临床及CT特征鉴别非结核分枝杆菌性和结核性椎体骨髓炎  

Clinical and CT differentiation of non-tuberculous and tuberculous mycobacterial spondylitis

作　　者：宋敏[1] 方伟军[1] 韩远远 SONG Min;FANG Wei-jun;HAN Yuan-yuan(Department of Radiology,Guangzhou Chest Hospital,Guangdong 510095,China)

机构地区：[1]广州市胸科医院放射科,广东广州510095

出　　处：《影像诊断与介入放射学》2023年第1期37-42,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的 探讨非结核分枝杆菌性椎体骨髓炎(NTM VO)和结核性椎体骨髓炎(TB VO)的临床及CT特征,进行鉴别诊断。方法 回顾性分析广州市胸科医院2009年~2022年收治的经实验室确诊的21例NTM VO患者(NTM组)与同时期性别年龄匹配的42例TB VO患者(TB组)的临床及CT资料,对比分析两组病例的临床特点和CT表现特征。结果NTM VO以中老年女性为主。NTM组和TB组的创伤史、严重基础病、脊柱外多骨受累、皮肤软组织脓肿、CD4+T细胞降低的发生率分别为38.10%比4.76%、47.62%比19.05%、76.19%比19.05%、61.90%比4.76%、38.10%比9.52%,NTM组的指标明显高于TB组,组间比较有统计学差异(P值分别为0.001、0.036、<0.001、<0.001、0.014)。NTM组和TB组的每个病例受累椎体个数、病灶在椎体内分布呈中央型、附件型、同一个椎体有1个以上的病灶、成骨为主的混合性骨质破坏、骨质密度增高的结节影或斑片影、厚环征的发生率分别为5(2.5,9)比2(2,4)、90.48%比11.90%、23.81%比2.38%、80.95%比1.52%、76.19%比35.71%、61.90%比0、38.10%比0,NTM组指标明显高于TB组,组间比较有统计学意义(P值分别为0.003、<0.001、0.013、<0.001、0.003、<0.001、<0.001)。TB组和NTM组中仅累及2个相邻椎体、死骨、椎体塌陷、脊柱畸形、椎间隙狭窄、椎旁脓肿、周围肌脓肿的发生率及椎旁软组织肿胀/脓肿的厚度、椎旁脓肿累及椎体数分别为52.38%比14.29%、95.24%比9.52%、64.29%比28.57%、40.48%比4.76%、73.81%比19.05%、100%比28.57%、45.24%比14.29%、1.45(1,1.9)比0.5(0.2,0.95)、3(2,4)比1(1,2),TB组指标明显高于NTM组,组间比较均有统计学差异(P值分别0.006、<0.001、0.015、0.003、<0.001、<0.001、0.024、<0.001、<0.001)。结论 基于临床特点及CT表现特征可鉴别NTM VO和TB VO,有助于早期诊疗。Objective To investigate the clinical and CT features of spondylitis caused by non-tuberculous mycobacteria(NTM) and Mycobacterium tuberculosis(TB). Methods The clinical information and CT of 63 gender-and age-matched patients with microbiologically confirmed NTM(21) and TB(42) spondylitis in our hospital from 2009 to 2022 were retrospectively analyzed. Results The majority of NTM spondylitis was middle-aged to elderly women. The incidence of trauma(38.10%), disease severity(47.62%), extraspinal bone involvement(76.19%), skin and soft tissue abscess(61.90%), and CD4+T cell reduction(38.10%) in NTM group was significantly higher(P=0.001, 0.036, <0.001, <0.001, 0.014) than those in TB group(4.76%, 19.05%, 19.05%, 4.76%, 9.52%). The number of infected vertebrae(5, 2.5-9), incidence of central(90.48%) or peripheral(23.81%) distribution of lesions within the vertebrae, more than 1 lesion in the same vertebrae(80.95%), predominant sclerotic mixed bone destruction(76.19%), nodular or patchy increased density(61.90%),and thick ring sign(38.10%) in NTM group were significantly higher(P=0.003, <0.001, 0.013, <0.001, 0.003, <0.001, <0.001) than that of TB group was(2, 2-4;11.90%;2.38%;1.52%;35.71%;0;0). The incidence of lesions involving only two adjacent vertebrae(52.38%),subligamentous lesions(95.24%), dead bone(64.29%), vertebral collapse(40.48%), spinal deformity(73.81%), intervertebral space stenosis(4.76%), calcification in paravertebral abscess(100%), peripheral muscle abscess(45.24%), the thickness of paravertebral soft tissue swelling/abscess(1.45 cm, 1-1.9 cm), and the number of vertebrae surrounded by paravertebral abscess(3, 2-4) in TB group were significantly higher(P=0.006, 0.006, 0.003, <0.001, 0.015, 0.003, <0.001, <0.001, 0.024, <0.001, <0.001) than that of NTM group(14.29%;9.52%;28.57%;19.05%;28.57%;14.29%;0.5 cm, 0.2-0.95 cm;1, 1-2). Conclusion The clinical and CT features are helpful for differential diagnosis of NTM and TB spondylitis.

关 键 词：非结核分枝杆菌 脊柱炎 结核 脊柱 临床表现 计算机体层摄影术 

分 类 号：R681.51[医药卫生—骨科学] R814.42[医药卫生—外科学]