脊柱布氏杆菌感染的临床特征表现及抗菌方案的研究

Clinical features and antibacterial program of spine brucella infection

目的探讨脊柱布氏杆菌感染的临床特征表现,比较多西环素+利福平、多西环素+利福平+左氧氟沙星的抗菌效果。方法回顾性分析2017年1月至2019年1月我院收治的78例脊柱布氏杆菌感染病人,分析其临床特征表现,并根据抗菌方案的不同分为观察组和对照组,每组39例,对照组行多西环素+利福平治疗,观察组行多西环素+利福平+左氧氟沙星治疗,观察两组治疗效果、临床症状及不良反应发生情况,采用疼痛数字评定量表(numerical rating scale,NRS)对病人关节疼痛程度予以评估。结果78例病人均有不同程度脊柱活动受限,其中关节疼痛78例(100.00%)、发热78例(100.00%)、乏力25例(32.05%)、多汗34例(43.59%)、肌肉痛12例(15.38%);CT检查显示病椎及相邻椎体边缘有不同程度破坏及明显骨质增生,病椎间隙狭窄;MRI检查显示病变椎旁软组织异常T1WI低信号、T2WI高信号;布氏杆菌特异性血清凝集试验均呈阳性,血白细胞水平异常11例(14.10%),C反应蛋白水平异常15例(19.23%),红细胞沉降率增快7例(8.97%)。治疗6周后,观察组总有效率为94.87%,明显高于对照组(79.49%,P<0.05);观察组体温、NRS评分明显低于同期对照组(P<0.05);观察组不良反应发生率为15.38%,与对照组(10.26%)比较,差异无统计学意义(P<0.05)。结论脊柱布氏杆菌感染的临床特征表现多样,对临床诊断及治疗有指导作用,相比于多西环素+利福平抗菌方案,多西环素+利福平+左氧氟沙星抗菌方案治疗效果更为显著,且具有较高安全性,值得推广。

Objective To investigate the clinical characteristics of spine brucella infection,and compare the antibacterial effects of doxycycline+rifampicin vs.doxycycline+rifampicin+levofloxacins.Methods The clinical data of 78 patients with spine brucella infection were retrospectively analyzed in our hospital from January 2017 to January 2019,and the patients were divided into observation group and control group according to different antibacterial programs,39 cases in each group.The control group was treated with doxycycline+rifampicin,and the observation group was treated with doxycycline+rifampicin+levofloxacin.The therapeutic effects,clinical symptoms and adverse reactions of two groups were observed.The numerical rating scale(NRS)was used to evaluate the degree of joint pain.Results Seventy-eight patients had different degrees of spinal activity limitation,including 78 cases(100.00%)of joint pain,78 cases(100.00%)of fever,25 cases(32.05%)of fatigue,34 cases(43.59%)of sweating,12 cases(15.38%)of muscle pain.CT examination showed that the edge of the diseased vertebrae and adjacent vertebral bodies had different degrees of destruction and obvious bone hyperplasia,and the intervertebral space was narrowed.MRI examination showed that the paravertebral soft tissue abnormality was low signal at T1WI and was high signal at T2WI.All brucellaspecific serum agglutination tests were positive,there were 11 cases(14.10%)of blood white blood cell abnormality,15 cases(19.23%)of C-reactive protein level abnormality,and 7 cases(8.97%)of increased erythrocyte sedimentation rate.After 6 weeks of treatment,the total effective rate of the observation group and control group was 94.87%and 79.49%respectively(P<0.05).The body temperature and NRS scores in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions was 15.38%in the observation group,and 10.26%in the control group(P>0.05).Conclusion The clinical features of spine brucella infection are diverse and have a guiding effect on clinical diagnosis and treatment.The therapeutic effect of doxycycline+rifampicin+levofloxacin antibacterial regimen is more significant and more safe than doxycycline+rifampicin antibacterial regimen.