脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险评估与应用研究

A study on risk assessment and application of systemic diffusion of mycobacterium tuberculosis after emergency operation for spinal tuberculosis with spinal cord injury

目的探讨脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险。方法研究组(44例)为脊柱结核伴脊髓损害并进行急诊手术治疗的患者;对照组(59例)为脊柱结核伴脊髓损害进行择期手术治疗的患者。分别在术前1天、术后第1天和术后第7天抽取外周血提取结核分枝杆菌DNA(Mycobacterium tuberculosis DNA,MTB-DNA),PCR扩增,进行MTB-DNA即时荧光定量检测,经对比分析研究,评估脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险。结果术前1天、术后第1天和术后第7天外周血结核杆菌的DNA阳性率研究组分别为 50.0%(22/44)、56.8%(25/44)和31.8%(14/44),对照组分别为49.1%(29/59)、52.5%(31/59)和33.9%(20/59);其中,研究组术前1天、术后第1天和术后第7天外周血结核杆菌的含量变化差异无统计学意义( F =0.08, P = 0.920 );对照组术前1天、术后第1天和术后第7天外周血结核杆菌的含量变化差异无统计学意义( F =1.29, P = 0.084 );研究组和对照组术前1天、术后第1天和术后第7天的结核杆菌DNA含量组间比较差异无统计学意义( t 值分别为1.415、0.158、0.144, P 值分别为0.078、0.874、0.889)。结论脊柱结核伴脊髓损害患者,术前没有结核杆菌耐药表现,术后正规抗结核治疗,急诊及择期手术前后外周血结核杆菌DNA含量测定无明显差异,提示脊柱结核伴脊髓损害患者急诊手术并没有造成结核杆菌全身外周血扩散的风险。

ObjectiveTo study the risk of systemic diffusion of mycobacterium tuberculosis after emergency operation for spinal tuberculosis with spinal cord injury. Methods44 cases of spinal tuberculosis with spinal cord lesion who underwent emergency operation were selected as research group,and 59 cases of spinal tuberculosis with spinal cord injury who underwent selective operation were selected as control group.Mycobacterium tuberculosis DNA(MTB-DNA) was extracted from peripheral blood on one day before operation,the first day after operation and the seventh day after operation,respectively.Real-time fluorescence quantitative detection of MTB-DNA was carried out by PCR amplification.And the risk of systemic diffusion of mycobacterium tuberculosis after emergency surgery for spinal tuberculosis with spinal cord injury was evaluated by comparative analysis. ResultsThe DNA positive rate of mycobacterium tuberculosis in peripheral blood was 50.0%(22/44),56.8%(25/44) and 31.8%(14/44) in the research group on one day before operation,the first day after operation and the seventh day after operation,respectively,and 49.1%(29/59),52.5%(31/59) and 33.9%(20/59) in the control group,respectively.There was no statistically significant difference in the contents of mycobacterium tuberculosis in peripheral blood in the research group on one day before operation,the first day after operation and the seventh day after operation( F =0.08, P =0.920).There was no statistically significant difference in the contents of mycobacterium tuberculosis in peripheral blood in the control group on one day before operation,the first day after operation and the seventh day after operation( F =1.29, P =0.084).In addition,there was no statistically significant difference in the contents of mycobacterium tuberculosis between the research group and the control group on one day before operation,the first day after operation and the seventh day after operation( t =1.415,0.158,0.144, P =0.078,0.874,0.889,respectively). ConclusionThere was no drug resistance of mycobacterium tuberculosis in patients with spinal tuberculosis with spinal cord injury before operation,and regular anti-tuberculosis treatment was performed after operation.Difference in the contents of mycobacterium tuberculosis in peripheral blood before and after emergency operation and selective operation was not significant,which shows that emergency operation in patients with spinal tuberculosis with spinal cord injury does not cause the risk of systemic diffusion of mycobacterium tuberculosis.