231例脊柱感染患者的流行病学和临床特点

Epidemiological and clinical characteristics of 231 cases with spinal infections

目的：了解脊柱感染的流行病学和临床特点，为临床正确诊治提供参考。方法回顾性分析河南省人民医院2010年1月至2014年12月收治的脊柱感染患者的临床资料，对人口学特征、危险因素、临床特点等进行评估。统计学处理采用 t检验、χ2检验和 Fisher确切概率法。结果231例患者符合入选标准，化脓性脊柱感染（PSI）组和结核性脊柱感染（TSI）组分别为179例（77．5％）和52例（22．5％）。既往脊柱手术史是最常见的危险因素（43．3％），其次是糖尿病（14．7％）；两组发生部位均为腰骶部最多，分别为114例（63．7％）和38例（73．1％）。PSI组治疗前白细胞计数[（10．8±4．5）×109／L比（7．3±3．2）×109／L ，t＝2．685]和C反应蛋白[（79±33） mg／L比（37±21） mg／L ，t＝6．241]均明显高于TSI组（均 P＜0．05）。PSI组血培养较组织培养阳性率显著升高（47．9％比21．8％，χ2＝6．782，P＜0．05），TSI组血培养较组织检查阳性率则显著降低（0比39．4％，χ2＝8．312，P＜0．05）。PSI组和 TSI组最终需采用开放性手术治疗的患者分别为54例（30．2％）、13例（25．0％）。结论既往脊柱手术史是最常见的脊柱感染危险因素，其次是糖尿病；PSI和 TSI多见的发生部位均为腰骶部；河南省人民医院脊柱感染中PSI发病率更高，金黄色葡萄球菌是PSI最常见的致病菌。

Objective To describe the epidemiology and clinical characteristics of spinal infections to assist the clinical diagnosis and treatment .Methods Clinical data of all cases with spinal infections at He′nan Provincial People′s Hospital from January 2010 to December 2014 were analyzed retrospectively . The demographic characteristics , risk factors , clinical characteristics and outcomes were evaluated . Variables were compared by t‐test ,chi‐square test or Fisher exact test when appropriate .Results Totally 231 patients fulfilled the inclusion criteria and were reviewed ,of which 179 （77 .5% ） were pyogenic spinal infection （PSI） and 52 （22 .5% ） were tuberculous spinal infection （TSI） .The most common risk factor for infection was history of previous spinal surgery or procedure （43 .3% ） ,followed by diabetes mellitus （14 .7% ） .The infection site of lumbosacral spine was prominent with 114 cases （63 .7% ） in PSI and 38 cases （73 .1% ） in TSI .At initial presentation ,white cell blood count （[10 .8 ± 4 .5] × 109/L vs [7 .3 ± 3 .2]× 109/L ,t=2 .685） and C‐reactive protein levels （[79 ± 33] vs [37 ± 21] mg/L ,t=6 .241） in PSI were higher compared to TSI （both P〈0 .05） .The positive rate of blood culture was significant higher than tissue culture in PSI （47 .9% vs 21 .8% ,χ2 = 6 .782 , P〈 0 .05 ） .But the positive rate of blood culture was significantly lower than tissue culture in TSI （0 vs 39 .4% ,χ2 =8 .312 , P〈0 .05） .Surgical treatment was performed in 30 .2% of PSI and 25 .0% of TSI .Conclusions History of spinal surgery or procedure is the most common risk factor for spinal infections , followed by diabetes mellitus . The lumbosacral spine is the common involved site in both PSI and TSI .The incidence of PSI is higher among spinal infections in our hospital .And Staphylococcus aureus is the most common pathogenic bacteria in PSI .