非典型布鲁杆菌脊柱炎的诊断与治疗

Diagnosis and treatment of atypical brucellar spondylitis

目的探讨非典型布鲁杆菌脊柱炎的诊断与治疗,以进一步提高临床医师对该病的认识水平及诊治能力。方法回顾分析19例布鲁杆菌脊柱炎患者,病变节段位于腰椎17例、颈椎2例。14例有羊、牛接触史。19例均行X线检查,16例行CT检查,11例行MRI检查,所有患者标准血清试管凝集试验（SAT）滴度均〉1∶160,虎红平板凝集试验（RBP）均为阳性。均采用规范抗菌治疗,3例患者行手术治疗。结果患者均获随访,时间3~12个月,经规范抗菌治疗后治愈18例,治愈率18/19。3例手术患者术后恢复良好。末次随访时,ESR（10.5±5.1）mm/1h,CRP（4.3±2.5）mg/L,VAS评分（0.9±0.7）分、JOA评分（25.0±1.8）分,JOA下腰痛评分治疗改善率78.9%;ESR、VAS及JOA评分与治疗前比较差异均有统计学意义（P〈0.05）,而CRP与治疗前比较差异无统计学意义（P=0.442）。结论布鲁杆菌脊柱炎易被误诊误治,对可疑患者宜早期行血清学检验,一经确诊应规范、联合、长期、足量抗菌治疗,必要时采用手术治疗,可取得良好效果。

Objective To investigate the diagnosis and treatment of atypical brucellar spondylitis,and in order to further improve the ability of clinicians about how to diagnose this disease. Methods 19 cases of brucellar spondylitis were retrospectively analysed. 17 cases of the lesions located in lumbar spine,2 cases located in cervical spine.14 cases had epidemiological contact history. All the 19 cases underwent X-ray examination,16 cases underwent CT scanning,and 11 cases underwent MRI examination. Among 19 cases,the titers of serum tube agglutination test（ SAT） were all beyond 1 ∶ 160,the test of rose bengal plate agglutination（ RBP） showed positive. All cases underwent standard antibiotic therapy,and 3 cases underwent operation. Results All cases underwent follow-up. The follow-up time was 3 ~ 12 months. 18 cases were cured after standard antibiotic treatment,the cure rate was 18 /19. 3cases that underwent operation recovered well. At last follow-up,ESR was（ 10. 5 ± 5. 1） mm /1h,CRP was（ 4. 3 ±2. 5） mg / L,VAS scores was（ 0. 9 ± 0. 7）,JOA score was（ 25 ± 1. 8）,low back pain improvement rate was78. 9%. ESR,VAS and JOA scores had statistical significance（ P〈0. 05）,while CRP had no statistical significance（ P = 0. 442）. Conclusions Brucellar spondylitis is easy to be misdiagnosed,so suspicious cases should be earlier underwent serological test. The brucellar cases should achieve standardized,united,long-term and adequate antimicrobial therapy. Operation may achieve good results when it is necessary.