布鲁氏菌性脊柱炎规范化诊断的临床研究

Clinical study on standardized diagnosis of Brucellosis spondylitis

目的探讨布鲁氏菌性脊柱炎(BS)规范化的诊断流程。方法选择2008年1月至2021年3月河北北方学院附属第一医院骨科收治的116例BS患者,回顾性分析其临床表现、流行病学史、影像学检查、实验室检查、病原学及病理学检查结果,总结BS的诊断学特征。依据有无手术,分为非手术治疗组(n=42)和手术治疗组(n=74),分析两组患者治疗后3个月、6个月、12个月的临床疗效。结果116例患者均有布鲁氏菌病流行病学史,临床表现为弛张热、腰痛、日常生活能力受限。脊柱X线显示早期骨质破坏、椎间隙狭窄,后期骨质修复反应强烈呈"鸟嘴征";CT显示椎间盘等密度均匀破坏、"唇样"骨赘、"花边椎"和椎旁脓肿;MRI显示椎间盘"中央裂隙征"消失、脊髓或硬膜囊受压、椎旁脓肿、椎体Schmorl结节样骨破坏。虎红平板凝集试验(RBPT)阳性率37.07%(43/116),血清试管凝集试验(SAT)阳性率69.86%(51/73),抗人球蛋白试验(Coomb′s检测)阳性率100.00%(22/22)。布鲁氏菌培养呈现无色透明的S型菌落,镜下表现为革兰氏阴性小杆菌且吉姆染色呈紫色;血培养阳性率17.24%(20/116),骨髓培养阳性率37.50%(36/96),病灶炎性组织或脓液培养阳性率51.35%(38/74)。74例手术患者病理学特征性表现为病变中心区有非结核性炎性肉芽肿,周边区有增殖性结节。两组患者治疗后3个月、6个月、12个月均无并发症,无复发、无肝肾功能损害,随着时间的推移,治愈率均逐渐提高。结论BS流行病学史、临床影像学表现、实验室检测、病原学和病理学检查均有特征性表现;规范化诊断体系的建立和诊断标准的制定有助于提高诊断率和鉴别诊断,且正确的诊断是正确实施个体化治疗的前提。

Objective To explore the standardized diagnostic procedure of Brucellosis spondylitis(BS).MethodsFrom January 2008 to March 2021,116 patients with BS were admitted to the Department of Orthopaedics of the First Affiliated Hospital of Hebei North University for retrospective analysis of their clinical manifestations,epidemiological history,imaging,laboratory,etiological,and pathological findings,and the diagnostic characteristics of BS were summarized.Patients were classified into non-surgical treatment group(n=42)and surgical treatment group(n=74)based on whether or not surgery was performed,and clinical efficacy was assessed at 3,6,and 12 months after treatment.ResultsThe 116 individuals all had brucellosis epidemiological histories,with clinical signs of relaxing fever,lumbago,and poor daily living abilities.The X-ray of spine revealed early bone degradation and intervertebral space stenosis,as well as a robust"bird′s beak"reaction to late bone healing.CT showed uniform disc density destruction,"labial"osteophytes,"lacework",and paravertebral abscesses.MRI showed the disappearance of the"central fracture sign"of the disc,spinal cord or dural sac compression,paraspinal abscess,and vertebral Schmorl nodular bone destruction.The rose bengal plate agglutination test(RBPT)had a positive rate of 37.07%(43/116),the standard tube agglutination test(SAT)had a positive rate of 69.86%(51/73),and the anti-human globulin test(Coomb′s test)had a 100.00%(22/22)positive rate.Brucella culture showed a colorless and transparent S-type colony.Under the microscope,it showed Gram-negative small bacilli and purple Jim stain.The positive rate of blood culture was 17.24%(20/116),bone marrow culture was 37.50%(36/96),and inflammatory tissue or pus culture was 51.35%(38/74).The pathological characteristics of 74 patients were non-tuberculous inflammatory granuloma in the central area and proliferative nodules in the peripheral area.There were no complications,recurrence or damage of liver or kidney function in 2 groups at 3,6 and 12 months after treatment,and the cure rate increased gradually with the passage of time.ConclusionsThe epidemiological history,clinical imaging manifestations,laboratory tests,etiology and pathological examinations of BS showed characteristic features.The establishment of standardized diagnostic system and diagnostic criteria are helpful to improve the diagnosis rate and differential diagnosis,and correct diagnosis is the premise of the correct implementation of individualized treatment.