、26.284、27.854、7.364、36.027、17.238、9270.286,P均＜0.05).结论 健康教育干预可以显著地提高布病职业人群高危行为习惯正确率,值得进行交流和推广.

Abstract：

Objective To find out demography characteristic and risk behaviors of occupation groups and to evaluate the effect of health education. Methods A baseline survey was conducted among occupation groups in the western part of Liaoning province by stratified random cluster sampling. Health education started to intervene in occupation groups in Linghai city of Liaoning province. An investigation of brucellosis related behaviors was carried out before and after a health education among occupation groups. Other occupational groups were as the control group. The research on high-risk behaviors of occupation groups was in the following eight aspects: protection taken when contact with abortion livestock, timely slaughter and burying deeply of sick animals, not selling sick animals do not eat dead meat, nor drink raw milk, do not eat raw meat, and immunity of livestock. Results Before the intervention, a total of 916 objects, of which intervention group 499 and control group 417 were investigated. The high-risk behaviors of brucellosis were not significantly different between the two groups[70.9% (354/499), 64.3%(321/499 ), 53.8% (268/499), 92.2% (460/499), 82.2% (410/499 ), 87.5% (437/499), 93.6% (467/499), 56.2%(280/499) in intervention group, 68.8% (287/417), 59.2% (247/417 ), 54.7% (228/417), 89.2% (372/417 ), 85.6%(360/417) ,885%(369/417),94.0%(392/417),55.9%(233/417) in control group, all P ＞ 0.05]. After the intervention,a total of 908 survey objects, of which intervention group 499 and control group 409, were investigated. The above eight aspects of high-risk behaviors in the intervention group were 85.4% (426/499),79.0% (394/499),69.9%(349/499),96.4%(481/499),943%(471/499),94.9%(474/499),94.0%(469/499), 99.4%(496/499), respectively; in the control 66.8% (273/409),57.3% (234/409),50.1% (205/409),85.3% (349/409),88.8% (363/409),89.5%(366/409) ,90.1% (369/409), and 57.2% (234/409), respectively. Between the two groups, the difference was statistically significant (x2 = 43.991,49.833,37.111,35.032,9.537,9.826,4.485,253.808, all P ＜ 0.05 ). The above seven aspects of high-risk behaviors except do not eat raw dairy at the beginning of intervention were compared with those of after the intervention, the differences were statistically significant (x2 = 30.426,26.284,27.854,7.364,36.027,17.238,9270.286, all P ＜ 0.05). Conclusions Health education intervention can significantly improve the behavior change rate of occupational groups at high risk of brucellosis, and the education intervention is worthwhile to communicate and promote.     

9例布鲁氏菌病并发感染性主动脉瘤患者临床诊治分析 临床指标及细胞因子水平变化特征

[摘要]?目的?分析布鲁氏菌病并发感染性主动脉瘤的临床特点,以提高临床医生对该疾病的认识及诊疗水平。方法?选取2002年1月1日—2022年6月1日北京安贞医院收治的9例布鲁氏菌病并发感染性主动脉瘤患者作为研究对象,收集其流行病学资料、临床表现、实验室检查结果、影像学资料、治疗及预后等情况。结果?32例血培养证实布鲁氏杆菌感染者中,9例并发主动脉瘤,发生率为28.13%。其中8例为男性,1例为女性,年龄为58～75岁。有明确牛、羊接触史者3例,有不洁羊奶饮用史者1例,有牧区旅游史者1例。所有患者均有发热,其中热型为典型波浪热者1例。患者主要症状为腰腹痛。误诊为腰椎结核者2例,误诊为腰椎管狭窄者3例。1例患者合并附睾炎。6例患者累及腹主动脉,1例累及升主动脉,2例累及主动脉弓。9例患者血清凝集试验均阳性。9例患者均接受利福平、多西环素和左氧氟沙星抗感染治疗,除1例失访外,其余8例总疗程均为3～6个月。7例手术治疗患者中,6例行主动脉替换或修补术,1例经6个月抗感染治疗后行支架植入手术,以上患者术后均随访5个月～7年（中位时间4年）,1例于术后5年死于脑血管疾病意外,其余6例均存活。2例未接受手术治疗患者中,1例出院后失访,1例随访3年存活至今。结论?布鲁氏菌病的主动脉受累较少见,且易危及生命,由于对该病认识不足,易导致漏诊、误诊。本病治疗的基石仍然是抗感染治疗联合开放性手术。血管内支架等介入手术治疗的作用尚未确定,须要考虑患者的病情和长期并发症的风险。