脊柱布氏杆菌病的诊断与治疗

Diagnosis and treatment of spinal brucellosis disease

背景：近几年,脊柱布氏杆菌病呈明显上升趋势,而脊柱布氏杆菌病缺乏特异性的诊断指标,鉴别诊断较困难。目的：回顾性分析我院收治的16例脊柱布氏杆菌病患者特点,观察脊柱布氏杆菌病的诊断规律、治疗要点、预后情况。方法：收集1999年1月至2015年9月我院收治的16例脊柱布氏杆菌病患者的病例资料。总结分析患者的病史、临床表现以及血清学、细菌学、影像学改变以及临床治疗与预后。结果：男女各8例,平均年龄49.25岁,主诉以剧烈腰背痛或臀部疼痛为主,均有牛羊接触史。平均病史3个月。实验室检查：14例（87.5%）红细胞沉降率增快,15例（93.75%）单核细胞或单核细胞百分率升高,所有16例患者的CRP升高、白细胞计数正常（100%）。血培养全部为阴性,活检组织细菌培养阳性率50%。病变主要累及腰椎（13例,81.25%）。影像学检查：7例（63.6%）X线片及CT出现＂鹦鹉嘴样＂改变,10例（71.4%）MRI表现T2等信号、T1低信号、压脂像高信号。9例患者手术治疗,保守治疗7例,随访2.5-197.0个月,平均20.22个月。所有患者预后良好。结论：有以下特征时应高度怀疑脊柱布氏杆菌病：剧烈腰背痛,单核细胞升高,有牛羊接触史,X线椎体前缘＂鹦鹉嘴样＂改变、MRI上T2等信号、T1低信号、压脂像高信号,血清学检查明确确诊。除严重脊髓或神经压迫者,保守治疗可达到较好的预后效果。

Background：In recent years,the incidenc of spinal brucellosis presents a rising trend. It is very difficult to clari-fy a diagnosis for spinal brucellosis because it lacks specific diagnostic criteria. Objective：To retrospectively analyze clini-cal data of 16 cases of spinal brucellosis and to summarize diagnostic rule, treatment tactic and prognosis of the disease. Methods：From January 1999 to July 2015, 16 patients with spinal brucellosis were treated in our hospital. Their medical re-cords were collected. Complaints, clinical manifestations, serological and bacteriological results, imaging changes, clinical treatment and prognosis were analyzed. Results：There were 8 males and 8 females with a mean age of 49.25 years. They complained mainly for severe back pain or hip pain, and all had a history of exposure to cattles. The average of history was 3 months. Laboratory examination：ESR became faster in 14 patients （87.5%）. The amount or percentage of monocytes in-creased in 15 patients （93.75%）. In all 16 patients, CRP increased while white blood cell count kept normal. Blood cultures were negative, and the positive rate of bacterial culture was 50%. Lesions mainly involved lumbar vertebrae （13 cases, 81.25%）. Imaging：X-ray and CT showed a parrot＇s beak appearance in 7 cases （63.6%）;hypointense on T1-weighted imag-es, equal signal intensity on T2-weighted and hyperintense on FLAIR sequences of the intervertebral disc in MRI were found in 10 cases （71.4%）. Nine patients underwent surgery and seven patients were treated by oral medicine. The mean du-ration of follow-up was 20.22 months （range, 2.5-197.0 months）. Good prognosis was achieved in all patients. Conclusions：Once people have the following characteristics, spinal brucellosis should be highly suspected： severe low back pain, in-creased monocytes or mononuclear cell percentage, a history of exposure to cattle, a parrot＇s beak appearance in X-ray and CT, hypointense on T1-weighted images of the intervertebral discin MRI, equal-to-intermediate signal intensity on T2-weighted MRI sequences, hyperintense on FLAIR sequences. Serology can be clearly diagnosed. Except for severe spinal cord or nerve compression, conservative treatment can achieve good prognosis.