摘要
目的分析耐药脊柱结核的个体化治疗措施及治疗效果。方法收集河北省胸科医院骨科2009年1月至2014年1月收治的耐药脊柱结核患者60例，根据病情及药物敏感性试验（简称“药敏试验”）结果制定个体化手术及化疗方案。对患者术前及末次随访时的疼痛视觉模拟评分（VAS）、血红细胞沉降率、美国脊柱损伤协会（ASIA）~经功能分级、Cobb角变化情况及治疗效果进行评价。应用SPSS17．0统计软件进行统计学分析，计量资料以“x±s”表示，在符合正态分布，且方差齐性的情况下采用配对t检验，以P〈0．05为差异有统计学意义。结果60例患者中单耐药14例，多耐药26例，耐多药5例，广泛耐药15例。患者化疗时间24～36个月，平均（28．41±3．50）个月。末次随访时VAS平均为（1．40±0．40）分，较术前[（8．10±1．18）分]明显下降，差异有统计学意义（t=34．54，P=0．001）；末次随访时血红细胞沉降率为（11．31±2．60）mm／1h，较术前[（53．60±9．51）mm／]h]明显下降，差异有统计学意义（t=13．86，P=0．001）；末次随访时脊柱Cobb角为（15．71±2．30）°，较术前[（49．52±8．21）°]明显改善，差异有统计学意义（t=11．63，P=0．005）。46例患者获得I级骨性愈合，10例获得Ⅱ级骨性愈合，3例获得Ⅲ级骨性愈合，1例获得Ⅳ级骨性愈合。并发神经功能损伤的42例患者，末次随访时，2例ASIA神经功能分级无变化，4例改善2级，35例改善1级，1例下降1级。至末次随访时，60例患者脊柱结核均获得治愈。结论基于药敏试验结果的个体化化疗联合手术治疗效果较好，是尽早治愈耐药脊柱结核的方法。
Objective To discuss individual treatment and efficacy of drug-resistant tuberculosis （TB） of the spine. Methyls Sixty drug-resistant spinal TB patients from the Chest Hospital of Hebei Province between January 2009 and January 2014 were included. All the patients were treated with individual surgery and chemotherapy according to the condition and the susceptibility test. The preoperative and last follow-up visual analogue scale （VAS）, erythrocyte sedimentation rate, ASIA grade, Cobb angle changes and the treatment effect were evaluated. Using SPSS 17.0 statistical software, data were shown as x±s and compared using paired t test in line with the nor- real distribution and homogeneity of variance case. P〈0. 05 was considered statistically significant. Results Of the 60 patients, 14 were single drug resistant, 26 were poly-resistance tuberculosis, 5 were muhidrug-resistant, and 15 were extensively drug-resistant tuberculosis. Individual chemotherapy patients were followed up for 24 to 36 months with mean of （28. 41±3.50） months. At the last follow-up, mean VAS was significantly lower than that of preoperative （1.40±0.40 vs. 8.10±1.18, t=34. 54, P=0. 001） ;the erythrocyte sedimentation rate was also significantly decreased （（11.31±2.60） mm/1 h vs. （53.60±9.51） mm/1 h） （t=13.86, P=0. 001）. while the spine Cobb angle was significantly improved （（ 15.71±2. 30）° vs. （49.52±8. 21）°） （ t = 11.63, P = 0. 005）. Further-more, the total 60 patients were all cured, and 46 patients were at bone healing grade Ⅰ, 10 were at grade Ⅱ, 3 were at grade Ⅲ and 1 case was at grade Ⅳ. Among the 42 patients complicated with spinal injury, ASIA grade of 2 cases neither improved nor worsen, 4 cases improved by 2 levels, 35 cases improved by 1 level, and 1 case decre- sed by 1 level during the last follow-up. Conclusion Individual chemotherapy combined with surgery based on susceptibility test is effcctive for drug-resistant spine tuberculosis, and it also could shorten the
出处
《中国防痨杂志》
CAS
2016年第11期978-984,共7页
Chinese Journal of Antituberculosis
基金
河北省医学科学研究重点课题（20160501）
关键词
结核
脊柱
结核
抗多种药物性
个体化医学
治疗结果
Tuberculosis, spinal
Tuberculosis, multidrug-resistant
Individualized medicine
Treatment outcome
