椎间盘炎型腰椎布鲁杆菌性脊柱炎诊断及疗效临床研究

Diagnosis of Discitis Type Lumbar Brucellosis Spondylitis and Curative effect Study

目的探讨椎间盘炎型腰椎布鲁杆菌性脊柱炎的诊断及药物治疗效果。方法回顾性分析36例椎间盘炎型腰椎布鲁杆菌性脊柱炎患者的临床表现、影像学特点、实验室检查等相关资料,采用多西环素+利福平+磺胺甲基异噁唑药物治疗方案。结果 36例患者临床表现均为午后低热、盗汗及乏力、腰疼,无神经压迫症状。影像学表现:X线示椎间隙狭窄,密度增加;腰椎MRI示腰椎间盘正常解剖结构及中央"裂隙征"消失,许莫氏结节样骨质破坏。实验室检查血清布鲁杆菌凝集试验(SAT)阳性,虎红平板凝集试验(rose-bengal plate agglutination test,RBP):26例+++、10例++,布鲁杆菌血培养阳性5例。重新配伍药物治疗3周后,患者乏力、低热等全身中毒症状消失,腰疼症状消失或明显减轻;治疗2个疗程后,患者腰疼症状均消失,连续3次实验室检查结果均正常,均未出现并发症。结论椎间盘炎型腰椎布鲁杆菌性脊柱炎可通过临床表现、影像学表现及实验室检查明确诊断,采用多西环素+利福平+磺胺甲基异噁唑药物治疗方案可取得满意效果。

Objective To explore diagnosis and medications efficacy of discitis type lumbar brucellosis spondylitis.Methods A retrospective analysis of 36 patients with discitis type lumbar brucellosis spondylitis was performed,including clinical manifestations,imaging features,laboratory tests and other related information.All patients received the medication therapeutic regimens of doxycycline+rifampin+sulfamethoxazole.Results The clinical manifestations of 36 patients were all afternoon low-grade fever,night sweating and fatigue,and back pain,without obvious symptoms of nerve compression.The imaging findings were as follows:X-ray showed intervertebral space narrowing and increased density;lumbar MRI showed that normal anatomy of the lumbar intervertebral disc and the central "fissure signs"disappeared,and Schmorl’s nodular bone was destructed.Laboratory examination of serum brucellosis agglutination test(SAT)was positive.Rose-bengal plate agglutination test(RBP)showed 26cases+++,10cases++.Brucellosis blood culture showed 5cases of positive responses.After 3weeks of drug treatment,the symptoms of total body poisoning such as fatigue and low-grade fever disappeared,and the symptoms of back pain disappeared or was obviously alleviated.After 2courses of treatment,the symptoms of back pain disappeared,and the results of three consecutive laboratory examinations were normal.No complications occurred.Conclusion Discitis type lumbar brucellosis spondylitis can be definitely diagnosed according to patients’ clinical manifestations,imaging findings and laboratory test results.The medication therapeutic regimens(doxycycline+rifampicin+sulfamethoxazole)can achieve satisfactory effect.