药物配伍与疗程对布鲁杆菌病性脊柱炎临床疗效影响的重新评价

Re-assessment of Clinical Effect of Drug Compatibility and Course of Treatment to the Brucellar Spondylitis

目的评价布鲁杆菌病性脊椎炎药物治疗方案,对该病的最佳药物选择及提高治疗效果提供科学依据。方法将2006年1月—2011年7月确诊且符合纳入标准的200例患者随机分为5组,自愿接受采用5种不同药物、5组不同配伍方法进行不同疗程治疗和对比研究。通过各组不同疗程的临床疗效比较、含多西环素组的临床疗效与不含多西环素组的临床疗效比较、5组之间的临床疗效相互比较,评价各组药物治疗效果。200例患者均作细菌培养及药敏试验,其中157例进行针吸活检。结果前4组第2个疗程治愈率、有效率与第1个疗程比较,差异有统计学意义(P<0.05),而第1,2,3组第3个疗程与第2个疗程比较,差异无统计学意义(P>0.05),说明2个疗程的治疗是合适的;含多西环素组与不含多西环素组的疗效相比,差异有统计学意义(P<0.05),说明含多西环素治疗组效果优于未含多西环素组;经过2个疗程,不同药物配伍治疗效果组间两两比较,除第2,3组间比较差异无统计学意义(P>0.05),其余各组间比较差异有统计学意义(P<0.05),说明第1药物配伍组疗效最明显。本研究仅43例患者布鲁杆菌培养阳性,对多西环素、利福平、SMZ/TMP、左氧氟沙星、链霉素敏感,157例活检镜下符合布鲁杆菌病性脊椎炎病理学表现。结论布鲁杆菌病性脊椎炎临床药物治疗,应以多西环素+利福平+磺胺甲基异噁唑为首选的抗菌素,且应用2个疗程是治疗和防止该病复发较合理的方法。

OBJECTIVE To evaluate the drug treatment programs of brucellar spondylitis and to provide scientific evidence for the best drug choice and therapeutic effect.METHODS 200 cases from January of 2006 to July of 2011 diagnosed as brucellar spondylitis and consistent with the criterion were divided into five groups randomly,accepting different courses of treatment therapy and control study of five different kinds of drugs and five different kinds of compatibility methods voluntary.Therapeutic efficacy was evaluated by comparison of clinical effect in different course of treatment of each group,comparison of the group with and without deoxycycline and comparison among groups.Bacterial culture in 200 cases and susceptibility test was performed.Aspiration-needle biopsy in 157 cases was performed.RESULTS The cure rate and effective rate of the first course of treatment were significantly different with those of the second in five groups（P0.05） while by comparing the cure rate and effective rate of the third course with those of the second in the first,second and third group,the difference had no significance（P0.05）,which indicated that the third course of treatment cannot improve the cure rate and effective rate,thus two courses of treatment was appropriate.By comparing the cure rate and effective rate in groups with deoxycycline with those without deoxycycline,the difference had significance（P0.05）,which indicated that the effect of groups with deoxycycline was better than that with no deoxycycline treatment.After two courses of treatment,the therapeutic effect between two different groups was significantly different（P0.05）,except the difference between the second and the third group（P0.05）,which indicated that the first group had the most obvious effect.In this experiment there were only 43 cases with positive bacterial culture,which were sensitive to deoxycycline,rifampicin,SMZ/TMP,Levofloxacin and phytomycin,and there were 157 cases consistent with pathologic manifestation of brucellar spondylitis by aspiration-needle biopsy.CONCLUSION Deoxycycline,rifampicin and SMZ/TMP should be chosen as the chief antibiotics for drug therapy of brucellar spondylitis and using the drugs for two courses of treatment is an appropriate method for the therapy and prevention of recurrence of brucellar spondylitis.