单纯应用抗结核药物治疗早期脊柱结核的疗效观察

Chemotherapy alone for early-stage spinal tuberculosis

目的:探讨单纯应用抗结核药物治疗早期脊柱结核患者的疗效及适应证。方法:回顾性分析宁夏医科大学附属医院2000年1月～2007年6月收治的36例督导下单纯应用抗结核药物治疗脊柱结核患者的治疗情况,治疗方案为联合用药(3HRZS/1～15HRZ),疗程4～18个月。随诊观察临床表现、影像学(椎体愈合、后凸畸形)变化、神经功能改变及抗结核药物对机体的不良反应,根据疗效情况及时调整疗程。结果:全部病例随访3～5年。36例中,在完成4个月的超短程化疗疗程后,16例达到治愈;未愈者用药延长至9个月,14例治愈;其余6例通过长程化疗18个月获得治愈。8例(22%)出现药物副作用,通过暂停用抗结核药物并配以相应药物治疗恢复正常。末次随访患者全身低热消失、体重增加;局部疼痛症状减轻或消失;椎体骨性融合;6例后凸畸形轻度加重(均<30°,支具制动);血沉下降至正常范围。结论:对于早期脊柱结核病例,单纯应用规范的抗结核药物治疗能够取得满意的疗效。

Objective：To evaluate the effect and indication of chemotherapy alone for early-stage spinal tuberculosis.Method：From January 2000 to June 2007,36 patients from the General Hospital of Ningxia Medical University suffering from spinal tuberculosis undergoing anti-TB chemotherapy alone were retrospectively reviewed.The chemotherapeutic regimen was combined medication（3HRZS/1-15HRZ）,and the course was 4~18 months.The effect of anti-tuberculosis,including clinical manifestation,the phantom study（bone heals,raised abnormal）,the neurofunction and complications related to tuberculosis chemotherapy were reviewed.The chemotherapy course can be adjusted individually according to the result of following up.Result：All cases were followed up for 3-5 years.Of them,16 patients healed with less than 4 months of the short-course chemotherapy.The patients with poor outcome had their course extended to 9 months.14 patients healed completely.The remaining 6 patients healed by 18 months long-range chemotherapy.At final follow-up,all patients had body temperature recovered to normal,weight increased,the local pain disappeared,and the bony union;while 6 cases had kyphosis angle increased（〈30°,application of external fixation）.All patients had ESR decreased to normal.8 cases（22%） presented with the medicine related complications,which resolved after ceasing chemotherapy and responsive intervention.Conclusion：The routine chemotherapy alone is reliable for early-stage spinal tuberculosis.