恩施地区脊柱结核病流行病学特点及其临床治疗观察

Enshi spinal tuberculosis epidemiological characteristics and the clinical observation

目的分析研究恩施地区脊柱结核病的流行特征，为今后制定更有效的防治措施提供科学依据。方法回顾性调查研究2009年1月至2013年12月到恩施州各县市二级及以上医院就诊并确诊为脊柱结核患者的临床资料，统计所有患者一般情况及诊疗情况，对病例进行流行病学及诊疗情况分析。结果2009年1月至2013年12月各医院共接诊218例确诊为脊柱结核的患者，前4年病例数相当，2013年病例数迅速增长，为历年最高。就诊病例中呈现20~40岁和40~60岁两个高峰，＜20岁所占比例最低。恩施市籍病例最高，利川市次之。以汉族、土家族为主，多种民族散发。病例中绝大多数为农民。腰椎节段结核所占比例最大，其次为胸椎。共有183例患者接受手术。患者采用三联或四联疗法，术前用药时间为2~4周，术后用药时间为12~18个月。18例（8.26%）患者术后出现复发，经处理后均好转。结论通过分析发现农民（包括外出农民工）为结核病好发人群，应被列为脊柱结核病防控工作的重点监控对象，对农民群体进行宣传教育，普及结核病防治知识，让他们在疾病的预防、诊断及治疗方面得到更多更有效的保障。

Objective To learn the epidemic features of spinal tuberculosis (TB) in Enshi, and formu?late the scientific basis for more effective prevention and control measures. Methods Retrospective analysiswas carried out, the spinal tuberculosis cases diagnosised in level II and higher level hospital detected in 2009?2013 in Enshi City were analyzed. General condition of patients, the diagnosis and treatment were trackedto analysis the epidemiology, diagnosis and treatment. Results From January 2009 to December 2013,218 patients diagnosed with spinal TB patients were accepted, the proportion between four years was approxi?mately the same, the number of cases increased rapidly in 2013, which was the highest. The two peaks of theclinic cases were 20?40 years old and 40?60 years old, patients less than 20 years old had the fewest numberamong the patients. Enshi has the highest cases, Lichuan take second place. The patients were mainly Han andTujia nationality. Lumbar segmental tuberculosis (TB) accounted for the largest percentage, followed by thoracic.One hundred and eighty?three patients undergone surgery. Triple therapy and quadruple therapy were mainlyused, preoperative medication time was usually 2?4 weeks, postoperative medication time over 12 months to 18months. Postoperative recurrence occurred in 18 cases (8.26%). Conclusion This data shows that farmers(including migrant workers) is high risk population for TB, they should be monitored as the important objects of spinal tuberculosis prevention and control.We should carry out activities such as spreading tuberculosis pre?vention knowledge to the countryside, the farmer groups were in education, popularize knowledge of TB preven?tion and control, to let them in the prevention, diagnosis and treatment of diseases more effective safeguard.