培养阴性的成人原发性化脓性脊柱炎

Culture-negative adults primary pyogenic spondylitis

目的旨在分析培养阴性的原发性化脓性脊柱炎临床特点,并探讨其诊断、治疗及预后。方法回顾性分析本院2015年1月-2019年1月收治的23例原发性化脓性脊柱炎患者,按照细菌培养结果分为两组:培养阴性组(A组)、培养阳性组(B组)。对比两组患者的临床特征及预后情况。结果培养阳性率为47.83%(11/23),培养阳性组以葡萄球菌最多,其次为大肠埃希菌。入院治疗前,两组患者年龄、性别、疼痛视觉模拟评分(visual analogue scale score,VAS)、临床症状、体征、脊柱受累节段、脊柱脓肿差异无统计学意义(P>0.05);培养阴性组红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、白细胞计数(white blood cell,WBC)均低于培养阳性组,差异有统计学意义(P<0.05);培养阴性组病程长于培养阳性组,但差异无统计学意义(P=0.194)。治疗后,两组患者住院时间、疼痛缓解情况及感染复发率差异无统计学意义(P>0.05);治疗后,培养阴性组出院时的ESR、CRP、ESR水平低于培养阳性组,但差异无统计学意义(P>0.05);培养阳性组CRP下降值大于培养阴性组,差异有统计学意义(P<0.05)。两组患者ESR下降值均小于CRP下降值。结论在原发性化脓性脊柱炎诊疗中,细菌培养阴性患者的ESR、CRP和WBC基础值均显著低于阳性患者;但两者的病情严重程度、治疗周期和预后情况均较为相近。

Objective To analyze the clinical characteristics of culture-negative primary pyogenic spondylitis,and to discuss its diagnosis,treatment and prognosis.Methods The clinical data of 23 cases of primary pyogenic spondylitis from January 2015 to January 2019 in our hospital were retrospectively analyzed.According to the bacterial culture results,they were divided into two groups:culture negative group(group A)and culture positive group(group B).Clinical characteristics and prognosis of patients with different culture results were compared.Results The culture positive rate was 47.83%(11/23),and staphylococcus was the most common culture positive type,followed by Escherichia coli.Before admission,there were no statistically significant differences between the two groups in age,gender,visual analogue scale score(VAS),clinical symptoms and signs of spinal involvement and spinal abscess(P>0.05).The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and white blood cell(WBC)count in culture negative group were lower than those in the positive group,the differences were statistically significant(P<0.05).The course of disease in the culture negative group was longer than that in the culture positive group,and the difference was not statistically significant(P=0.194).After treatment,there were no statistically significant differences in length of hospital stay,pain relief and infection recurrence rate between the two groups(P>0.05).After treatment,the levels of ESR,CRP and ESR in the cultured negative group at discharge were lower than those in the cultured positive group,but the differences were not statistically significant(P>0.05).The decrease of CRP in the positive culture group was higher than that in the negative culture group,and the difference was statistically significant(P<0.05).The decrease value of ESR in both two groups was lower than that of CRP.Conclusion In the diagnosis and treatment of primary pyogenic spondylitis,the basic values of ESR,CRP and WBC in patients with negative bacterial culture are significantly lower than those in patients with positive bacterial culture.However,the severity,treatment cycle and prognosis of the two groups are similar.