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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 356 -359. doi: 10.3877/cma.j.issn.1674-1358.2021.05.011

病例报告

妊娠期布鲁菌病一例并文献复习
冯铁柱1, 岑枝梅2,†(), 王禄林3   
  1. 1. 010031　呼和浩特市，呼和浩特市第二医院中西医结合科
    2. 010031　呼和浩特市，呼和浩特市第二医院检验科
    3. 010031　呼和浩特市，呼和浩特市第二医院妇产科
  • 收稿日期:2020-10-27 出版日期:2021-10-15
  • 通信作者: 岑枝梅

A case of brucelosis in pregnancy and literature review

Tiezhu Feng1, Zhimei Cen2,†(), Lulin Wang3   

  1. 1. Department of Traditional Chinese and Western Medicine, Hohhot Second Hospital, Inner Mongolia Hohhot City, Hohhot 010031, China
    2. Clinical Laboratory, Hohhot Second Hospital, Inner Mongolia Hohhot City, Hohhot 010031, China
    3. Department of Obstetrics and Gynecology, Hohhot Second Hospital, Inner Mongolia Hohhot City, Hohhot 010031, China
  • Received:2020-10-27 Published:2021-10-15
  • Corresponding author: Zhimei Cen
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引用本文：

冯铁柱, 岑枝梅, 王禄林. 妊娠期布鲁菌病一例并文献复习[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(05): 356-359.

Tiezhu Feng, Zhimei Cen, Lulin Wang. A case of brucelosis in pregnancy and literature review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(05): 356-359.

目的

提高临床医务人员对妊娠期布鲁菌病的认识。

方法

分析2019年11月呼和浩特市第二医院收治的1例妊娠期合并布鲁菌病孕妇诊治过程并复习相关文献。

结果

孕妇仅有轻微乏力、游走性关节痛及腰痛，妊娠20周时虎红平板实验（RBPT）（+）和试管凝集实验（SAT）1︰100（++++）。孕妇于30周发生先兆流产，行剖腹产分娩。产妇于分娩后第2日出现发热，给予头孢曲松钠和左氧氟沙星静脉滴注，同时口服多西环素片及利福喷丁胶囊，7天后体温恢复正常，维持上述治疗20 d后改为口服多西环素片及利福喷丁胶囊治疗90 d后停用药物，随访患者6个月，布鲁菌病无复发。新生儿于分娩后第2天检测RBPT（+）和SAT 1︰100（+++）。给予利福平及复方磺胺甲基异噁唑治疗60 d结束疗程，出生后第30天时检测RBPT（+），SAT 1︰100（++），随访患儿6个月，无复发；生长发育正常，复查RBPT（+）和SAT（+）。

结论

妊娠期布鲁菌病可导致孕妇流产、早产及新生儿先天性布鲁菌病，应引起重视。

关键词: 布鲁菌病, 妊娠, 先天性
Objective

To improve the awareness of brucellosis in pregnancy among clinical medical staff.

Methods

The treatment process of a pregnant woman with brucellosis during pregnancy enrolled in Hohhot Second Hospital on December, 2019 was analyzed, while the relevant literatures were reviewed.

Results

This pregnant women occurred only slight fatigue, migratory joint pain and low back pain, with rose bengal plate agglutination test (RBPT) (+) and serum agglutination test (SAT) 1︰100 (++++) at the 20th week during pregnancy. This case had threatened abortion at the 30th week and delivered by caesarean section. The patient developed fever on the second day after delivery, and was given intravenous drip of ceftriaxone sodium and levofloxacin, and oral doxycycline tablets and rifapentine capsules. After 7 days, the body temperature of the case returned to normal. After maintaining the above treatment for 20 days, oral doxycycline tablets and rifapentine capsules were applied for 90 days and then suspended. The case was followed up for 6 months, without recurrence of brucellosis. The newborn was examined for RBPT (+) and SAT 1︰100 (+++) on the second day after delivery. After treatment with rifampicin and compound sulfamethoxazole for 60 days, the course of treatment ended. RBPT (+) and SAT 1︰100 (++) were examined on the 30th day after birth. The child was followed up for 6 months, with no recurrence and normal growth, both RBPT and SAT showed (+).

Conclusions

Brucellosis during pregnancy could lead to serious adverse consequences such as abortion, premature delivery and neonatal congenital brucellosis, which should be paid more attention.

Key words: Brucellosis, Pregnancy, Congenital
表1 妊娠期布鲁菌病孕妇及其新生儿实验室指标
指标 孕妇入院时 孕妇分娩后2 d 新生儿
白细胞（× 109/L） 7.2 7.62 16.12
中性粒细胞（× 109/L） 5.1 5.31 10.32
淋巴细胞（× 109/L） 1.9 2.13 5.26
红细胞（× 1012/L） 3.86 4.18 6.77
血小板（× 109/L） 267 216 228
尿素氮（mmol/L） 3.02 — —
肌酐（μmol/L） 50.7 — —
尿酸（μmol/L） 223 — —
ALT（IU/L） 46.2 — 38.6
AST（IU/L） 29.7 — 40.1
总蛋白（g/L） 52.9 — 56.1
白蛋白（g/L） 40.9 — 41.2
总胆红素（μmol/L） 7.3 — 19.6
直接胆红素（μmol/L） 1.2 — 6.3
总胆汁酸（μmol/L） 2.9 — 6.8
INR 1.03 1.04 —
纤维蛋白原（g/L） 3.16 3.68 —
空腹血糖（mmol/L） 5.8 5.6 —
hsCRP（mg/L） 0.8 1.2 —
降钙素原（ng/L） 0.3 0.4 —
RBPT + — +
SAT +++ — +++
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