药敏试验指导下个体化治疗方案治疗脊柱结核的临床疗效分析

发布时间：2018-11-20 12:15

【摘要】：目的分析我院脊柱结核耐药情况及研究脊柱结核在药敏试验指导下的个体化抗结核药物治疗方案的临床疗效。方法2010年01月至2011年08月对60例脊柱结核患者实施手术治疗,术中收集脓液、肉芽组织,进行常规处理后接种至L-J(Lowenstein-Jensen改良罗氏培养基),阳性者进行抗酸染色,明确为结核分枝杆菌属,再接种至L-J培养基,进行药物敏感试验测定,根据药物敏感测试结果,参照耐药结核药物使用原则,制定出个体化抗结核药物治疗方案。1.药敏测试结果为耐多药结核,选用其它敏感的一线药物和静脉注射的二线敏感药物,组成5联抗痨方案。2.药敏测试结果只对原治疗方案中一种药物耐药者,将该药物更换为另一敏感的一线杀菌药或静脉注射的二线敏感药物；3.细菌培养结果为阴性、药敏测试结果无耐药或对原治疗药物均敏感者,继续原治疗方案。定期随访,观察患者的全身情况和局部情况,结合X、CT片、ESR(Erythrocyte sedimentation rate血沉),评价结核治愈及椎间植骨融合情况。结果培养标本60例,有34例培养阳性,阳性率为56.7%(34/60)。出现耐药的有11例,耐药率为18.3%(11/60),其中耐多药的1例(同时耐利福平和异烟肼),耐多药率为1.67%(1/60)。利福平耐药率为1.67%(1/60),异烟肼耐药率为3.33%(2/60),左氧氟沙星耐药率为3.33%(2/60),卡那霉素耐药率为6.67%(4/60),链霉素耐药率为8.33%(5/60)。对耐多药的1例患者将利福平和异烟肼更换为卷曲霉素、左氧氟沙星和卡那霉素继续治疗,3个月后停用卡那霉素,共完成疗程18个月；对单耐异烟肼的1例患者将异烟肼更换为左氧氟沙星,完成疗程18个月；对耐左氧氟沙星、卡那霉素、链霉素的9例患者继续原治方案,完成疗程18个月；对培养结果阴性的26例和药敏测试结果为全敏感的23例患者继续原治方案,完成疗程18个月。对耐药的11例患者进行随访,术后3个月全部患者的局部症状和结核中毒症状消失,术后6个月血沉恢复正常,术后18个月,椎间植骨均为4-5级骨性融合,术前有神经症状的5例患者中有3例神经功能完全恢复,1例获得改善,结核均无复发。结论本地区脊柱结耐药率为18.3%,耐多药率为1.67%。药敏测试指导下制定个体化治疗方案治疗脊柱结核的疗效更确切,值得临床推广运用。
[Abstract]:Objective to analyze the drug resistance of spinal tuberculosis in our hospital and to study the clinical effect of individualized antituberculous drug therapy under the guidance of drug sensitivity test. Methods from January 2010 to August 2011, 60 patients with spinal tuberculosis received surgical treatment. The pus and granulation tissue were collected during the operation and then inoculated into L-J (Lowenstein-Jensen modified Roche medium) after routine treatment. The positive patients were stained with acid-fast. For Mycobacterium tuberculosis, then inoculated into L-J medium, drug sensitivity test was carried out. According to the results of drug sensitivity test and referring to the principle of drug resistant TB drug use, the individualized anti-tuberculosis drug treatment scheme was worked out. 1. The results of drug sensitivity test were multidrug resistant tuberculosis. Other sensitive first-line drugs and intravenous second-line sensitive drugs were selected to form a 5-linked anti-tuberculosis regimen. 2. Drug sensitivity test results only to the original treatment of one drug resistance, the drug will be replaced by another sensitive first-line bactericidal drug or intravenous injection of second-line sensitive drug; 3. The results of bacterial culture were negative, the drug sensitivity test results were not resistant or sensitive to the original treatment drugs, continue the original treatment plan. The patients were followed up regularly to observe the whole body and local condition, combined with, ESR (Erythrocyte sedimentation rate erythrocyte sedimentation rate (ESR), to evaluate the cure of tuberculosis and the fusion of intervertebral bone graft. Results the positive rate of culture was 56.7% (34 / 60). The drug resistance rate was 18.3% (11 / 60) in 11 cases, including 1 case of multidrug resistance (both rifampicin and isoniazid), and the multidrug resistance rate was 1.67% (1 / 60). Rifampicin resistance rate was 1.67% (1 / 60), isoniazid resistance rate was 3.33% (2 / 60), levofloxacin resistance rate was 3.33% (2 / 60), kanamycin resistance rate was 6.67% (4 / 60). Streptomycin resistance rate was 8.33% (5 / 60). Rifampicin and isoniazid were replaced by rifampicin and isoniazid as capriamycin, levofloxacin and kanamycin were continued to be treated for 3 months, kanamycin was stopped after 3 months, and the course of treatment was 18 months. Isoniazid was replaced with levofloxacin for 18 months in one patient with isoniazid resistance, and 9 patients who were resistant to levofloxacin, kanamycin and streptomycin were treated with isoniazid for 18 months. 26 cases with negative culture results and 23 cases with full sensitivity test were treated with primordial therapy for 18 months. 11 patients with drug resistance were followed up. After 3 months, the local symptoms and tuberculosis poisoning symptoms of all the patients disappeared, and the ESR returned to normal at 6 months after operation. After 18 months, the intervertebral bone graft was 4-5 grade bone fusion. Of the 5 patients with neurological symptoms before operation, 3 cases recovered completely, 1 case improved and no recurrence of tuberculosis occurred. Conclusion the drug resistance rate of spinal node and multi-drug resistance in this area is 18. 3 and 1. 67 respectively. Under the guidance of drug sensitivity test, individualized treatment of spinal tuberculosis is more effective and worthy of clinical application.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.2

【参考文献】