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目的分析神经型布氏杆菌病(NB)患者的临床以及影像学表现、实验室检查等特点。方法收集2009年1月~2016年10月在第四军医大学唐都医院住院治疗诊断为神经型布氏杆菌病的患者14例,并进行回顾性分析。结果男女发病比例10∶4,平均发病年龄(38.6±4)岁,以中枢神经系统感染症状起病9例,以脑血管病起病3例,眼肌麻痹起病1例,周围神经病起病1例,头颅影像学异常者2例,肌电图异常1例。腰3-5平面椎管内异常强化影1例,后手术证实为布氏杆菌感染。4例脑脊液培养阳性。7例血培养阳性,6例患者行凝集试验均>1∶160。结论神经型布氏杆菌病临床表现、影像学以及实验室检查缺乏特异性,患者有不明原因的发热以及神经系统症状、听力下降,流行病学的接触史,脑脊液不典型,应警惕NB的可能,必要时行血培养、脑脊液培养以及布氏杆菌凝集试验。由于该病早期发现预后良好,早期诊断及治疗意义重大。
Objective To analyze the clinical, imaging and laboratory tests of patients with neurogenic brucellosis (NB). Methods From January 2009 to October 2016, 14 cases of patients with neurogenic brucellosis who were hospitalized in Tangdu Hospital of the Fourth Military Medical University were collected and analyzed retrospectively. Results The incidence of males and females was 10: 4 and the average age of onset was (38.6 ± 4) years old. Nine patients had symptoms of central nervous system infection, three patients had cerebrovascular disease, one had ocular muscle paralysis, one had peripheral neuropathy 1 case, 2 cases of abnormal skull imaging, 1 case of abnormal EMG. Lumbar 3-5 spinal vertebral anomalous enhancement in 1 case, after surgery confirmed brucellosis. 4 cases of cerebrospinal fluid culture positive. Seven cases of blood culture positive, 6 patients were agglutination test> 1: 160. Conclusions The clinical manifestations, imaging and laboratory tests of neurogenic brucellosis are not specific. Patients with unexplained fever and neurological symptoms, hearing loss, epidemiological exposure history and atypical cerebrospinal fluid should be alert to the possibility of NB Blood cultures, cerebrospinal fluid cultures, and Brucella agglutination tests were performed as necessary. As early detection of the disease with a good prognosis, early diagnosis and treatment of great significance.