山东医药2017，Vol.57Issue(43)：17-20,4.DOI:10.3969/j.issn.1002-266X.2017.43.006
脊柱结核死骨范围与抗结核药物治疗效果的相关性
Correlation between the range of dead bone of patients with spinal tuberculosis and the therapeutic effect of antituberculosis drugs
摘要
Abstract
Objective To investigate the correlation between the range of dead bone of the patients,with spinal tuber-culosis and the therapeutic effect of antituberculosis drugs. Methods Ninety-six patients with spinal tuberculosis of adja-cent double vertebral bodies were enrolled in the prospective cohort study. The lesions were scanned continuously with a thickness of 0. 5mm by 320 slice spiral CT. The largest extent of the dead bone on the axial section,the coronal section and the sagittal section were calculated respectively. The patients were treated by standard antituberculosis chemotherapy regi-men. The patients whose symptoms of tuberculosis poisoning and range of dead bone and abscesses were reduced,local pain were relieved,ESR and C reactive protein decreased,were included in the effective group and were conservatively treated for 12 months. The patients with increased range of dead bone and abscesses,or achieved the indication of operation were included in the invalid group. Risk factors affecting the effectiveness of antituberculosis drugs,such as sex,age, course of disease,and range of dead bone were analyzed by univariate and multivariate logistic regression. The ROC curve was used to determine the appropriate positive reference value. Results One case of atlantoaxial tuberculosis was excluded because the dead bone of whom couldn't be measured according to the method of measurement of spinal tuberculosis in other places. Four cases of drug-resistant tuberculosis were excluded,in which one case showed resistance by abscess puncture and culture,one by puncture biopsy and resistance gene detection,2 by postoperative pathological tissue culture. Two ca-ses strongly required surgery because of worrying about the effectiveness of conservative treatment and then were excluded. Fifty eight patients of 89 patients enrolled in the study at last were successfully treated with antituberculosis drugs and the others undertook operation. The effective rate of conservative treatment with antituberculosis drugs was 65. 2％ . The 89 pa-tients aged 15-80 years,with an average age of 41. 2 years. There were 57 males and 32 females. The course of disease ranged from 0. 5 months to 72 months,with an average of 7. 6 months. The average range of dead bone was 5. 8％ in trans-verse section,4. 6％ in coronal section,4. 9％ in sagittal section,5. 1％ of composite range. When transverse sectional dead bone range exceeded 1. 9％,surgical treatment was needed probably by the result of the ROC curve. When composite dead bone range exceeded 2. 6％,surgical treatment was needed probably. Conclusions The range of dead bone of the patients with spinal tuberculosis has the correlation with the therapeutic effect of antituberculosis drugs,whereas sex,age and the course of disease do not. When transverse sectional dead bone range exceeds 1. 9％,surgical treatment is needed probably by the result of the ROC curve. When composite dead bone range exceeds 2. 6％,surgical treatment is needed probably.关键词
结核病/脊柱结核/死骨/抗结核治疗/手术指征Key words
tuberculosis/spinal tuberculosis/dead bone/antituberculosis/surgical indication分类
医药卫生引用本文复制引用
崔旭,杨晓英,马远征,李力韬,于龙,马一光..脊柱结核死骨范围与抗结核药物治疗效果的相关性[J].山东医药,2017,57(43):17-20,4.基金项目
首都临床特色应用研究项目(Z141107002514055). （Z141107002514055）
