本文選題：脊柱結(jié)核 + 診斷　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景近年來,隨著人類免疫性疾病的增加、人口流動(dòng)性的增大,以及濫用、不規(guī)律應(yīng)用抗結(jié)核藥物,結(jié)核病發(fā)病率有增高的趨勢(shì)。目前關(guān)于脊柱結(jié)核的基礎(chǔ)研究尚缺乏,例如脊柱結(jié)核的診斷、耐藥問題,以及手術(shù)適應(yīng)征的把握、手術(shù)方式的選擇等。典型的脊柱結(jié)核診斷不難,但是不典型脊柱結(jié)核和早期脊柱脊柱結(jié)核的診斷仍是臨床醫(yī)生的一大難題。如何利用現(xiàn)有的檢查手段,探索出一條快速、準(zhǔn)確的脊柱結(jié)核的診斷方法,顯得尤為必要。目的總結(jié)脊柱結(jié)核患者的影像學(xué)及實(shí)驗(yàn)室化驗(yàn)特點(diǎn),并做對(duì)比分析,探討如何根據(jù)現(xiàn)有的檢查手段診斷脊柱結(jié)核,為臨床醫(yī)生對(duì)脊柱結(jié)核的診斷提供幫助。方法收集我院骨外科2015.05-2016.06收治的經(jīng)組織病理學(xué)及抗結(jié)核藥物治療證實(shí)的脊柱結(jié)核的患者65例,所有患者均施行了X線、CT平掃+骨骼三維成像(以下簡稱CT)、MRI檢查;以及結(jié)核菌素(PPD)皮膚試驗(yàn)、血清抗結(jié)核抗體、結(jié)核桿菌抗原特異性γ干擾素釋放試驗(yàn)(T-SPOT.TB)等實(shí)驗(yàn)室化驗(yàn)。收集每例患者的基本臨床信息、影像學(xué)資料及實(shí)驗(yàn)室化驗(yàn)結(jié)果,比較并分析各種檢測方法對(duì)脊柱結(jié)核的診斷價(jià)值。結(jié)果65例脊柱結(jié)核患者,平均年齡40.7±10.6歲,主訴中含有背部疼痛癥狀的有60例,占92.3%;伴有低熱、盜汗等結(jié)核桿菌中毒癥狀的有10例,占15.4%;65例患者,從出現(xiàn)癥狀到本次確診時(shí)間平均477.3天。在診斷脊柱畸形方面,X線較CT及MRI敏感性高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),在診斷死骨形成方面,CT的敏感性高于X線和MRI(P0.05)。在診斷椎旁膿腫形成、硬膜囊受壓方面,MRI的敏感性高于X線和CT(P0.05)。在診斷椎間隙狹窄、椎間盤受累方面,三種影像學(xué)檢查方法無明顯差異(P0.05)。PPD皮膚試驗(yàn)、血清抗結(jié)核抗體、T-SPOT.TB的陽性率分別為:46.2%、41.5%、86.2%。T-SPOT.TB的陽性率顯著高于PPD皮膚試驗(yàn)(P0.05),和血清抗結(jié)核抗體(P0.05)。結(jié)論(1)脊柱結(jié)核的三種影像學(xué)表現(xiàn)各具特點(diǎn),結(jié)合起來更有利于脊柱結(jié)核的診斷;(2)T-SPOT.TB檢測與傳統(tǒng)的結(jié)核病檢測方法相比具有較高的敏感性,可以作為脊柱結(jié)核的輔助診斷方法。
[Abstract]:Background in recent years, with the increase of human immune diseases, the increase of population mobility, as well as abuse, irregular use of anti-tuberculosis drugs, the incidence of tuberculosis has increased. At present, there is a lack of basic research on spinal tuberculosis, such as the diagnosis of spinal tuberculosis, drug resistance, as well as the grasp of surgical adaptation, the choice of surgical methods, and so on. The diagnosis of typical spinal tuberculosis is not difficult, but the diagnosis of atypical spinal tuberculosis and early spinal tuberculosis is still a difficult problem for clinicians. It is necessary to explore a rapid and accurate method for the diagnosis of spinal tuberculosis. Objective to summarize the imaging and laboratory characteristics of patients with spinal tuberculosis, and make a comparative analysis, and discuss how to diagnose spinal tuberculosis according to the existing examination methods, so as to provide help for clinicians in the diagnosis of spinal tuberculosis. Methods Sixty-five patients with spinal tuberculosis confirmed by histopathology and antituberculous drug therapy in our hospital from May 2005 to June 2006 were enrolled in this study. And the laboratory tests of tuberculin (PPD) skin test, serum anti-tuberculosis antibody, Mycobacterium tuberculosis antigen-specific interferon- 緯 release test (T-SPOT.TB) and so on. The basic clinical information, imaging data and laboratory results of each patient were collected, and the diagnostic value of various detection methods for spinal tuberculosis was compared and analyzed. Results the average age of 65 patients with spinal tuberculosis was 40.7 鹵10.6 years old. There were 60 cases (92.3%) with symptoms of back pain in the main complaint, 10 cases (15.44%) with symptoms of mycobacterium tuberculosis poisoning such as low fever, night sweat, etc. The average time from symptoms to this diagnosis was 477.3 days. The sensitivity of CT and MRI in the diagnosis of spinal deformity was higher than that of CT and MRI (P0.05). The sensitivity of CT in the diagnosis of dead bone formation was higher than that of X-ray and MRI (P0.05). In the diagnosis of paravertebral abscess, the sensitivity of MRI was higher than that of X ray and CT (P0.05). In the diagnosis of intervertebral space stenosis and disc involvement, there was no significant difference among the three imaging methods (P0.05). PPD skin test showed that the positive rates of serum anti-TB antibody T-SPOT.TB were 46.2% and 41.5% respectively. The positive rate of T-SPOT.TB was significantly higher than that of PPD skin test (P0.05) and serum anti-tuberculosis antibody (P0.05). Conclusion (1) the three imaging features of spinal tuberculosis have their own characteristics, and the combination of T-SPOT.TB is more beneficial to the diagnosis of spinal tuberculosis, and (2) T-SPOT.TB is more sensitive than the traditional tuberculosis detection method, and can be used as an auxiliary diagnostic method for spinal tuberculosis.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R529.2

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