耐药脊柱结核的临床分析及疗效研究

发布时间：2019-04-28 12:10

【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(P0.05)。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]:Aim to analyze the culture and drug sensitivity of tuberculous bacteria in patients with spinal tuberculosis, and to explore the efficacy and significance of CT-mediated paravertebral puncture combined with systemic anti-tuberculosis drugs in the treatment of drug-resistant spinal tuberculosis. Methods 1156 inpatients with spinal tuberculosis diagnosed from June 2005 to September 2013 in Changsha Central Hospital were retrospectively studied. Pus and cheese-like samples from bone lesions were obtained by paravertebral puncture for culture and drug sensitivity test of Mycobacterium tuberculosis, and drug resistance analysis was carried out. Drug-resistant spinal tuberculosis was treated with CT-guided paravertebral puncture combined with systemic anti-tuberculosis drugs, and the curative effect was evaluated according to the clinical cure standard of tuberculosis. Results the positive rate of Mycobacterium culture was 24.74% (286 / 156), and the drug-resistant rate was 28.67% (82 / 286) in 82 cases of drug-resistant tuberculosis of spinal column, and the positive rate of mycobacterium culture was 24.74% (286 / 156). The resistance to isoniazid (H), rifampicin (R) and streptomycin (S) were 52, 50 and 44 (18.18%), 17.48% (50 / 286) and 15.38% (44 渭 286), respectively. There were 23 cases of multidrug-resistant tuberculosis (MDR-TB), accounting for 8.04% (23 / 286) of the positive patients. The initial drug resistance rate was 18.13% (33 / 182) in the first treatment group and 47.12% (49 / 104) in the retreatment group. The difference of total drug resistance rate between the two groups was statistically significant by 蠂 ~ 2 test (P0.05). 72 patients with drug-resistant spinal tuberculosis were cured by conservative medical treatment and 12 patients were converted to surgery. Follow-up for 1-3 years showed no recurrence in all patients with drug-resistant spinal tuberculosis. Conclusion CT-guided paravertebral puncture is helpful for the early diagnosis of drug-resistant spinal tuberculosis, and the combination of standardized and personalized systemic anti-tuberculosis drugs is of great significance in curing drug-resistant spinal tuberculosis, preventing complications and preventing acquired drug resistance.
【作者单位】：湖南省长沙市中心医院肺二科;
【分类号】：R529.2

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