耐药脊柱结核的临床分析及疗效研究

Retrospective study of drug-resistant spinal tuberculosis and efficacy of clinical treatment

摘要:

目的  分析脊柱结核的结核菌培养及药敏情况，探讨CT介导的椎旁穿刺注药联合全身抗结核药物治疗耐药脊柱结核的疗效及意义。方法  回顾性研究长沙市中心医院结核科2005年6月-2013年9月确诊为脊柱结核的住院患者1156例。通过椎旁穿刺获得骨病灶中的脓液及干酪样物进行结核分枝杆菌培养和药敏试验，并进行耐药分析。耐药脊柱结核均采用CT定位椎旁穿刺注药联合全身抗结核药物治疗，按结核临床治愈标准进行疗效评估。结果  分枝杆菌培养阳性286例，阳性率为24.74%（286/1156）；确诊为耐药脊柱结核82例，耐药率为28.67%（82/286）；耐异烟肼（H）、利福平（R）及链霉素（S）分别为52、50和44例，占18.18%（52/286）、17.48%（50/286）和15.38%（44/286）；耐多药结核（MDR-TB）23例，占阳性患者的8.04%（23/286）。初治组182例，初始耐药率为18.13%（33/182）；复治组104例，获得性耐药率为47.12%（49/104）；两组的总耐药率比较，经χ2检验，差异有统计学意义（P <0.05）。72例耐药脊柱结核患者通过内科保守治疗临床痊愈，12例转外科手术。随访1～3年，所有耐药脊柱结核患者无复发。结论  CT定位椎旁穿刺注药有利于尽早明确耐药脊柱结核的诊断；联合规范且个性化的全身抗结核药物对治愈耐药脊柱结核、预防并发症、预防获得性耐药具有重要意义。

Abstract:

Objective To analyze bacterial culture and drug sensitivity of spinal tuberculosis and to explore the curative effect and significance of the treatment for drug-resistant spinal tuberculosis by CT-guided para-vertebral puncture local therapy combined with systemic anti-tuberculosis drug treatment. Methods A total of 1,156 cases of spinal tuberculosis in the Central Hospital of Changsha from June 2005 to September 2013 were retrospectively studied. The pus and caseous substance of the bone lesions obtained by CT-guided para-vertebral puncture were used in Tuberculosis Mycobacterium culture and drug-sensitivity test. All the drug-resistant spinal tuberculosis patients were treated by CT-guided drug injection through para-vertebral puncture combined with systemic anti-tuberculosis drug treatment. The therapeutic effect was evaluated according to the clinical cure standard of spinal tuberculosis. Results Mycobacterium culture was positive in 286 cases, the positive rate was 24.74% (286/1,156); among which 82 cases were diagnosed as drug-resistant spinal tuberculosis and its drug-resistance rate was 28.67% (82/286). The drug-resistant rate to Isoniazid (H), Rifampicin (R) and Streptomycin (S) was 18.18% (52/286), 17.48% (50/286) and 15.38% (44/286) respectively. Multidrug-resistant Mycobacterium Tuberculosis (MDR-TB) was diagnosed in 23 cases, its rate was 8.04% (23/286) in all the patients with positive Mycobacterium cultures. In the initial treatment group (n = 182), the initial drug-resistance rate was 18.13% (33/182); in the retreatment group (n = 104), the drug-resistance rate was 47.12% (49/104). The total drug-resistance rate of the two groups was statistically different (P < 0.05). Among all the patients, 72 cases of drug-resistant tuberculosis were cured by conservative treatment in Department of Internal Medicine, and 12 cases were transferred to surgical operation. During the follow-up of 1-3 years, none of the patients with drug-resistant spinal tuberculosis has recurrence. Conclusions CT-guided para-vertebral puncture local therapy is conducive to the early definite diagnosis of drug-resistant spinal tuberculosis. Combined standardized and personalized systemic anti-tuberculosis drug therapy is important for cure of drug-resistant spinal tuberculosis, prevention of complications and acquired drug-resistance.