【摘要】：目的分析我院脊柱結(jié)核耐藥情況及研究脊柱結(jié)核在藥敏試驗指導(dǎo)下的個體化抗結(jié)核藥物治療方案的臨床療效。 方法2010年01月至2011年08月對60例脊柱結(jié)核患者實施手術(shù)治療,術(shù)中收集膿液、肉芽組織,進行常規(guī)處理后接種至L-J(Lowenstein-Jensen改良羅氏培養(yǎng)基),陽性者進行抗酸染色,明確為結(jié)核分枝桿菌屬,再接種至L-J培養(yǎng)基,進行藥物敏感試驗測定,根據(jù)藥物敏感測試結(jié)果,參照耐藥結(jié)核藥物使用原則,制定出個體化抗結(jié)核藥物治療方案。1.藥敏測試結(jié)果為耐多藥結(jié)核,選用其它敏感的一線藥物和靜脈注射的二線敏感藥物,組成5聯(lián)抗癆方案。2.藥敏測試結(jié)果只對原治療方案中一種藥物耐藥者,將該藥物更換為另一敏感的一線殺菌藥或靜脈注射的二線敏感藥物；3.細菌培養(yǎng)結(jié)果為陰性、藥敏測試結(jié)果無耐藥或?qū)υ委熕幬锞舾姓?繼續(xù)原治療方案。定期隨訪,觀察患者的全身情況和局部情況,結(jié)合X、CT片、ESR(Erythrocyte sedimentation rate血沉),評價結(jié)核治愈及椎間植骨融合情況。 結(jié)果培養(yǎng)標本60例,有34例培養(yǎng)陽性,陽性率為56.7%(34/60)。出現(xiàn)耐藥的有11例,耐藥率為18.3%(11/60),其中耐多藥的1例(同時耐利福平和異煙肼),耐多藥率為1.67%(1/60)。利福平耐藥率為1.67%(1/60),異煙肼耐藥率為3.33%(2/60),左氧氟沙星耐藥率為3.33%(2/60),卡那霉素耐藥率為6.67%(4/60),鏈霉素耐藥率為8.33%(5/60)。對耐多藥的1例患者將利福平和異煙肼更換為卷曲霉素、左氧氟沙星和卡那霉素繼續(xù)治療,3個月后停用卡那霉素,共完成療程18個月；對單耐異煙肼的1例患者將異煙肼更換為左氧氟沙星,完成療程18個月；對耐左氧氟沙星、卡那霉素、鏈霉素的9例患者繼續(xù)原治方案,完成療程18個月；對培養(yǎng)結(jié)果陰性的26例和藥敏測試結(jié)果為全敏感的23例患者繼續(xù)原治方案,完成療程18個月。對耐藥的11例患者進行隨訪,術(shù)后3個月全部患者的局部癥狀和結(jié)核中毒癥狀消失,術(shù)后6個月血沉恢復(fù)正常,術(shù)后18個月,椎間植骨均為4-5級骨性融合,術(shù)前有神經(jīng)癥狀的5例患者中有3例神經(jīng)功能完全恢復(fù),1例獲得改善,結(jié)核均無復(fù)發(fā)。 結(jié)論本地區(qū)脊柱結(jié)耐藥率為18.3%,耐多藥率為1.67%。藥敏測試指導(dǎo)下制定個體化治療方案治療脊柱結(jié)核的療效更確切,值得臨床推廣運用。
[Abstract]:Objective to analyze the drug resistance of spinal tuberculosis in our hospital and to study the clinical effect of individualized antituberculous drug therapy under the guidance of drug sensitivity test. Methods from January 2010 to August 2011, 60 patients with spinal tuberculosis received surgical treatment. The pus and granulation tissue were collected during the operation and then inoculated into L-J (Lowenstein-Jensen modified Roche medium) after routine treatment. The positive patients were stained with acid-fast. For Mycobacterium tuberculosis, then inoculated into L-J medium, drug sensitivity test was carried out. According to the results of drug sensitivity test and referring to the principle of drug resistant TB drug use, the individualized anti-tuberculosis drug treatment scheme was worked out. 1. The results of drug sensitivity test were multidrug resistant tuberculosis. Other sensitive first-line drugs and intravenous second-line sensitive drugs were selected to form a 5-linked anti-tuberculosis regimen. 2. Drug sensitivity test results only to the original treatment of one drug resistance, the drug will be replaced by another sensitive first-line bactericidal drug or intravenous injection of second-line sensitive drug; 3. The results of bacterial culture were negative, the drug sensitivity test results were not resistant or sensitive to the original treatment drugs, continue the original treatment plan. The patients were followed up regularly to observe the whole body and local condition, combined with, ESR (Erythrocyte sedimentation rate erythrocyte sedimentation rate (ESR), to evaluate the cure of tuberculosis and the fusion of intervertebral bone graft. Results the positive rate of culture was 56.7% (34 / 60). The drug resistance rate was 18.3% (11 / 60) in 11 cases, including 1 case of multidrug resistance (both rifampicin and isoniazid), and the multidrug resistance rate was 1.67% (1 / 60). Rifampicin resistance rate was 1.67% (1 / 60), isoniazid resistance rate was 3.33% (2 / 60), levofloxacin resistance rate was 3.33% (2 / 60), kanamycin resistance rate was 6.67% (4 / 60). Streptomycin resistance rate was 8.33% (5 / 60). Rifampicin and isoniazid were replaced by rifampicin and isoniazid as capriamycin, levofloxacin and kanamycin were continued to be treated for 3 months, kanamycin was stopped after 3 months, and the course of treatment was 18 months. Isoniazid was replaced with levofloxacin for 18 months in one patient with isoniazid resistance, and 9 patients who were resistant to levofloxacin, kanamycin and streptomycin were treated with isoniazid for 18 months. 26 cases with negative culture results and 23 cases with full sensitivity test were treated with primordial therapy for 18 months. 11 patients with drug resistance were followed up. After 3 months, the local symptoms and tuberculosis poisoning symptoms of all the patients disappeared, and the ESR returned to normal at 6 months after operation. After 18 months, the intervertebral bone graft was 4-5 grade bone fusion. Of the 5 patients with neurological symptoms before operation, 3 cases recovered completely, 1 case improved and no recurrence of tuberculosis occurred. Conclusion the drug resistance rate of spinal node and multi-drug resistance in this area is 18. 3 and 1. 67 respectively. Under the guidance of drug sensitivity test, individualized treatment of spinal tuberculosis is more effective and worthy of clinical application.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R529.2

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