布鲁杆菌性脊柱炎临床特征及误诊分析  

Clinical features and＇ misdiagnosis of brucellosis spondylitis

作　　者：于占水[1] 程大伟[1] 陈雪英[1] 谢福杰[1] 李福兴[1] 

机构地区：[1]黑龙江省农垦总局总医院布鲁杆菌病科,哈尔滨150088

出　　处：《中华地方病学杂志》2013年第5期559-561,共3页Chinese Journal of Endemiology

摘　　要：目的观察布鲁杆菌性脊柱炎临床特征，分析该病易误诊原因，提高诊断及鉴别诊断水平。方法选择2011年1月至2012年12月在黑龙江省农垦总局总医院确诊且住院治疗的布鲁杆菌性脊柱炎患者42例作为观察对象，回顾性调查分析其住院病历资料。观察指标包括患者的一般情况、病史、临床症状体征，磁共振检查结果、血清试管凝集试验（SAT）检查结果等。结果布鲁杆菌性脊柱炎患者临床症状与体征主要表现为严重的持续性颈背及腰腿疼痛，腰背部呈板状，无后凸畸形，脊柱活动明显受限，常呈固定姿势，站立时脊柱侧弯或骨盆倾斜，跛行，可出现典型神经根压迫症状。病史中误诊为脊柱结核的占30．95％（13／42）、腰椎间盘突出症的占14．28％（6／42）、强直性脊柱炎的占4．76％（2／42），总误诊率为50％（21／42）。磁共振检查可见，病变椎体内不规则异常信号影，T1加权像（T1WI）呈低信号，T2加权像（T2WI）呈高信号或高低混杂信号影，椎体未见塌陷呈楔形变，未见死骨；椎间盘内见条形、片状异常信号影，正常结构消失，椎间隙变窄，相应平面硬膜囊受压．脊柱旁可见脓肿形成，但未见腰大肌脓肿。SAT试验阳性率为92．85％（39／42）。结论布鲁杆菌性脊柱炎临床特征不典型，误诊原因主要是询问病史不详、临床症状不典型、影像学缺乏特征性改变等。Objective To observe the clinical features of brucellosis spondylitis and analyse the reasons for its misdiagnosis, and improve the level of diagnosis and differential diagnosis. Methods Forty-two clinically diagnosed patients with brucellosis spondylitis were studied retrospectively, and these patients were diagnosed and hospitalized in the General Hospital of Heilongjiang Land Reclamation Bureau. Their medical records were analyzed, which included the general information, medical history, clinical symptoms, results of magnetic resonance imaging（MRI） and serum tube agglutination test（SAT） and so on. Results Main clinical symptoms and signs were severe persistent neck, back and leg pain. They also had plate shape low back but without kyphosis. In addition, patients had to keep in one posture because their spinal activity was limited. Also, scoliosis or pelvic tilt and lameness may occur when standing, which were typical symptoms of nerve root compression. Thirteen cases were diagnosed as tuberculosis, accounting for 30.95% （13/42）; 6 cases were diagnosed as lumbar disc herniation, accounting for 14.28% （6/42）; 2 cases were diagnosed as ankylosing spondylitis, accounting for 4.76% （2/42）. Therefore, the total rate of misdiagnosis was 50% （21/42）. Abnormal MRI signal intensity can be seen in the pathological vertebrae. Specifically, Tl-weighted images（T1WI） showed low signal, T2-weighted images（T2WI） showed high signal, or mixed high and low signal intensity was observed. Vertebral showed wedge deformation without collapse and sequestrum; strip and sheet abnormal signal can also be found within the intervertebral disc. Normal structure disappeared and disc space became narrow. Accordingly, the plane dural sac was compressed to form visible abscess near the spine, but psoas abscess was not found. Patients with positive SAT result accounted for 92.85% （39/42）. Conclusion Reasons for misdiagnosis include lack of detailed medical records, atypical clinical symptoms and similar imagin

关 键 词：布鲁杆菌病 脊柱炎 疾病特征 

分 类 号：R516.7[医药卫生—内科学]