摘要
[目的]探讨有效鉴别结核性脊柱炎与布鲁氏菌性脊柱炎的临床指标,减少误诊率。[方法]回顾性分析2014年7月~2017年7月首次就诊于本院脊柱外科最终通过血培养、术后病检和组织培养确诊为结核性脊柱炎49例、布鲁氏菌性脊柱炎患者14例。比较两组患者病畜接触史、发热程度、是否大汗,以及VAS、ESR、CRP、WBC、NC%、病椎上下终板CT值、病椎椎体高度丢失(mm)、病变椎间隙高度丢失(mm)和T-SPOT.TB。[结果]与结核性脊柱炎相比较,布鲁氏菌性脊柱炎有更明确的病畜接触史,有更明显的发热、伴大汗,差异有统计学意义(P<0.05)。结核性脊柱炎的疼痛程度(VAS)明显轻于布鲁氏菌性脊柱炎,两者差异有统计学意义(P<0.05)。但常规检验方面,两组患者在WBC、NC%、ESR、CRP方面的差异均无统计学意义(P>0.05)。结核性脊柱炎的病椎上下终板CT值、椎间隙高度丢失、椎体高度丢失明显大于布鲁氏菌性脊柱炎,两者差异有统计学意义(P<0.05)。结核性脊柱炎T-SPOT.TB阳性率显著高于布鲁氏菌性脊柱炎,两者的差异有统计学意义(P<0.05)。[结论]病畜接触史、发热程度、是否大汗,以及病椎上下终板CT值、椎间隙高度丢失、椎体高度丢失和T-SPOT.TB结果是鉴别结核性与布鲁氏菌性脊柱炎的重要指标。
[Objective] To explore effective differential diagnostic criteria for tuberculous and brucella spondylitis and reduce the misdiagnosis rate.[Methods] A retrospective study was conducted on 63 patients who firstly visited our hospital from July 2014 to July 2017.Of them,49 patients were firmly diagnosed as tuberculous spondylitis（the tuberculosis group）,while the remaining 14 patients were verified as brucella spondylitis（the brucellosis group） by blood culture,postoperative pathological examination and tissue culture.The history of exposure to sick animals,extent of fever and sweat,visual analogue scale（VAS） of pain,as well as routine laboratory tests,imaging measurement and T-SPOT.TB were compared between the two groups.[Results] Compared with the tuberculosis,the brucellosis had more significant history of exposure to sick animals,more severe fever and sweat with statistical differences between them（P〈0.05）.By contrast,the tuberculosis got significantly less VAS than the brucellosis（P〈0.05）,despite the fact that no significant differences were proved regarding to routine laboratory tests,such as WBC,NC%,ESR and CRP between the two groups（P〉0.05）.In term of imagine measuring,the tuberculosis proved significantly higher CT value in the upper and lower endplates of affected vertebrae,more significant intervertebral space and vertebral height loss than the brucellosis,where were statistically significant（P〈0.05）.In addition,the tuberculosis obtained significantly higher positive results of T-SPOT.TB test than the brucellosis（P〈0.05）.[Conclusion] The history of exposure to sick animals,fever and sweat,CT value of the endplates,the intervertebral space and vertebral height loss as well as T-SPOT.TB test should be used as important differential diagnostic criteria for the tuberculous and brucella spondylitis to reduce the misdiagnosis rate.
作者
何少波
孙宇鹏
张春强
杜开利
郭培宇
赵润民
HE Shao-bo;SUN Yu-peng;ZHANG Chun-qiang;DU Kai-li;GUO Pei-yu;ZHAO Run-rain(The First Affiliated Hospital,Kunming Medical University,Kunming 650032,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第17期1580-1584,共5页
Orthopedic Journal of China
基金
云南省科技厅-昆明医科大学联合项目(编号:2013FZ269
2014FB025)
云南省骨科研究所内设机构基金(编号:2016NS022
2017NS024)
关键词
结核性脊柱炎
布鲁氏菌性脊柱炎
CT
鉴别诊断
tuberculous spondylitis
brucella spondylitis
computer tomography （CT）
differential diagnosis
