数字减影血管造影下置管药物灌注治疗脊柱结核的疗效  

Clinical efficacy of catheteringdrug infusion with digital subtraction angiography in the treatment of spine tuberculosis

作　　者：禹志军 王锋[1] 白曼莫 何维新[1] 吴海波[1] 王炳南[2] YU Zhi-jun;WANG Feng;BAI Man-mo;HE Wei-xin;WU Hai-bo;WANG Bing-nan(Department of Orthopedics and Traumatology,Sanya Hospital of Chinese Medicine,Hainan Province,Sayan 572000,China;Department of Orthopedics and Traumatology,Yuehai Hospital of Guangzhou University of Chinese Medicine,Sayan 572000,China)

机构地区：[1]海南省三亚市中医院骨伤科,三亚572000 [2]广州中医药大学粤海医院骨伤科,三亚572000

出　　处：《临床药物治疗杂志》2020年第10期24-29,共6页Clinical Medication Journal

摘　　要：目的探讨数字减影血管造影(DSA)下置管药物灌注治疗脊柱胸腰椎结核的疗效。方法对2014年10月至2017年10月在海南省三亚市中医院接受治疗的91例胸腰椎结核患者,根据是否采用置管引流冲洗,分为灌注组(n=39)和非灌注组(n=52)。比较2组患者治疗后血沉(ESR)和C反应蛋白(CRP)水平;比较患者症状改变、脊柱结核灶的体积变化及不良反应情况。结果 2组患者治疗后的ESR和CRP水平比较,灌注组[ESR:治疗1个月(33.3±4.3)mm/h、治疗6个月(7.7±1.8)mm/h、治疗12个月(7.3±1.8)mm/h;CRP:治疗1个月(104.26±11.16)mg/L、治疗6个月(98.05±10.33)mg/L、治疗12个月(74.02±9.94)mg/L]的改善明显好于非灌注组[ESR:治疗1个月(43.1±4.3)mm/h、治疗6个月(38.0±3.2)mm/h、治疗12个月(26.8±2.9)mm/h;CRP:治疗1个月(152.89±12.04)mg/L、治疗6个月(144.26±12.22)mg/dL、治疗12个月(121.01±10.0)mg/L],差异具有统计学意义(P<0.05)。其中,灌注组治疗第6个月时ESR改善了45.7(95%CI:40.9~50.4)mm/h,非灌注组治疗第12个月时ESR改善了22.7(95%CI:17.8~27.6)mm/h;灌注组治疗第1个月时CRP改善了83.05(95%CI:76.30~89.80)mg/L、非灌注组至治疗第12个月CRP改善了68.54(95%CI:62.66~74.43)mg/L。治疗12个月后,灌注组患者的发热(χ^2=5.186,P<0.05))、乏力(χ^2=9.848,P<0.05)、背痛(χ^2=6.303,P<0.05)症状均改善,而非灌注组仅发热症状得到改善(χ^2=6.190,P<0.05),灌注组结核相关症状的改善情况优于非灌注组。治疗12个月后,灌注组病灶大小的改善比非灌注组更多,差异有统计学意义(t=-9.247,P<0.05);治疗期间灌注组共8例出现不良反应、非灌注组出现12例不良反应,差异无统计学意义(χ^2=0.085,P>0.05)。结论 DSA下置管药物灌注治疗胸腰椎脊柱结核的临床疗效确切,未增加不良反应,值得在临床推广应用。Objective To investigate the clinical efficacy of athetering drug infusion with digital subtraction angiography(DSA)for thoracolumbar spine tuberculosis. Methods A total of 91 patients with thoracolumbar tuberculosis who treated in Sanya Hospital of Chinese Medicine from October 2014 to October 2017 were divided into lavage group(n=39)and non-lavage group(n=52)according to whether they were catheterized or not. Between the two groups,the levels of erythrocyte sedimentation rate(ESR),and the changes of symptoms,volume of spinal tuberculosis foci,and adverse reactions were compared.Results The improvement of ESR and CPR level after treatment in both groups was significantly better in the lavage group than in the non-lavage group,and the difference was statistically significant(P<0. 05)[ESR:(33. 3±4. 3)mm/h after 1 month,(7. 7±1. 8)mm/h after 6 months and(7. 3±1. 8)mm/h after 12 months;CRP:(104. 26±11. 16)mg/L after 1 month,(98. 05±10. 33)mg/L after 6 months and(74. 02±9. 94)mg/L after 12 months]than that in the non-lavage group[ESR:(43. 1±4. 3)mm/h after 1 month,(38. 0±3. 2)mm/h after 6 months and(26. 8±2. 9)mm/h after 12 months;CRP:(152. 89±12. 04)mg/L after 1 month,(144. 26±12. 22)mg/L after 6 months and(121. 01±10. 00)mg/L after 12 months],and the difference was statistically significant(P<0. 05). ESR ranged 45. 7(95% CI:40. 9-50. 4)mm/h in the lavage group after 6 months,and ranged 22. 7(95% CI:17. 8-27. 6)mm/h in the non-lavage group after 12 months;CRP in the lavage group ranged 83. 05(95% CI:76. 30-89. 80)mg/L after the first month of treatment,and ranged 68. 54(95% CI:62. 66-74. 43)mg/L after the 12 th month of treatment. After 12 months of treatment,the symptoms of fever(χ^2=5. 186,P<0. 05),weakness(χ^2=9. 848,P<0. 05),and back pain(χ^2=6. 303,P<0. 05)was significantly improved in the lavage group,while only fever symptom was improved in the non-lavage group(χ^2=6. 190,P<0. 05),the improvement of tuberculosis-related symptoms in the lavage group was better than that in the non-lavage group.

关 键 词：灌洗疗法 结核 脊柱 血管造影术 

分 类 号：R978.3[医药卫生—药品] R969.3[医药卫生—药学]