Clinical Characteristics And Related Factors Of Spondylitis In Patients With Brucellosis

Objective:Spondylitis is one of the serious complications of brucellosis.It has aextremely bad impact on the patient's body and mind.The correct diagnosis and identification of the clinician is very important for the patient's recovery.This study described the characteristics of epidemiology,clinical manifestations,and auxiliary examinations of brucellosis combined with spondylitis;the differences in the combined spondylitis group and the unassociated spondylitis group were compared,and the clinical features and related factors of the disease were explored for the clinician.The aim of this study is providing the scientific basis for diagnosis and identification.Method:Data on hospitalized patients with brucellosis admitted from January 1,2015 to December 31,2016 were collected from a clinical hospital in Liaoning Province.The diagnosis of brucellosis is based on WS 269-2007 "Diagnosis Criteria for Brucellosis" and the National Office of Health's Disease Control Letter [2018] No.141 "National Brucellosis Detection Work Plan".Diagnosis and classification of spondylitis are based on literature "Imaging of Brucellosis Spondylitis and Its Clinical Significance".Exclude previous medical history such as tuberculosis,spinal surgery,repetition,review,and information loss.The detailed information includes population characteristics,epidemiological contact history,clinical symptoms,comorbidities,auxiliary examination indicators,imaging diagnosis,and etiological separation.Data was entered by Epidata 3.1 software and data was analyzed by SPSS 19.0 software.Measured data were statistically described using the mean±standard deviation and the median(interquartile range);the count data were described using the composition ratio and rate;single factor analysis was performed using the ?2 test,etc.P <0.05 was considered statistically significant;multivariate analysis was performed using a non-conditional Logistic regression.Result:In this study,568 cases of patients with effective hospitalized brucellosis were collected,including 358 cases(63.03%)of patients with spondylitis and 210 cases(36.97%)of patients without spondylitis.1.Clinical characteristics of brucellosis patients with spondylitis(1)The male to female sex ratio was 2.48:1;the youngest was 15 years old and the oldest was 80 years old;the average age was 51.40±11.55;226 cases(63.13%)in the 41 to 60 age group;and the 78 cases in over 80 years old group(21.79 %);Han ethnic 284 cases(79.33%),Manchu 52 cases(14.53%);Farmers 237 cases(66.20%),herdsman animal products processing and sales staff 53 cases(14.80%).(2)Among the patients,275(76.82%)were exposed to sheep and 102(28.49%)were exposed to cattle.There were 275 cases(76.82%)with specific contact methods,of which 247 cases(68.99%)were bred,11 cases(3.07%)were uncooked meat or contaminated food,and 6 cases(1.68%)were drink milk.(3)Clinical diagnosis: a.The clinical stage: 273 cases(76.26%)in acute stage of brucellosis,51 cases(14.24%)in subacute stage,and 34 cases(9.50%)in chronic stage;b.Clinical manifestations: 281 cases(78.49%)of fever,324 cases(90.50%)of bone and joint pain,253 cases(70.67%)of fatigue,11 cases(3.07%)of psychiatric symptoms,and 6 cases(1.68%)of splenomegaly;c.Clinical complications: 18 cases of orchitis(7.06%),15 cases of meningitis(4.19%),28 cases of anemia(7.82%),63 cases of splenomegaly(18.00%),45 cases of fatty liver(12.86%),There were 39 cases of hepatic cysts(11.14%),24 cases of renal cysts(6.70%),15 cases of diabetes(4.19%),and 12 cases of pneumonia(3.37%);d.The main results of laboratory tests: Hemoglobin decreased in 158 cases(44.13%),creatine kinase decreased in 228 cases(63.69%),ALT increased in 102 cases(28.49%),ALB decreased in 202 cases(56.42%),and uric acid decreased in 82 cases(22.91).%),LDL increased in 47 cases(13.13%),blood glucose increased in 53 cases(14.80%),and CRP increased in 269 cases(75.14%);e.Main imaging findings: 63 cases(18.00%)of splenomegaly,45 cases(12.86%)of fatty liver,29 cases of lung texture enhancement(8.14%),230 cases of intervertebral ectasia(64.25%),vertebral body Degenerative changes occurred in 207 cases(57.82%),vertebral body inflammation in 171 cases(47.77%),and paravertebral soft tissue involvement in 74 cases(20.67%).(4)Serological tests results: 351(99.04%)were positive for SAT,23(6.42%)were titered 1:50,and 328(92.62%)were titered ? 1:100.(5)Etiological cultures results: Brucella was positive in 143 cases(40.50%)and fungal positive in 18 cases(5.10%).(6)Types of spondylitis: Type I 283 cases(79.05%),type II 258 cases(72.07%),the highest incidence of the two,followed by type IV 74 cases(20.67%),type V(4.47%).Simple type of spondylitis was type I and type II,with 71 cases(19.83%)and 72 cases(20.13%)respectively.There were type I+II(37.99%),type I+II+IV(10.89%)and type I+IV(6.14%),etc.in complex spondylitis.2.Analysis of factors associated with brucellosis and spondylitis(1)Univariate analysis of the combined and uncombined spondylitis groups showed: patients in different age groups,occupations,sheep exposure history,cattle exposure history,clinical stage,fever,muscle soreness,decreased hemoglobin content,decreased creatine kinase,increased incidence of alanine aminotransferase,elevated glutamyl transpeptidase,decreased albumin,elevated uric acid,elevated low-density lipoprotein,CRP increase,Brucella isolation and culture positive,etc.The incidence of the differences were statistically significant(P<0.05).(2)Multivariate analysis of combined and uncombined spondylitis showed that the age range was 41 to 60 years old(OR=4.901,95% CI=1.153~20.838),61 to 80 years old(OR=7.813,95%CI=1.649~37.012);the occupation was farmer(OR=3.296,95% CI =1.715~6.336);exposure to sheep(OR = 3.095,95% CI = 1.257 ~ 7.621)and disease in the subacute phase(OR = 3.149,95% CI = 1.541~6.436),had increased risk of brucellsis patients combine with spondylitis.Conclusions:1.There are more male than female in bruising and spondylitis,mainly middleaged and older,mostly farmers.The main contact route is feeding sheep.2.Symptoms of brucellosis combined with spondylitis are mostly fever,fatigue,spinal joint pain,etc.Most of the complications are orchitis,meningitis,anemia,and splenomegaly.3.Patients with spondylitis mainly occur in the vertebral body and intervertebral discs,and multi-complex spondylitis is the most common.4.Brucellsis patients who were high age,farmers,exposure to sheep and disease in the subacute phase may increase risk of combine with spondylitis.