摘要目的 观察28例急性布鲁杆菌病(简称布病)患者血清学动态检测结果,探讨布病血清学检测对疾病临床诊断、疗效评价及预后判断的意义.方法 以黑龙江省农垦总局总医院布病科确诊收治的28例急性布病患者(由同一实验室感染羊种布病)作为观察对象,于治疗前,治疗第3、6、9周观察其临床症状体征(包括发热、乏力、多汗、关节疼痛、淋巴结肿大)及生化指标[谷丙转氨酶(ALT)、乳酸脱氢酶(L)H)],应用试管凝集试验(SAT)测定观察对象血清学抗体效价,并与临床转归进行对比研究.结果 28例急性布病患者以治疗第3周时SAT试验检测抗体效价为最高峰,集中在1∶400(++),占39.29％(11/28);而治疗第6周时有28.57％(8/28)转阴；治疗第9周时有50.00％ (14/28)转阴.治疗前发热20人(71.43％)、乏力17人(60.71％)、多汗8人(28.57％)、关节疼痛28人(1 00.00％)、淋巴结肿大7人(25.00％)、ALT升高28人(100.00％)、LDH升高26人(92.86％)；治疗第3周时,除3人(10.71％)偶有低热外,其余患者体温恢复正常,乏力、多汗、关节疼痛人数有所减少,分别为13人(46.43％)、2人(7.14％)、21人(75.00％),而ALT、LDH基本恢复正常(仅有1人ALT升高)；治疗第6周,全部患者发热、多汗临床体征消失,关节疼痛及淋巴结肿大人数减少,分别为12人(42.86％)、3人(10.71％),生化指标ALT、LDH全部正常；治疗第9周,多数患者主要临床症状体征消失,少数患者仍诉有乏力[2人(7.14％)]、关节疼痛[6人(21.43％)].结论经过有效治疗,抗体效价迅速降低,临床症状很快得到改善,二者之间大致呈平行关系,提示布病特异性抗体出现的早晚、抗体滴度的高低及消长的速度不仅可用于疾病诊断,而且对疗效评价及预后判断具有重要意义.

abstractsObjective To observe the dynamic serological test results of 28 patients with acute brucellosis,and to investigate the relationship between serological test results and diagnosis,curative effect and prognosis of brucellosis.Methods Twenty eight patients(infected with sheep brucellosis) with acute brucellosis in the Department of Brucellosis in Heilongjiang Provincial Land Reclamation Headquarters General Hospital were selected as research subjects,and their serological changes were tested by means of tube agglutination test (SAT)and clinical outcomes were compared before and after each stage of treatment.In addition,symptoms of fever,weakness,sweating,joint pain,swollen lymph nodes and biochemical parameters [alanine aminotransferase (ALT),lactate dehydrogenase (LDH)] were also tested 3,6 and 9 weeks after the treatment.Results Antibody titer reached the peak at the third week,1 ∶ 400(++),which accounted for 39.29％ (11/28); 2857％(8/28) of the patients became negative at the sixth week; 50.00％ (14/28) became negative at the ninth week.Before the treatment,20(71.43％) patients had the symptom of fever,8 (28.57％) patients had the symptom of hyperhidrosis,28 (100.00％) patients had the symptom of joint pain,7(25.00％) patients had the symptom of lymph node enlargement,28 (100.00％) patients' ALT was elevated,and 26(92.86％) patients' LDH was elevated.After three weeks of treatment,except the three patients (10.71％) who occasionally had fever,the rest of the patient's temperature was returned to normal.Also the numbers of patients with the symptoms of fatigue,sweating and joint pain were significantly reduced,and specifically,the conesponding number was 13(46.43％),2(7.14％),and 21 (75.00％)patients,respectively.ALT and LDH returned to normal(only one patient's ALT was out of the range).At the sixth week,all the patients' symptoms of fever and hyperhidrosis disappeared.The number of patients with the symptoms of joint pain and lymph node enlargement reduced to 12(42.86％) and 3(10.71％),respectively.The results of biochemical tests(ALT and LDT) returned to normal.At the ninth week,most patients' clinical symptoms disappeared.A few patients still had the symptoms of weakness[2(7.14％)] and joint piin[6(21.43％)].Conclusions After effective treatment,antibody titer of patients decreases rapidly,at the same time,the clinical symptoms improve quickly.There is a parallel relationship between the change of antibody titer and clinical symptoms.It is demonstrated that the appearing time of brucellosis specific antibodies,the ampfitude and speed of change of antibody titers can be used in diagnosis,therapeutic evaluation and prognosis of the disease.