培养阴性化脓性脊柱炎患者的临床特征及预后

发布时间：2018-05-02 16:04

本文选题：脊柱炎 + 细菌感染　；参考：《北京大学学报(医学版)》2017年02期

【摘要】：目的:分析培养阴性化脓性脊柱炎的临床特征,探讨培养阴性是否影响患者治疗及预后。方法:回顾性分析北京大学第一医院骨科2010年1月至2015年12月期间收治的化脓性脊柱炎患者共27例,根据病原菌培养结果将患者分为培养阴性组和培养阳性组,对比不同培养结果患者临床特征以及预后情况。结果:培养阴性率为48.1%(13/27),培养阳性组病原菌以葡萄球菌为主。统计结果显示,培养阴性组的红细胞沉降率(erythrocyte sedimentation rate,ESR)(P=0.056)、C-反应蛋白(C-reactive protein,CRP)低于培养阳性组,椎旁脓肿的发生率(P=0.046)高于培养阳性组。两组患者年龄、性别、入院疼痛视觉模拟评分(visual analogue scale score,VAS)、危险因素、临床症状、体征和脊柱受累情况差异无统计学意义(P0.05)。培养阴性组患者行开放清创手术率与培养阳性组患者相比差异无统计学意义(P=0.414)。经治疗后,两组患者住院时间、ESR、CRP下降速度、疼痛缓解情况以及感染复发率差异无统计学意义(P0.05)。两组患者ESR下降速度均慢于CRP。结论:化脓性脊柱炎培养阴性患者的ESR、CRP低于培养阳性患者,椎旁脓肿发生率高于培养阳性患者。药物治疗后,两组患者行开放清创手术率、抗生素应用时间、复发率相比差异无统计学意义,培养阴性并不影响化脓性脊柱炎患者的治疗及预后,但培养阴性患者的抗生素抗菌谱广,长时间应用需警惕耐药菌及二重感染。
[Abstract]:Objective: to analyze the clinical features of culture-negative suppurative spondylitis and to explore whether culture-negative affects the treatment and prognosis of patients. Methods: a total of 27 patients with suppurative spondylitis treated in the Orthopaedic Department of Peking University first Hospital from January 2010 to December 2015 were retrospectively analyzed. According to the results of pathogen culture, the patients were divided into culture negative group and culture positive group. The clinical characteristics and prognosis of patients with different culture results were compared. Results: the negative rate of culture was 48.1% and 13 / 27%. Staphylococcus was the main pathogen in positive culture group. The results showed that the erythrocyte sedimentation rate of the negative culture group was lower than that of the positive culture group, and the incidence of paravertebral abscess was higher than that of the positive culture group. There was no significant difference in age, sex, visual analogue scale scoreVASA, risk factors, clinical symptoms, signs and spinal involvement between the two groups (P 0.05). The rate of open debridement in culture negative group was not significantly different from that in positive culture group. After treatment, there was no significant difference between the two groups in the time of hospitalization and the decreasing speed of ESR-CRP, the relief of pain and the recurrence rate of infection (P 0.05). The decrease rate of ESR in both groups was slower than that in CRP. Conclusion: the level of ESR-CRP in the culture-negative patients with suppurative spondylitis is lower than that in the culture-positive patients, and the incidence of paravertebral abscess is higher than that in the culture-positive patients. After drug treatment, there was no significant difference in open debridement rate, antibiotic use time and recurrence rate between the two groups. Negative culture did not affect the treatment and prognosis of patients with suppurative spondylitis. However, the antibiotic spectrum of culture-negative patients is wide, and it is necessary to be on guard against drug resistant bacteria and double infection for a long time.
【作者单位】：北京大学第一医院骨科;
【分类号】：R681.5

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