脊髓结核1例并文献复习

Spinal cord tuberculosis:one case report and literature review

目的了解脊髓结核的临床表现、诊断、治疗及预后。方法对西南医科大学附属医院感染科诊断的1例脊髓结核患者的临床表现、实验室及影像学检查结果、治疗及预后进行分析,并回顾1989-2019年国内外关于脊髓结核的文献报道,筛选并总结分析脊髓结核患者的相关临床资料。结果该例患者为18岁青年女性,合并血行播散性肺结核、结核性脑膜脑炎、腹腔结核。患者主要以反复发热、头部及颈背部疼痛为主要症状,伴随双下肢肌力下降,排尿功能障碍,结合病史、脑脊液及影像学检查,给予抗结核治疗后,病情好转。结合相关文献和该病例,共16例患者,平均年龄32.5岁(17~50岁)。13例患者行脊髓MRI检查,3例行脊髓造影检查,11例行病理检查。经治疗,有8例患者好转。结论脊髓结核在临床上较为罕见,尽早明确诊断是临床治疗的关键,应根据脊髓病变的范围、程度、大小以及抗结核药物的敏感性来综合考虑。

Objective To understand the clinical manifestations,diagnosis,treatment and prognosis of spinal cord tuberculosis.Methods The clinical manifestations,laboratory and imaging findings,treatment and prognosis of a case of spinal cord tuberculosis were reviewed.The patient was treated in the Department of Infectious Diseases of Affiliated Hospital of Southwest Medical University.The relevant literature reports on spinal cord tuberculosis at home and abroad from 1989 to 2019 were also reviewed to summarize the features of spinal cord tuberculosis patients.Results This case was an 18-year-old young woman.She was confirmed with hematogenous disseminated tuberculosis,tuberculous meningocelphalitis and abdominal tuberculosis.The main symptoms were recurrent fever,head and neck pain,decreased muscle strength of lower limbs and urinary dysfunction.Anti-tuberculosis treatment was given according to patient’s medical history,cerebrospinal fluid and imaging examination.The patient’s condition improved after anti-tuberculosis treatment.Of the 16 cases (mean age of 32.5 years,ranging from 17 to 50) of spinal cord tuberculosis (including this report),MRI scan of spinal cord was administered in 13 cases,myelography in 3 cases,and pathological examination in 11 cases.All the 8 patients whose outcome was available showed improvement after treatment.Conclusions Spinal cord tuberculosis is rare in clinical practice.Early and confirmed diagnosis is the key to clinical treatment.The extent,degree,size of spinal cord lesions and susceptibility to antituberculosis drugs should be considered when prescribing antituberculous drugs.