脊柱结核影像学表现及实验室检测分析

发布时间：2018-06-25 04:54

本文选题：脊柱结核 + 诊断　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景近年来,随着人类免疫性疾病的增加、人口流动性的增大,以及滥用、不规律应用抗结核药物,结核病发病率有增高的趋势。目前关于脊柱结核的基础研究尚缺乏,例如脊柱结核的诊断、耐药问题,以及手术适应征的把握、手术方式的选择等。典型的脊柱结核诊断不难,但是不典型脊柱结核和早期脊柱脊柱结核的诊断仍是临床医生的一大难题。如何利用现有的检查手段,探索出一条快速、准确的脊柱结核的诊断方法,显得尤为必要。目的总结脊柱结核患者的影像学及实验室化验特点,并做对比分析,探讨如何根据现有的检查手段诊断脊柱结核,为临床医生对脊柱结核的诊断提供帮助。方法收集我院骨外科2015.05-2016.06收治的经组织病理学及抗结核药物治疗证实的脊柱结核的患者65例,所有患者均施行了X线、CT平扫+骨骼三维成像(以下简称CT)、MRI检查;以及结核菌素(PPD)皮肤试验、血清抗结核抗体、结核杆菌抗原特异性γ干扰素释放试验(T-SPOT.TB)等实验室化验。收集每例患者的基本临床信息、影像学资料及实验室化验结果,比较并分析各种检测方法对脊柱结核的诊断价值。结果65例脊柱结核患者,平均年龄40.7±10.6岁,主诉中含有背部疼痛症状的有60例,占92.3%;伴有低热、盗汗等结核杆菌中毒症状的有10例,占15.4%;65例患者,从出现症状到本次确诊时间平均477.3天。在诊断脊柱畸形方面,X线较CT及MRI敏感性高,差异有统计学意义(P0.05),在诊断死骨形成方面,CT的敏感性高于X线和MRI(P0.05)。在诊断椎旁脓肿形成、硬膜囊受压方面,MRI的敏感性高于X线和CT(P0.05)。在诊断椎间隙狭窄、椎间盘受累方面,三种影像学检查方法无明显差异(P0.05)。PPD皮肤试验、血清抗结核抗体、T-SPOT.TB的阳性率分别为:46.2%、41.5%、86.2%。T-SPOT.TB的阳性率显著高于PPD皮肤试验(P0.05),和血清抗结核抗体(P0.05)。结论(1)脊柱结核的三种影像学表现各具特点,结合起来更有利于脊柱结核的诊断;(2)T-SPOT.TB检测与传统的结核病检测方法相比具有较高的敏感性,可以作为脊柱结核的辅助诊断方法。
[Abstract]:Background in recent years, with the increase of human immune diseases, the increase of population mobility, as well as abuse, irregular use of anti-tuberculosis drugs, the incidence of tuberculosis has increased. At present, there is a lack of basic research on spinal tuberculosis, such as the diagnosis of spinal tuberculosis, drug resistance, as well as the grasp of surgical adaptation, the choice of surgical methods, and so on. The diagnosis of typical spinal tuberculosis is not difficult, but the diagnosis of atypical spinal tuberculosis and early spinal tuberculosis is still a difficult problem for clinicians. It is necessary to explore a rapid and accurate method for the diagnosis of spinal tuberculosis. Objective to summarize the imaging and laboratory characteristics of patients with spinal tuberculosis, and make a comparative analysis, and discuss how to diagnose spinal tuberculosis according to the existing examination methods, so as to provide help for clinicians in the diagnosis of spinal tuberculosis. Methods Sixty-five patients with spinal tuberculosis confirmed by histopathology and antituberculous drug therapy in our hospital from May 2005 to June 2006 were enrolled in this study. And the laboratory tests of tuberculin (PPD) skin test, serum anti-tuberculosis antibody, Mycobacterium tuberculosis antigen-specific interferon- 纬 release test (T-SPOT.TB) and so on. The basic clinical information, imaging data and laboratory results of each patient were collected, and the diagnostic value of various detection methods for spinal tuberculosis was compared and analyzed. Results the average age of 65 patients with spinal tuberculosis was 40.7 卤10.6 years old. There were 60 cases (92.3%) with symptoms of back pain in the main complaint, 10 cases (15.44%) with symptoms of mycobacterium tuberculosis poisoning such as low fever, night sweat, etc. The average time from symptoms to this diagnosis was 477.3 days. The sensitivity of CT and MRI in the diagnosis of spinal deformity was higher than that of CT and MRI (P0.05). The sensitivity of CT in the diagnosis of dead bone formation was higher than that of X-ray and MRI (P0.05). In the diagnosis of paravertebral abscess, the sensitivity of MRI was higher than that of X ray and CT (P0.05). In the diagnosis of intervertebral space stenosis and disc involvement, there was no significant difference among the three imaging methods (P0.05). PPD skin test showed that the positive rates of serum anti-TB antibody T-SPOT.TB were 46.2% and 41.5% respectively. The positive rate of T-SPOT.TB was significantly higher than that of PPD skin test (P0.05) and serum anti-tuberculosis antibody (P0.05). Conclusion (1) the three imaging features of spinal tuberculosis have their own characteristics, and the combination of T-SPOT.TB is more beneficial to the diagnosis of spinal tuberculosis, and (2) T-SPOT.TB is more sensitive than the traditional tuberculosis detection method, and can be used as an auxiliary diagnostic method for spinal tuberculosis.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R529.2

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