天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2014年
3期
280-282
,共3页
布鲁杆菌病%流行病学%诊断,鉴别%误诊%临床特征
佈魯桿菌病%流行病學%診斷,鑒彆%誤診%臨床特徵
포로간균병%류행병학%진단,감별%오진%림상특정
brucellosis%epidemiology%diagnosis,differential%diagnostic errors%clinical feature
目的：分析布鲁菌病的临床资料，查找误诊原因，使临床医生对本病及早做出正确诊断。方法收集我院感染内科1995-2013年确诊的17例布鲁菌病患者的临床资料，对其流行病学史、临床特征、实验室检查、治疗等资料进行回顾性分析。结果17例患者中有羊、牛等接触史13例，曾食用羊肉（羊肉串和涮羊肉）2例，无明显接触史2例。在首诊就诊时均被误诊为其他疾病。17例患者均有高热，伴畏寒13例，多汗11例，体质量减轻8例，头痛8例，脾肿大7例，肝肿大6例，关节痛5例，淋巴结肿大5例，腰痛1例，生殖系统受累1例。实验室检查肝功能指标15例有不同程度异常，红细胞沉降率、C反应蛋白均升高13例，血培养布鲁菌阳性9例，布鲁菌虎红玻片凝集试验（RBPT）阳性17例，试管凝集试验（STA）阳性17例（1∶400~1∶800）。采用多西环素联合利福平或联合链霉素治疗后患者均好转出院。结论布鲁菌病临床症状不典型，易误诊，对发热原因不明患者，医务人员要警惕本病。
目的：分析佈魯菌病的臨床資料，查找誤診原因，使臨床醫生對本病及早做齣正確診斷。方法收集我院感染內科1995-2013年確診的17例佈魯菌病患者的臨床資料，對其流行病學史、臨床特徵、實驗室檢查、治療等資料進行迴顧性分析。結果17例患者中有羊、牛等接觸史13例，曾食用羊肉（羊肉串和涮羊肉）2例，無明顯接觸史2例。在首診就診時均被誤診為其他疾病。17例患者均有高熱，伴畏寒13例，多汗11例，體質量減輕8例，頭痛8例，脾腫大7例，肝腫大6例，關節痛5例，淋巴結腫大5例，腰痛1例，生殖繫統受纍1例。實驗室檢查肝功能指標15例有不同程度異常，紅細胞沉降率、C反應蛋白均升高13例，血培養佈魯菌暘性9例，佈魯菌虎紅玻片凝集試驗（RBPT）暘性17例，試管凝集試驗（STA）暘性17例（1∶400~1∶800）。採用多西環素聯閤利福平或聯閤鏈黴素治療後患者均好轉齣院。結論佈魯菌病臨床癥狀不典型，易誤診，對髮熱原因不明患者，醫務人員要警惕本病。
목적：분석포로균병적림상자료，사조오진원인，사림상의생대본병급조주출정학진단。방법수집아원감염내과1995-2013년학진적17례포로균병환자적림상자료，대기류행병학사、림상특정、실험실검사、치료등자료진행회고성분석。결과17례환자중유양、우등접촉사13례，증식용양육（양육천화쇄양육）2례，무명현접촉사2례。재수진취진시균피오진위기타질병。17례환자균유고열，반외한13례，다한11례，체질량감경8례，두통8례，비종대7례，간종대6례，관절통5례，림파결종대5례，요통1례，생식계통수루1례。실험실검사간공능지표15례유불동정도이상，홍세포침강솔、C반응단백균승고13례，혈배양포로균양성9례，포로균호홍파편응집시험（RBPT）양성17례，시관응집시험（STA）양성17례（1∶400~1∶800）。채용다서배소연합리복평혹연합련매소치료후환자균호전출원。결론포로균병림상증상불전형，역오진，대발열원인불명환자，의무인원요경척본병。
Objective To find reasons of the misdiagnosis by analyzing the medical cases of brucellosis, in order to make the correct diagnosis for brucellosis as soon as possible. Methods Seventeen confirmed cases were collected from 1995-2013. The epidemiological, clinical, laboratory and treatment data were retrospectively analyzed. Results Among 17 cases, 13 cases had a history of close contact with sheep or cattle, 2 cases had a history of eating mutton(mutton string and mutton hotpot) and 2 cases had no history of exposure. The primary diagnosis was not brucellosis for all 17 cases. The symp-toms of high fever, chills, sweat, weight loss, headache, splenomegaly, hepatomegaly, joint pain, lymph node enlargment, low back pain and reproductive system involvement were found in 17, 13, 11, 8, 8, 7, 6, 5, 5, 1 and 1 cases respectively. Fifteen cases had different degrees of abnormal liver function indicators. The values of erythrocyte sedimentation rate and C-reac-tive protein were increased in 13 cases. The blood culture for brucella was positive in 9 cases. Both RBPT and STA tests were positive in 17 cases. After treatment with the combination of doxycycline and rifampicin or streptomycin, all patients im-proved and were discharged from hospital. Conclusion Clinical symptoms of brucellosis are not typical and easy to be mis-diagnosed. We should pay attention to the patients with fever of unknown origin.
