背景:布鲁氏菌病是一种严重的人畜共患疾病,经常被忽视,特别是在贫困国家。及时识别布鲁氏菌病的局灶性并发症对于改善治疗结果至关重要。然而,目前缺乏诊断这些并发症的既定指标或生物标志物.因此,这项研究旨在调查人类布鲁氏菌病局灶性并发症的潜在警告信号,目的是为临床医生提供实用参数,以帮助患者的诊断和管理。
方法:于2019年12月至2021年8月在中国进行了多中心横断面研究。本研究采用问卷调查和病历系统,探讨布鲁氏菌病患者的临床特点和并发症。使用单变量和多变量逻辑回归模型评估并发症的警告标志的存在。采用受试者工作特征曲线(ROC)和曲线下面积(AUC)进行变量筛选和模型评价。
结果:共纳入880名被诊断为人类布鲁氏菌病的参与者。患者的中位年龄为50岁[四分位距(IQR):41.5-58.0],54.8%有并发症。受并发症影响最常见的器官系统是骨关节系统(43.1%),伴有周围性关节炎(30.0%),脊柱炎(16.6%),椎旁脓肿(5.0%),和骶髂关节炎(2.7%)是最普遍的。其他器官系统的并发症包括泌尿生殖系统(4.7%),呼吸系统(4.7%),和血液系统(4.6%)。发现几个因素与局灶性布鲁氏菌病有关。这些因素包括诊断的长时间延迟[优势比(OR)=3.963,95%置信区间(CI)1.906-8.238超过90天],潜在疾病的存在(OR=1.675,95%CI1.176-2.384),关节痛(OR=3.197,95%CI1.986-5.148),眼睛膨出疼痛(OR=3.482,95%CI1.349-8.988),C反应蛋白(CRP)>10mg/L(OR=1.910,95%CI1.310-2.784)和红细胞沉降率(ESR)升高(OR=1.663,95%CI1.145-2.415)。ROC分析的最佳截断值为CRP>5.4mg/L(敏感性73.4%,特异性51.9%),ESR>25mm/h(敏感性47.9%,特异性71.1%)。
结论:超过50%的布鲁氏菌病患者出现并发症。诊断延迟等因素,潜在的疾病,关节痛,眼睛疼痛,CRP和ESR水平升高被确定为并发症发生的重要标志物。因此,出现这些情况的患者应密切监测潜在的并发症,无论其培养结果和标准管凝集试验滴度。
BACKGROUND: Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.
METHODS: A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.
RESULTS: A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5-58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906-8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176-2.384), arthralgia (OR = 3.197, 95% CI 1.986-5.148), eye bulging pain (OR = 3.482, 95% CI 1.349-8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310-2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145-2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).
CONCLUSIONS: More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.