脊柱结核959例临床特征分析  

Analysis of clinical characteristics of 959 cases of spinal tuberculosis

作　　者：刘建 王学伟[1] 王发选 马宏宝 施建党[1,2] 丁惠强[1,2] 乔永东[1,2] 牛宁奎[1,2] LIU Jian;WANG Xuewei;WANG Faxuan;MA Hongbao;SHI Jiandang;DING Huiqiang;QIAO Yongdong;NIU Ningkui(Department of Spine and Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院脊柱骨科,银川750004 [2]宁夏医科大学总医院病案统计室,银川750004 [3]宁夏医科大学公共卫生与管理学院

出　　处：《中国感染与化疗杂志》2022年第3期271-276,共6页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81860395);宁夏自然科学基金(2020AAC03391);自治区卫生健康系统科研课题(2019-NW-011);宁夏高等学校一流学科建设(宁夏医科大学国内一流建设学科临床医学)资助项目(NXYLXK2017A05)。

摘　　要：目的探讨脊柱结核患者的临床特征及其流行病学特点。方法收集2002年1月1日—2020年12月31日就诊于宁夏医科大学总医院经临床表现、影像学检查、实验室检查、组织病理学等确诊的脊柱结核住院患者临床资料,分析患者性别、年龄、临床表现、实验室检查、影像学检查、治疗方案、是否有结核病史及相关基础疾病。结果纳入959例脊柱结核患者,男477例,女482例,平均年龄(46.2±17.8)岁,>45~55岁年龄段发病人数最多,农村患病人数(80.71%)较城市(19.29%)多,患者职业主要以农民(47.03%)为主。最主要临床症状以颈、胸、腰、骶部疼痛为主,占93.64%,其次盗汗(40.02%)、乏力(43.83%)、体重减轻(29.02%)常见;508例患者(52.97%)合并肺结核病史,基础疾病以心血管系统疾病(15.74%)最常见,其中以高血压最为突出,无合并HIV感染患者;白细胞计数(WBC)、C反应蛋白(CRP)、红细胞沉降率(ESR)检验结果异常率分别为11.26%、82.27%、88.74%;共累及2389个椎体,腰椎最常见(47.72%),其次是胸椎(41.98%)、骶椎(6.24%)、颈椎(3.98%)、尾骨(0.08%),在颈、胸、腰、骶椎体各个节段分别以颈6、胸12、腰4、骶1椎体最常见,267例患者(27.84%)病灶在椎体间有跳跃病变,腰骶椎体跳跃病变最常见,671例患者(69.97%)累及2个椎体病灶;718例患者合并寒性脓肿,其中以椎旁脓肿(56.52%)最常见。治疗以异烟肼(94.89%)、利福平(93.43%)等一线化疗药物联合抗结核治疗为基础,附加外科手术干预(76.02%),以后路固定、前路病灶清除术最常见(82.58%);91.55%患者均能获得良好的临床疗效。结论脊柱结核主要以农村、中壮年居多,应加强农民宣教,关注中壮年,注重肺结核防控及脊柱结核的早期筛查;脊柱结核临床症状以颈、胸、腰、骶部疼痛为主,全身结核病中毒症状较轻;治疗以异烟肼、利福平、吡嗪酰胺、乙胺丁醇一线药物为主,临床上常以4种药物联合用药�Objective To investigate the clinical and epidemiological characteristics of patients with spinal tuberculosis.Methods The clinical data of inpatients with spinal tuberculosis diagnosed in the General Hospital of Ningxia Medical University from January 1,2002 to December 31,2020 were collected,including sex,age,tuberculosis history,underlying diseases,clinical manifestations,imaging examinations,laboratory tests,and histopathology,treatment regimens.Results A total of 959 patients(average 46.2±17.8 years of age)with spinal tuberculosis were included,including 477 males and 482 females.The age group of>45-55 years had the largest number of patients.More patients lived in rural areas than in urban areas(80.71%vs 19.29%).About half of the patients(47.03%)were farmers.The main clinical symptoms were pain in neck,chest,lumbar,and sacral region(93.64%),followed by night sweats (40.02%), weakness (43.83%), and weight loss (29.02%). Overall, 508 patients (52.97%) had a history of pulmonary tuberculosis. Cardiovascular disease was the most common underlying disease (15.74%), most of which was hypertension. None of the patients was positive for HIV. The results of white blood cell count (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were abnormal in 11.26%, 82.27%, and 88.74% of the patients, respectively. A total of 2 389 vertebral bodies were involved. The lumbar spine was the most common site (47.72%), followed by thoracic vertebrae (41.98%), sacral vertebrae (6.24%), cervical vertebrae (3.98%), coccyx (0.08%). C6, T12, L4, and S1 were the most common site of tuberculosis. Lesions spanning two or more vertebral bodies were found in 267 patients (27.84%), especially lumbosacral lesions. Two- vertebrae lesion was identified in 671 patients (69.97%). In the 718 patients with chronic abscess, paravertebral abscess (56.52%) was the most common. The first-line chemotherapy drugs were the mainstay treatment, including isoniazid (94.89%) and rifampicin (93.43%) combined with other anti-tuberculosis t

关 键 词：脊柱结核 临床特征 诊断 治疗 

分 类 号：R529.2[医药卫生—内科学]