本文選題：結(jié)核病 + 脊柱結(jié)核��； 參考：《山東醫(yī)藥》2017年43期

【摘要】：目的探討脊柱結(jié)核死骨范圍和抗結(jié)核藥物治療效果的相關(guān)性。方法選擇相鄰雙椎體脊柱結(jié)核患者96例,進(jìn)行前瞻性隊(duì)列研究。采用東芝Aquillon one 320排螺旋CT對病灶區(qū)進(jìn)行層厚0.5 mm的連續(xù)掃描,并進(jìn)行二維重建,分別選取病灶區(qū)橫斷面、冠狀面和矢狀面死骨范圍最大的層面,用320排螺旋CT的面積測量工具測量該層面死骨面積。橫斷面的死骨面積與相鄰正常椎體橫斷面積比值的百分?jǐn)?shù)為橫斷面死骨范圍,冠狀面的死骨面積與相鄰正常椎體最大冠狀面積比值的百分?jǐn)?shù)為冠狀面死骨范圍,矢狀面的死骨面積與相鄰正常椎體正中矢狀面積比值的百分?jǐn)?shù)為矢狀面死骨范圍;橫斷面、冠狀面和矢狀面死骨范圍之和的平均值為綜合死骨范圍。對96例患者采用標(biāo)準(zhǔn)抗結(jié)核化療方案進(jìn)行治療,將治療過程中結(jié)核中毒癥狀減輕、局部疼痛緩解、死骨膿腫范圍縮小、血沉和C反應(yīng)蛋白下降的病例判為治療有效者,繼續(xù)保守治療至療程滿12個(gè)月;將治療過程中死骨、膿腫范圍增大,或者達(dá)到手術(shù)指征,停止保守治療改為手術(shù)治療的患者判為治療無效者。對影響抗結(jié)核藥物治療效果的危險(xiǎn)因素,包括性別、年齡、病程、死骨范圍,進(jìn)行Logistic回歸單因素及多因素分析,判斷各因素的相對危險(xiǎn)性。利用受試者工作特征曲線(ROC)確定合適的死骨范圍陽性參考值(即最適合進(jìn)行抗結(jié)核藥物治療的死骨范圍),此范圍以上就是達(dá)到手術(shù)指征的死骨范圍。結(jié)果治療過程中1例寰樞椎結(jié)核患者因無法按照其他部位脊柱結(jié)核的測量方法測量死骨范圍而被排除出組,4例因耐藥排除出組(其中1例膿液穿刺培養(yǎng)顯示耐藥,1例穿刺活檢耐藥基因檢測顯示耐藥,2例抗結(jié)核治療、術(shù)后病理組織培養(yǎng)顯示耐藥),2例不具備手術(shù)指征但患者強(qiáng)烈要求手術(shù)而被排除出組。最終入組的89例患者中,58例抗結(jié)核藥物治療有效,31例抗結(jié)核治療失敗而采取手術(shù)治療。89例患者年齡15~80歲(平均41.2歲),男57例、女32例,病程0.5~72個(gè)月,橫斷面死骨范圍平均值為5.8%,冠狀面死骨范圍平均值為4.6%,矢狀面死骨范圍平均值為4.9%,綜合死骨范圍平均值為5.1%。Logistic逐步回歸分析顯示橫斷面死骨范圍、綜合死骨范圍和抗結(jié)核藥物治療效果相關(guān)(P均0.01)。以橫斷面死骨范圍作為診斷指標(biāo),適合抗結(jié)核治療或手術(shù)治療的最佳臨界值為1.9%,其預(yù)測敏感度和特異度分別達(dá)96.77%、65.52%,橫斷面死骨范圍超過1.9%更需要手術(shù)治療。以綜合死骨范圍作為診斷指標(biāo),適合抗結(jié)核治療或手術(shù)治療的最佳臨界值為2.6%,其預(yù)測敏感度和特異度分別為93.55%、68.97%,綜合死骨范圍超過2.6%更需要手術(shù)治療。結(jié)論脊柱結(jié)核死骨范圍與抗結(jié)核藥物治療效果具有相關(guān)性,橫斷面死骨范圍超過1.9%需要手術(shù)治療的可能性大,綜合死骨范圍超過2.6%需要手術(shù)治療的可能性大。
[Abstract]:Objective to investigate the correlation between the dead bone range of spinal tuberculosis and the effect of anti tuberculosis drug treatment. Methods 96 cases of adjacent double vertebral tuberculosis were selected for prospective cohort study. Using Toshiba Aquillon one 320 row spiral CT, the thickness of the lesion area was continuously scanned with the thickness of 0.5 mm, and two dimensional reconstruction was performed to select the cross section of the lesion area and the crown respectively. The dead bone area was measured by the area measuring tool of 320 rows of spiral CT. The percentage of the ratio of the dead bone area to the adjacent normal vertebral area was the cross section of the dead bone. The percentage of the ratio of the dead bone area to the adjacent normal vertebral area was the crown. The percentage of the ratio between the dead bone area of the sagittal plane and the median sagittal area of the adjacent normal vertebral body was the dead bone range of the sagittal plane; the average value of the cross section, the average dead bone range of the coronal and sagittal plane was the comprehensive dead bone range. 96 patients were treated with the standard anti tuberculosis chemotherapy regimen, and the tuberculosis intoxication in the treatment process was carried out. The symptoms were relieved, local pain relieved, the scope of the dead bone abscess narrowed, the cases of erythrocyte sedimentation and C reaction protein decline were judged to be effective, and continued conservative treatment lasted for 12 months; the dead bone, the abscess range increased, or the surgical indication was reached, and the patients who had stopped conservative treatment to surgical treatment were judged to be ineffective. The risk factors for the effect of anti tuberculosis drugs, including sex, age, course of disease, dead bone range, single factor and multi factor analysis of Logistic regression, were used to determine the relative risk of each factor. The positive reference value of the suitable dead bone range was determined by using the working characteristic curve (ROC) of the subjects (that is, the most suitable for anti tuberculosis drug treatment. " 1 cases of atlantoaxial tuberculosis were excluded because of the failure to measure the range of the dead bone according to the measurement of other parts of the spinal tuberculosis, and 4 cases were excluded from the drug resistance group (1 cases of pus piercing culture showed resistance, 1 cases of drug-resistant biopsies. " 2 cases of anti tuberculosis treatment and postoperative pathological tissue culture showed drug resistance. 2 cases had no indications of surgery but the patients were strongly required to be excluded from the operation. Of the 89 patients, 58 cases of anti tuberculosis drugs were effective, 31 cases of anti tuberculosis treatment failed and.89 patients were aged 15~80 years old (average 41.2 years old). There were 57 men and 32 women, with a course of 0.5~72 months, the average value of the dead bone range was 5.8%, the average of the dead bone range was 4.6%, the average of the dead bone of the sagittal plane was 4.9%. The average dead bone range was 5.1%.Logistic stepwise regression analysis showed the cross section of the dead bone range, and the comprehensive range of dead bone was related to the effect of anti tuberculosis drug treatment (P all 0.01. As a diagnostic index, the optimum critical value for the treatment of anti tuberculosis or surgical treatment is 1.9%, and its predictive sensitivity and specificity are 96.77%, 65.52%, and more than 1.9% of the cross section of the dead bone need surgical treatment. The critical value was 2.6%, its predictive sensitivity and specificity were 93.55%, 68.97%, and the comprehensive range of dead bone was more than 2.6%. Conclusion the dead bone range of spinal tuberculosis was related to the effect of anti tuberculosis drug treatment. The possibility of surgical treatment in the cross section of the cross section of the cross section was greater than 1.9%, and the comprehensive range of dead bone was more than 2.6%. The possibility of surgical treatment is great.
【作者單位】： 中國人民解放軍第309醫(yī)院;吉林省長春通源醫(yī)院北京阜外醫(yī)院吉林診療中心;
【基金】：首都臨床特色應(yīng)用研究項(xiàng)目(Z141107002514055)
【分類號】：R529.2

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