耐多药脊柱结核的临床应对措施

COUNTERMEASURES IN TREATMENT OF MULTIDRUG-RESISTANT VERTEBRA TUBERCULOSIS

目的探讨脊柱结核耐药规律、耐药菌株对脊柱结核疗效影响及临床应对措施。方法对2007—2009年临床送结核菌培养的204例确诊为脊柱结核患者进行回顾性分析,总结结核菌的耐药规律、了解耐药菌株对临床疗效的影响,探讨耐药菌株脊柱结核的治疗方法。结果 204份标本中,培养出人型结核分枝杆菌102例,牛型结核分枝杆菌8例,总计培养阳性110例,阳性率53.9%。阳性结果中,耐药菌株26例,耐药发生率占培养阳性的23.6%。耐药菌株中符合耐多药标准的13例,占耐药菌株的50.0%。204例患者中发生术后早期骨病灶未愈4例,新发病灶3例,总计7例,其中6例为耐药结核菌感染,6例行2次手术治疗痊愈,1例行3次手术治疗后痊愈。本组193例随访1年,随访病例骨病灶全部愈合。结论结核菌培养及药物敏感性测定在脊柱结核诊断与治疗中有重要意义。耐多药结核菌株对脊柱结核疗效有明显影响。对耐药结核菌株感染要依据药物敏感测定报告制定个体化治疗方案。对耐药脊柱结核早期病灶未愈和新发病灶及时配合合理手术有助于骨病灶愈合。

Objective To investigate the method and the influence of multi-drug resistant mycobacterium strain tuberculosis on the clinical outcomes and its countermeasures in the treatment of vertebra tuberculosis. Methods Retrospective analysis was made on 204 revised vertebra tuberculosis cases who admitted in our hospital from 2007 to 2009. The method of drug resistance, the influence on the clinical outcomes of drug resistant strain and the treatment of vertebra tuberculosis were investigated. Results In 204 cases, tuberculosis mycobacterium Strain was positive in 110 cases （53.9%） among which M. tuberculosis was 102 cases and Mbovi 8 cases. In positive findings, drug resistant strain was positive in 26 cases（23.6% ） ,in which consistent with the standard of multi-drug resistant was 13 cases （50.0%）. Four cases were unrecovered in early period after operation, 3 cases were new lesions, totally 7 cases ,in which 6 cases were infected with drug resistant strain,6 cases were healed by the re-operations. One case was healed by the ter-operations. All cases were healed in a year. Conclusion The culture of tuberculosis mycobacterium and the test of drug sensitivity were important for the diagnosis and treatment of vertebra tuberculosis. Those cases with multi-drug resistant mycobacterium strain tuberculosis can influence the curative effect of vertebra tuberculosis significantly. Based on the drug-sensibility, the therapeutic regimen should be modified and individualized. The multidrug-resistant mycobacteria tuberculosis occurs in lesions of vertebra tuberculosis, those cases which refer to unrecovered in early period after operation and new lesions must be combined in treatment with operation, which is found helpful in raising the recovery rate.