El Miedany Yasser M, El Gaafary Maha, Baddour Manal, Ahmed Ihab
Department of Rheumatology and Rehabilitation, Ain Shams University, 2 Italian Hospital, St. Abbassia, Cairo 11381, Egypt.
J Rheumatol. 2003 Dec;30(12):2666-72.
To identify risk factors of relapse among patients with osteoarticular brucellosis.
In a prospective cohort study, we investigated 90 patients with diagnosis of brucellosis, as established by clinical picture and at least 4-fold rise in antibody titer. Osteoarticular involvement was defined by inflammatory signs and radiographic changes. Thirty-five patients received combination therapy of 2 drugs (rifampicin + cotrimoxazole or doxycycline), while 55 patients received a combination of 3 drugs (streptomycin + rifampicin + doxycycline). Monthly followup comprised clinical and laboratory examinations (seroagglutination, IgG, IgM antibody titers). Recovery of patients was based on clinical improvement and seroagglutination antibody titer < or = 1:80, as well as negative results for IgG and IgM antibody titers. Incidence of relapse was recorded during the 2 year period of followup after finishing the course of treatment.
All patients continued treatment beyond the usual 6 week period previously recommended. Relapse occurred in 59.3% in patients who received treatment for 5 months or less, while relapse occurred in 7.9% among those who received treatment for more than 5 months (p < 0.001). Sixty percent of patients who received combination therapy of 2 drugs had relapse, while there was no relapse in patients who received 3 drugs in combination (p < 0.001). Logistic regression analysis identified duration of treatment < 5 months and IgG level (above 50 U/ml) as independent predictors for relapse; the predictivity of the model was 85.6%.
Extending treatment for longer than previously recommended (6 weeks) resulted in an incidence of relapse significantly lower than for shorter courses of treatment. IgG antibody in addition to seroagglutinating antibody titers are useful for serological followup of patients with brucellosis.
确定骨关节炎型布鲁氏菌病患者复发的危险因素。
在一项前瞻性队列研究中，我们调查了90例经临床症状及抗体滴度至少升高4倍确诊为布鲁氏菌病的患者。骨关节炎受累通过炎症体征和影像学改变来定义。35例患者接受两种药物（利福平+复方新诺明或强力霉素）联合治疗，而55例患者接受三种药物（链霉素+利福平+强力霉素）联合治疗。每月随访包括临床和实验室检查（血清凝集试验、IgG、IgM抗体滴度）。患者康复的标准为临床症状改善、血清凝集抗体滴度≤1:80，以及IgG和IgM抗体滴度呈阴性。在完成治疗疗程后的2年随访期内记录复发率。
所有患者的治疗时间均超过了之前推荐的常规6周疗程。治疗5个月或更短时间的患者复发率为59.3%，而治疗超过5个月的患者复发率为7.9%（p<0.001）。接受两种药物联合治疗的患者中有60%复发，而接受三种药物联合治疗的患者无复发（p<0.001）。逻辑回归分析确定治疗时间<5个月和IgG水平（高于50 U/ml）是复发的独立预测因素；该模型的预测能力为85.6%。
将治疗时间延长至超过之前推荐的6周，可使复发率显著低于较短疗程的治疗。除血清凝集抗体滴度外，IgG抗体对布鲁氏菌病患者的血清学随访也有帮助。
