【作者】 王欢；

【导师】 李玉香；

【作者基本信息】 吉林大学 ， 内科学， 2012， 硕士

【副题名】附本院216例临床患者特征分析

【摘要】 布鲁氏菌病(brucellosis)，又称为波状热或波浪热、地中海弛张热、马尔他热，是由布鲁氏菌(Brucella)通过皮肤粘膜、消化道、呼吸道等多种传播途径侵入机体引起的人畜共患的急性或慢性传染病，属自然疫源性疾病，可造成免疫系统、骨关节系统、循环系统、神经系统等多系统、器官、组织损害，临床上主要以长期反复发热、多汗、乏力、关节疼痛、肝脾及淋巴结肿大等为特征。布鲁氏菌病广泛分布于世界170多个国家和地区，在我国波及28个省区，流行范围广、危害严重，《中华人民共和国传染病防治法》将其列为乙类传染病。人类感染布病后病程较长、反复发作、经久难愈。因此，布病的流行严重危害人类的健康和畜牧业发展，破坏社会正常的生产与生活。吉林省是我国布病重病区之一，白城市是吉林省布病流行的重病区。1938年首次发现布病病人，1952年7月～1953年初，因从外地购入大批羊，布病逐渐蔓延。1966年以后白城市实行综合性的布病防治措施，布病疫情逐渐有所下降。1999年以来疫情呈现回升状态，出现多个爆发点。因此，加强对布鲁氏菌病的研究，提升防治水平和能力，加强宣传教育，引导政府高度重视，重新审视并修订布病的新的防制策略，建立健全具体的防控措施，在当前是极其迫切的。本文收集了白城市2002年～2011年通过疫情报告系统报告的所有布病患者的流行病学资料，深入分析了10年间白城市布病的流行病学特征，以及吉林大学第一医院感染科收治的216名布病患者的临床特点，尤其是不典型的临床表现及体征，旨在掌握白城市近十年来布病疫情的流行情况和发展趋势，掌握现今情况下布病的临床特征，为布病防制策略和措施的修订提供科学而客观的依据，并提高临床工作中对布病的诊断的准确性，切实做到早发现、早诊断、早治疗，避免病人由急性期转变为亚急性期或慢性期，避免出现“因病致贫，因病返贫”现象，切实提高人群的劳动能力，促进当地经济社会的协调发展。通过研究发现：白城市布病疫情分布以洮南市最高，其他依次为大安市、通榆县、洮北区，最低为镇赉县。十年间布病发病率呈逐年上升趋势，尤其在2004年、2006年至2010年，在2011年出现拐点，但仍维持在较高水平。从十年间月份报告病例看，3月-8月发病一直保持在较高水平，10月-12月和1月处于相对平稳期。布病患者男性多于女性，发病例数较多见于20-64岁。发热、关节痛、多汗、乏力是其主要特征性症状，且急性期发热、关节痛、皮疹较亚急性期和慢性期多见，而多汗、乏力特征各期无明显差异；淋巴结肿大和肝脾肿大特征明显，各期之间出现几率无显著差异，但单纯脾肿大多于单纯肝肿大；具备相应的血象、血沉和C-反应蛋白改变，但各期无明显特征；肝功能损害以丙氨酸氨基转移酶和门冬氨酸氨基转移酶改变较为明显，以急性期尤为明显；血培养及骨髓培养阳性率较高，但急性期阳性率低于亚急性期和慢性期。本研究结果有助于布鲁氏菌病的临床流行病学研究，提高专业防治人员的认知水平，对降低布病的误诊率、提高临床诊治水平有一定的帮助，并为相关研究提供较为科学的数据支持。更多还原

【Abstract】 Brucellosis, also called Bang’s disease, Crimean fever, Gibraltar fever, Malta fever, Maltesefever, Mediterranean fever, rock fever, or undulant fever, is a highly contagious zoonosis caused byingestion of unsterilized milk or meat from infected animals or close contact with their secretions.Brucellosis induces inconstant fevers, sweating, weakness, anaemia, headaches, depression andmuscular and bodily pain. Brucellosis has been categorized by the Law of the People’s Republic ofChina on Prevention and Treatment of Infectious Diseases as category B infectious disease. It hasspread over more than170countries and regions around the world, and affected28provinces inChina. The duration of the disease can vary from a few weeks to many months or even years. Thedisease will break out repeatedly, and it is hard to be cured completely.Brucellosis is a serious threat to human health and the development of animal husbandry, and itwill disrupt the normal production and life of society. During1930s-1960s, Brucellosis was rampantall over the world, and from1970s to the end of1980s, the world had witnessed a decrease ofBrucellosis. However, since1990s, the disease began to spread again, and after the year of2000, thedeterioration began to accelerate. The trend of Brucellosis in China has basically been the same asthat of the world. Jilin province suffered a lot from brucellosis, its first Brucellosis was discoveredin1938. During the period between July1952and the beginning of1953, due to the rush in ofsheep as commodities, brucellosis became rampant in Jinlin. In the year of1966, Baicheng citybegan to take comprehensive measures to prevent and cure the disease. Therefore, it is urgent forthe Government to pay close attention to the disease and enhance relevant propaganda. Measuressuch as deepening the research of Brucellosis, raising the capability of prevention and treatment andestablishing prevention and control mechanism must be taken immediately.By using relevant materials, this thesis analyzes the situation of brucellosis in Baicheng Citybetween2002and2011. This thesis also analyzes the216cases of brucellosis in the First Hospitalof Jilin University. In order to master the situation of brucellosis in nearly a decade, the atypicalsymptoms and physical traits of these patients were closely observed. The effects of prevent and clinical measures, the accuracy of diagnostics were also evaluated in this paper. This will contributeto the better diagnostic and treatment of brucellosis.This thesis discovered that Taonan County suffered most from brucellosis, Da’an county,Tongyu County, and Taobei County follows, while Zhenlai has the lowest outbreak of brucellosis.In the past ten years, brucellosis kept a rising trend. Although there were fluctuations in the year of2004,2006,2010and2011, the disease has been very much alive all the time. Brucellosis is veryactive in the period between March and August, while it remains relatively stable in the periodbetween October and January. The research also indicated that male patients aged from20to64aremore than female patients at the same age. And inconstant fevers, sweating, weakness, anaemia,headaches, depression and muscular and bodily pain are main symptoms of Brucellosis. Fever,arthralgia and erythra appear more in acute Brucellosis than in sub-acute and chronical Brucellosis.However, sweating and weakness were almost the same during different phases. Lymphadenectasisand hepatosplenomegaly traits were apparent, and they were almost the same during differentphases. Simple Lymphadenectasis happens more than simple hepatosplenomegaly. Changes ofhemogram, blood sedimentation and C-reactive protein happened, but they showed no clear traits;Liver function damage focused on the observable change of alanine aminopherase and AST, but thelevel of serum total bilirubin and x-protein almost kept unchanged; the rate of active hemoculturewas high, but acute phase active rate was relative low than that of sub-acute and chronical phase.The research results in this thesis are helpful to the clinical epidemic disease research ofBrucellosis. It will promote the knowledge level of professional personnel, lower the rate ofmisdiagnose about Brucellosis, and enhance the clinical treatment measures. This research will alsoprovide scientific data support for other relevant researches.更多还原