脊柱结核影像学表现及实验室检测分析

Analysis of imaging manifestations and laboratory detection of spinal tuberculosis

目的分析脊柱结核患者的影像学及实验室检查特点。方法收集新乡医学院第一附属医院(河南省结核病医院)骨外科2015年5月至2016年6月收治的经病理学和细菌学检查确诊为脊柱结核的患者65例,所有患者均接受X线、CT、MRI检查以及血沉、C反应蛋白、结核菌素(PPD)皮肤试验、血清抗结核抗体、结核杆菌抗原特异性γ干扰素释放试验(T-SPOT.TB)等实验室检查。收集每例患者的基本临床信息、影像学资料及实验室化验结果,分析并比较各种检测方法对脊柱结核的诊断价值。结果 65例患者中,60例在3种影像学检查中均表现出椎间隙狭窄征象,占92.3%;23例患者X线显示有不同程度的后凸畸形,占35.4%;53例患者CT显示有死骨形成,占81.5%;64例患者MRI表现出椎间盘受累,占98.5%;54例MRI表现出椎旁脓肿征象,占83.1%。PPD皮肤试验、血清抗结核抗体、T-SPOT.TB的阳性率分别为61.5%、41.5%、86.1%。T-SPOT.TB的阳性率高于PPD皮肤实验(P<0.05)和血清抗结核抗体(P<0.05)。结论脊柱结核的3种影像学表现各具特点,3种影像学检查结合起来更有助于脊柱结核的诊断。与传统的结核病检测方法相比,T-SPOT.TB具有较高的敏感性,可以作为脊柱结核的辅助诊断方法。

Objective To analyze the imaging manifestations and laboratory test results of spinal tuberculosis. Methods Six- ty -five patients with spinal tuberculosis diagnosed by pathological and bacteriological xamination in the first Affiliated Hospital of Xinxiang Medical College from May of 2015 to June of 2016 were selected. All the patients accepted the X - ray, computed tomography（CT） and MRI examination. At the same time, they ＂also accepted laboratory test, including blood sedimentation, C -reactive protein, the tuberculin test （PPD） , serum anti- tuberculosis antibody, T- SPOT. TB. The basic clinical information, imaging data and laboratory test results were collected. The value of various detection methods in the diagnosis of spinal tuberculosis was analyzed. Results Among 65 patients, there were 60 patients showed signs of the intervertebral disc narrow by three kinds of imaging examination, accounted for 92. 3% ; 23 patients showed different degree of the protruding ＇after deformity by X - ray, accounted for 35.4% ; 53 patients showed the dead bone by CT, accounted for 81.5% ; 64 patients showed interver- tebral disc involvement by MRI, Accounted for 98.5% ; 54 patients showed vertebral abscess by MRI, accounted for 83.1%. The positive rates of PPD, serum anti - tuberculosis antibody and T - SPOT. TB were 61.5% , 41.5% , and 86. 1% rcspeetivcly. The positive rate of T - SPOT. TB was significantly higher than PPD skin test （ P 〈 0. 05 ） and serum anti - tuberculosis anti- body （P 〈 0. 05 ）. Conclusion Three kinds of imaging findings have their own characteristics. The combination of the 3 ima- ging modalities is more helpful in the diagnosis of spinal tuberculosis. T - SPOT. TB has higher sensitivity compared with tradi- tional tuberculosis detection methods, which could be used for auxiliary diagnosis of spinal tuberculosis.