20年间哈尔滨市及周围县布鲁杆菌病流行病学变化和临床特征回顾分析

摘要

目的 分析20年问哈尔滨市及周围县布鲁杆菌病(简称布病)的流行病学和临床特征的变化.方法 采用回顾性方法 ,对1982-1984年和2002-2004年在哈尔滨医科大学第二临床医学院感染科收治的哈尔滨市及周围县布病患者的流行病学和临床资料进行分析,比较两个不同时间组患者的感染途径,发病地区,发病时间,临床症状,实验窒检查和不同治疗时间患者的复发率.结果 共收集165例患者病历资料,其中1982-1984年79例,2002-2004年86例.流行病学调查结果 显示,两组患者感染途径和发病地区比较差异有统计学意义(X2值分别为11.758,8.903,P＜0.01或＜0.05).在临床表现上,两时间组多汗分别为74.7%(59/79)和50.0%(43/86),肝肿大分别为21.5%(17/79)和9.3%(8/86),睾丸炎分别为25.3%(20/79)和8.1%(7/86),头痛分别为20.3%(16/79)和7.0%(6/86),组间比较差异有统计学意义(X2值分别为10.629,4.780,8.877,6.281,P＜0.01或＜0.05).两时间组发热分度,热型分布,白细胞总数变化率组问比较差异有统计学意义(X2值分别为11.671,29.946,11.550,P＜0.01),血小板减少发生率分别为2.5%(2/79)和19.8%(17/86),肝功能异常率分别为21.5%(17/79)和54.7%(47/86),组间比较差异有统计学意义(X2值分别为12.005,19.037,P＜0.01).在2002-2004年,治疗3周患者复发率[25.0%(6/24)]明显高于治疗6周[6.5%(4/62)].结论 20年间急件布病在流行病学和临床特征发生了变化,可能与感染不同布鲁杆菌菌株有关.%Objective To analyze the changes of epidemiological and clinical features of patients with acute brucellosis over the past twenty years.Methods The epidemiological and clinieM data of patients with acute brucellosis in Harbin and counties around from 1982-1984 and 2002-2004 in our hospital were retrospeclively analyzed,and the routes of infection,epidemiologieal area,clinical manifestations,laboratory examination,time distribution and the treatment for relapse of different groups were compared.Results One hundred and sixty-five cases were collected.including 79 cases in 1982-1984 and 86 cases in 2002-2004.There were significant differences in routes of infection(X2＝11.758,P＜0.01)and epidemiological area(X2＝8.903,P＜0.05)between two groups of patients based on epidemiologieal data.Clinical manifestations were significantly different in two groups.such as sweating 74.7%(59/79)and 50.0%(43/86)(X2=10.629,P＜0.01);hepatomegaly 21.5%(17/79)and 9.3%(8/86)(X2＝4.780,P＜0.05);orchiditis,25.3%(20/79)and 8.1%(7/86)(X2＝8.877,P＜0.01);headache,20.3%(16/79)and 7.0%(6/86)(X2=6.281,P＜0.05);the distribution of fever severity(X2＝11.671,P＜0.01)and type(X2＝29.946,P＜0.01);the distribution of total white blood cells(X2=11.550,P＜0.01);rates of thrombocytopenia,2.5%(2/79)and 19.8%(17/86)(X2＝12.005,P＜0.01);and rates of liver dysfunction,21.5%(17/79)and 54.7%(47/86)(X2＝19.037,P7＜0.01).Relapse rate at 3-week 25.0%(6/24)was higher than that 6.5%(4/62)at 6-week(X2＝5.793,P＜0.05).Conclusion The epidemiologieal and clinical feature of acute burgeri infection has changed over the past twenty years due to the different strain of Bacterium.