培养阴性化脓性脊柱炎患者的临床特征及预后  

Clinical characteristics and prognosis of cultured negative pyogenic spondylitis

作　　者：崔云鹏[1] 米川[1] 施学东[1] 王冰[1] 潘元星 林云飞[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《北京大学学报（医学版）》2017年第2期226-230,共5页Journal of Peking University:Health Sciences

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(P>0.05)。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(P>0.05)。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。Objective：There are limited data describing the clinical characteristics and prognosis of culture negative pyogenic spondylitis.The aim of this study was to investigate the treatment,prognosis and clinical characteristics of culture negative pyogenic spondylitis.Methods： A retrospective study reviewed 74 patients who were diagnosed with spondylitis in Peking University First Hospital from January 2010 to December 2015.A total of 27 patients suffered from pyogenic spondylitis.According to the pa-thogenic culture results,the patients were divided into two groups： culture negative group and culture positive group.The clinical characteristics and treatment outcomes between the two groups were compared.Results： The elder were more vulnerable to pyogenic spondylitis,and of the 27 patients,12 patients were female and 15 male.All patients had no history of administration of antibiotics prior to obtaining culture samples.A causative germ was identified in 14/27 patients （51.9%） with Staphylococcus aureus being the most common pathogen.There was no significant difference between the two groups in the patient＇s age,gender,visual analogue score （VAS）,predisposing factor,clinical symptom,sign and spinal segment （P〉0.05）.Erythrocyte sedimentation rate （ESR） （P=0.056） and C-reactive protein （CRP） （P=0.040） of culture negative group were lower in contrast to culture positive group.The incidence of vertebral abscess in culture negative group was higher than in culture positive group （P=0.046）.After treatment,ESR dropped almost equally in both groups,and CRP dropped faster in the culture positive group （P=0.192）.At last,there was no significant difference between the two groups in hospital stay,pain relief,open debridement operation rate,and recurrence rate of infection.Conclusion： ESR and CRP of the culture negative patient were lower than those of the culture positive patient,and the incidence rate of paravertebral abscess was higher than that of the culture positive patient.Afte

关 键 词：脊柱炎 细菌感染 治疗结果 培养阴性 

分 类 号：R681.5[医药卫生—骨科学]