【作者】 常琳；

【导师】 于雅琴；

【作者基本信息】 吉林大学 ， 医学基因组学， 2010， 硕士

【摘要】 布鲁氏菌病(Brucellosis)是由布鲁氏菌引起的一种人兽共患的慢性细菌性传染病,在全世界各地都有很广泛的分布。近年来我国布鲁氏菌病发病率逐年递增,给畜牧业及其相关产业造成了相当严重的经济损失,同时也给人民的生命健康带来极大的威胁。本研究采用流行病学现况调查的方法,使用自行设计的《布鲁氏菌病门诊病人个案调查表》调查了吉林省松原市疾病预防控制中心就诊人员,并分析了吉林省松原市布鲁氏菌病的流行病学特征,探索影响布鲁氏菌病发病的相关危险因素及随访患者的临床症状和免疫学指标的转归情况。调查结果显示,就诊人员共计1103人,布鲁氏菌病阳性率为36.6%;就诊人群临床分期构成中,最高为急性期,其次为亚急性期、慢性期和残余期;临床症状及合并症分布中,患者主要的症状为发热,其次为肌肉关节疼痛和乏力,主要合并症为睾丸炎,患者与非患者在发热、多汗、背痛、髋痛、腰间盘突出、骨质增生及颈椎病的分布上经检验差异有统计学意义(P<0.05);就诊时间主要集中在6～8月份;阳性率最高的就诊地区为乾安县,其次为扶余县及前郭县;就诊患者在性别、年龄、职业及文化程度上的分布差异有统计学意义,同时还受到畜别接触史、家庭成员感染史、接触途径及传播媒介等方面因素的影响;26名随访患者进行抗生素治疗,治疗后1个月主要症状为多汗,3个月主要症状为肌肉关节疼痛,6个月主要症状为腰痛,临床症状随时间呈减少趋势;随访患者治疗后3个月和6个月SAT指标均呈现下降趋势,3个月、6个月SAT结果是否达到诊断标准在临床症状分布上差异无统计学意义。本研究为布鲁氏菌病的预防和临床治疗提供了科学依据,为布鲁氏菌病的病因预防提供了理论支持。建议政府、疾病预防控制部门及高危职业者给予足够的重视,从而有效地控制布鲁氏菌病的疫情。更多还原

【Abstract】 BackgroundBrucellosis is a kind of chronic bacterial transmitted diseases caused by Brucella which had a very broad distribution all over the world. According to the WHO survey, human and livestock brucellosis had a wide spread in 170 countries and regions in more than 200 countries around the world.350 million people are threated by brucellosis in China and 5,000 ~ 6,000 people catch Brucellosis each year. As well as the threat to people’s lives and health, Brucellosis also leads to great economic losses to the livestock and related industries.Jilin Province is the hardest hit of brucellosis, the province reported 3,617 new cases in 2009 which increased by 57.53% compared to last year’s.The incidence rate of the nation is in the nation’s first three, the number of cases ranks No.4. The cases of Songyuan come to 1636 accounted for 45.2% of the whole province.At present, in face of rising prevalence, factors of brucellosis is still a lack of systematic research in our country, and few dometic follow-up studies about patients’symptoms and immunological results were repored because a non-clinical treatment is quite popular in China.The epidemiological status of the investigation were used in the research of Songyuan City CDC in Jilin Province to study brucellosis-positive rate, epidemiological characteristics and risk factors of treatment groups, while follow-up study of their clinical symptoms and immunological changes after antibiotic treatment were also included in the research.The results of the study provide a scientific basis for the brucellosis prevention and clinical treatment.MethodsIn this study, treatment groups in Songyuan City CDC from January 1 to December 31 in 2009 were studied, a total of 1103 people left after excluding repeated, while 26 patients were chosen as follow-up survey. The self-designed questionnaire of brucellosis cases and one-to-one interviews were used in the research.The questionnaire have been collated and a database were built by EpiData 3.0 software, SPSS 12.0 software were used for statistical analysis.Descriptive analysis andχ2 test were used to analyze the distribution differences of brucellosis in gender, age, nationality, occupation, education, treatment time, the incidence areas, clinical symptoms and complications and follow-up conditions; risk factors of brucellosis were studied by regression analysis.Results1. Treatment group countained a total of 1103 people, brucellosis-positive rate was 36.6%. Brucellosis in gender, age, and occupation and education level has a significant difference.2. Treatment groups in clinical stages of composition, acute phase accounted for 82.4%, sub-acute phase of 8.2%, chronic phase of 5.7%, the residual period of 3.7%. Brucellosis in patients with clinical symptoms and complications of distribution, the main symptoms in patients was fever (68.1%), followed by muscle and joint pain (40.1%) and fatigue (27.2%), the main complication is orchitis (4.4%).3. Brucellosis in patients with temporal distribution of the patients the positive rate of population up to January (50.0%), followed by February (45.4%) and May (41.8%); In the regional distribution, the difference of positive rate among the areas shows no statistical significance.4. Through single and multi- factor analysis showed the risk factors of brucellosis: The patient’s general situation: gender, age, educational level and occupation; animal exposure history: contact with cattle, sheep, and dogs; family history of infection: spouses and children get infection; transmission channels: contact through the skin and respiratory tract infections; the mass media: the flow of products of infected animals, fur, soil, manure and dust.5. 26 follow-up of patients after treatment with antibiotics.In the 1 month the main symptoms are excessive sweating (46.2%), 3 months for the muscle and joint pain (34.6%), 6 months for low back pain (23.1%); 3 months SAT indicator 9 lower than the diagnostic criteria (34.6%), 6-month SAT indicator 10 (38.5%) was lower than the diagnostic criteria, while two people (7.7%) to negative; 3 months, 6 months, whether come to the diagnostic criteria for SAT results showed no significant difference in the distribution of clinical symptoms.ConclusionA high brucellosis detection rate was found in outpatients in Songyuan CDC and it had a clear gender differences. The incidence of brucellosis is also affected by age, educational level, occupation, animal exposure history, and family history of infection, time of onset of disease areas, transmission routes and the media and other implications. This study provides theoretical basis for prevention and treatment of brucellosis and affords a theoretical support for the cause of prevention. Government, the disease control departments and high-risk occupational people should pay enough attention to effectively reduction of the brucellosis incidence.更多还原