psk1 virulence gene-induced pulmonary and systemic tuberculosis in a young woman with normal immune function:A case report

BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.

Tuberculosis of the spine

Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.

One-stage Surgical Treatment for Thoracic and Lumbar Spinal Tuberculosis by Transpedicular Fixation, Debridement, and Combined Interbody and Posterior Fusion via a Posterior-only Approach

This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.

Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult

Purpose: The complexity of chest radiography (CXR) is a source of variability in its interpretation. We assessed the effect of an interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis. Methods: The study was conducted in Yaounde (Cameroon). Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in medical imaging) interpreted 47 frontal CXR twice two months apart without (R1) and with (R2) the aid of an interpretation grid. We focused on the detection of micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n = 7). Results: The average score for accurate detection of elementary lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and 52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1) than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly variable with a modest improvement for the diagnosis of tuberculosis in R2. Conclusion: Standardized interpretation scheme improved the detection of CXR anomalies and diagnosis of tuberculosis. It significantly improved inter-observer’s agreement in diagnosing tuberculosis but not in detecting most lesions.

Diagnosis and treatment of spinal tuberculosis after liver transplantation

BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.

Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach

Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.

Susceptibility of spinal tuberculosis and its related gene polymorphisms

Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of life with high incidences of deformity and disability.The onset of spinal tuberculosis is related to many factors such as gender,age,environment,habits and hereditary factor.As a genetic factor,gene polymorphism plays an important role in the occurrence and development of tuberculosis.This article reviews the research progress of the susceptibility of spinal tuberculosis and its related gene polymorphisms,in order to provide reference for early prevention and treatment of spinal tuberculosis.

The Effect of Intensive Psychological Nursing on the Mood and Solutions of Spinal Tuberculosis Patients

Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in our hospital from February 2017 to January 2020 were retrospectively analyzed.A11 the cases were grouped according to different nursing plans,patients who received routine care were included in the control group(n=50),and the ones with intensive psychological care were included in the observation group(n=52).Compare negative emotions after nursing[assessment using self-assessment scale of anxiety(SAS),depression self-assessment scale(SDS)]and solutions[assessment using medical response questionnaire(MCMQ)]of the two groups.Results:After nursing,the SAs,SDs scores,avoidance and yield scores of the two groups were reduced,and the coping scores were increased,and the change of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05).Conclusion:Spinal tuberculosis surgery patients were treated with intensive psychological care,which can relieve patients'negative emotions,improve solutions and are worthy of clinical use.

Surgical treatment of spinal tuberculosis in older patients

Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Extra-Pulmonary Tuberculosis: Retrospective Review of 83 Confirmed Cases, Observed in Radiology in Lomé(TOGO)

Background: Tuberculosis primarily affects lungs, but all organs may be affected. Extra-pulmonary forms of tuberculosis cause a big public health problem as it is diagnosed late. This delay in diagnosis is not only due to the delay in the examination, but also due to difficulties related to extra-pulmonary tuberculosis diagnostic. Aim: To describe the different locations of extra-pulmonary Tuberculosis and its aspects in Togo. Patients and Methods: A retrospective analysis of all extra-pulmonary tuberculosis cases diagnosed by imaging over five years (January 2010 to December 2015) was done. All the cases were confirmed either by direct examination of biological fluids or by histological analysis of biopsy and surgical samples or by culture on specific area. Data were collected from the Department of Radiology, from Microbiology Laboratory of the Pneumo-phthisiology unit and from Pathology Laboratory of Sylvanus Olympio Teaching Hospital of Lomé. Results: A total of 83 cases of extra-pulmonary Tuberculosis had been taken into account: 45 men and 38 women, with a maximum number of cases (66.3%) in the age group between 20 to 40 years old. An HIV infection was known in 51 patients (61.4%). Pulmonary damage was associated in 21 patients (25.3%). A total of 116 extra-pulmonary tuberculosis locations were recorded. Damages were pleural in 37.1% (43), ganglion in 24.1% (28), osteo-articular in 15.5% (18), abdominal in 12.9% (15), military represented 8.6% (10), a case of testicular damage, and a case of mammary tuberculosis. Conclusion: The medical scanning based on conventional radiography, ultrasonography and TDM is indispensable for the diagnosis and the care taking of extra-pulmonary tuberculosis since some locations may be confused with many other diseases and lead to misdiagnosis errors and delay the treatment.

Application of artificial intelligence in digital chest radiography reading for pulmonary tuberculosis screening

Currently, the diagnosis of tuberculosis (TB) is mainly based on the comprehensive consideration of the patient’s symptoms and signs, laboratory examinations and chest radiography (CXR). CXR plays a pivotal role to support the early diagnosis of TB, especially when used for TB screening and differential diagnosis. However, high cost of CXR hardware and shortage of certified radiologists poses a major challenge for CXR application in TB screening in resource limited settings. The latest development of artificial intelligence (AI) combined with the accumulation of a large number of medical images provides new opportunities for the establishment of computer-aided detection (CAD) systems in the medical applications, especially in the era of deep learning (DL) technology. Several CAD solutions are now commercially available and there is growing evidence demonstrate their value in imaging diagnosis. Recently, WHO published a rapid communication which stated that CAD may be used as an alternative to human reader interpretation of plain digital CXRs for screening and triage of TB.

Clinical and radiographic predictors in diagnosing sputum smear- negative pulmonary tuberculosis in HIV-negative patients： a cross- sectional study in China

Background In county-level tuberculosis （TB） dispensaries in China,the accurate diagnosis of sputum smear-negative pulmonary tuberculosis （SNPT） needs to be improved by developing and validating clinical and radiographic predictors.Methods The study was conducted simultaneously in three counties per province in Chongqing Municipality and Liaoning Province in China between May 2005 and May 2006.A total of 432 new SNPT patients who are HIV-negative and more than 15 years old diagnosed by expert panels in county-level TB dispensaries were recruited.Their sputum samples were collected for culture before anti-TB treatment,and the treatment outcomes （changes of X-rays） were followed up at the end of the 6th month.Results Of the 432 SNPT patients,sputum culture positive （9.7%） or culture negative with good changes of X-rays at the end of the 6th month （73.6%） was validated as SNPT.Four predictive variables were associated with validated SNPT in the multivariate logistic regression model：age ≤55 years old （odds ratio （OR） 5.66; 95% CI 2.69-11.91）,〉60 days of cough （OR 3.73; 95% CI 1.10-12.65）,≥10% of pulmonary consolidation in the lungs （OR 5.40; 95% CI 2.90-10.06）,and pulmonary consolidation in the upper lobe anterior segment （OR 3.00; 95% CI 1.57-5.72）.The area under the receiver operating characteristic curve of the model was 0.77 （95% CI 0.71-0.83）.Conclusion Four predictors of clinical and radiological characteristics that had a good diagnostic performance of SNPT deserve to be recommended as index indicators of SNPT diagnosis in county-level TB dispensaries in China.

Influence of moxibustion apparatus as adjuvant treatment for pulmonary tuberculosis andpatient's immune function

Objective To verify efficacy of moxibustion apparatus on pulmonary tuberculosis(PT)and explore adjuvant treatment method for PT.Methods One hundred cases of PT were randomly divided into a moxibustion group and a routine treatment group,50 cases in each.The regular

Analytic Study of Spinal Infections: Clinical Picture, Treatment, and Outcomes in King Fahad Military Medical Complex in Dhahran, Saudi Arabia

Objective: To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. Design: Retrospective cross-sectional study. Setting: Single hospital in Dhahran, Saudi Arabia. Patients: Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. Methods: We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. Results: Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2 - 6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was Mycobacterium tuberculosis (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing Escherichia coli (4 patients, 25%), Brucella spp (3 patients, 18.75%), Staphylococcus aureus (1 patient, 6.25%), and Quambalaria cyanescens (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. Conclusion: M. tuberculosis was found to be the major cause of infectious spondylodiscitis. Additionally, Quambalaria cyanescens was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.

Spinal Decompression with 360&deg;Instrumented Fusion for Unstable Tuberculous Quadriplegia in a Young Adult—A Case Report

Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°;instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.

优化T-SPOT.TB在区分脊柱结核与其他脊柱感染中的诊断效能

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)在脊柱结核(STB)鉴别诊断中的效能,并通过受试者工作特征(ROC)曲线最佳截断值优化诊断效能。方法 收集2010年1月—2019年5月某院脊柱感染患者的临床资料,包括术前T-SPOT.TB检测结果、白细胞计数、C-反应蛋白、血沉、降钙素原和结核抗体等相关数据,根据诊断标准进行临床诊断,分析T-SPOT.TB在术前诊断STB与其他脊柱感染中的灵敏度和特异度,评价优化后的T-SPOT.TB指标的诊断效能。结果 共纳入132例患者,其中78例(59.09%)为STB,54例(40.91%)为非结核脊柱感染。T-SPOT.TB在鉴别诊断STB方面的灵敏度为67.68%,特异度为66.67%。单因素logistic回归分析显示,与非结核脊柱感染比较,T-SPOT.TB检测诊断STB的OR值为4.188(95%CI:1.847~9.974,P<0.001)。优化T-SPOT.TB评价指标,通过绘制ROC曲线,确定ESAT-6、CFP-10、CFP-10+ESAT-6在STB和非结核脊柱感染鉴别诊断中的最佳截断值,分别为12.5、19.5、36,曲线下面积(AUC)分别是0.765 6、0.741 5、0.778 6,均具有较好的诊断性能,其中以CFP-10+ESAT-6的AUC最高。CFP-10+ESAT-6特异性斑点数在脊柱结核诊断中性能更佳,其诊断准确度为75.56%,较优化前T-SPOT.TB的67.42%高。结论 T-SPOT.TB检测在区分STB与非结核脊柱感染方面显示出较高的诊断效能,T-SPOT.TB检测呈阳性,尤其是当CFP-10+ESAT-6的斑点数超过36时,提示脊柱结核的可能性较大。

脊柱结核术后TLR-4、TNF-α、IL-6、IL-17的变化及与预后的相关性研究

目的分析脊柱结核术后Toll样受体(TLR)-4、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-17的变化及与预后的相关性。方法选择2021年1月—2022年12月收治的60例接受手术治疗的脊柱结核患者作为观察组,另选60例非脊柱结核且行脊柱手术的患者作为对照组(部分病例由基金项目中合作医院提供)。检测两组患者血清及病灶组织TLR-4、TNF-α、IL-6、IL-17表达水平。根据观察组患者术后6个月的预后情况,分为预后良好组和预后不良组,比较两组术前及术后6个月的血清TLR-4、TNF-α、IL-6、IL-17表达水平,使用Pearson相关性分析评价脊柱结核患者术前血清TLR-4、TNF-α、IL-6、IL-17表达水平与术后6个月改良巴氏指数(MBI)量表评分的关系,受试者工作特征(ROC)曲线分析术后血清TLR-4、TNF-α、IL-6联合IL-17对脊柱结核术后预后不良的预测效能。结果观察组术前血清及病灶组织的TLR-4、TNF-α、IL-6、IL-17表达水平均高于对照组,差异均有统计学意义(P<0.05);预后不良组术前血清TLR-4、TNF-α、IL-6、IL-17表达水平均高于预后良好组,差异均有统计学意义(P<0.05);术后6个月,预后良好组血清TLR-4、TNF-α、IL-6、IL-17表达水平较术前明显降低,与预后不良组比较,差异均有统计学意义(P<0.05);经Pearson相关性分析,脊柱结核患者术前血清TLR-4、TNF-α、IL-6、IL-17表达水平与术后6个月MBI量表评分呈负相关(P<0.05);经ROC曲线分析,术前血清TLR-4、TNF-α、IL-6联合IL-17预测脊柱结核术后预后不良的ROC曲线下面积为0.921。结论脊柱结核术后血清TLR-4、TNF-α、IL-6、IL-17较术前明显降低,与预后密切相关,术前血清TLR-4、TNF-α、IL-6联合IL-17预测预后不良的效能较好,值得临床予以重视。

脊柱结核术后并发症的干预对策研究进展

临床上对于脊柱结核(STB)通常采取手术治疗以改善患者生存质量,但是术后易并发多种并发症,不仅对手术效果造成不良影响,甚至可危及患者的生命安全.对于术后并发症的干预,常规的干预模式已经无法满足临床及患者的需求.基于此,本文对STB术后并发症的干预对策进行综述,以期为临床制定科学、完善、有效的干预方案提供参考依据.