布鲁菌性脊柱炎的诊疗分析
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摘要
目的探讨布鲁菌性脊柱炎的诊断及治疗疗效。方法回顾2013年9月～2016年9月我院收治的46例布鲁菌性脊柱炎患者的诊治过程及预后,年龄36～68岁,通过流行病学、临床表现、影像学检查、实验室检查及病理学检查确诊,均采取抗布鲁菌药物治疗和其他对症支持治疗。观察治疗方法、治疗效果及治疗疗程。结果优先给予多西环素、利福平及头孢类或左氧氟沙星三联抗生素抗布鲁菌药物治疗,并予以对症治疗,治疗成功的患者总疗程均需超过半年,治疗成功率为84.80%(39/46),复发率13.04%(6/46)。结论通过流行病学、临床症状,结合影像学、实验室检查及病理学检查,本病可作出明确诊断,遵循"早期、长期、足量、联合"的原则,如出现神经损害等严重并发症,在抗感染的基础上可采取手术治疗。
Objective To investigate the diagnosis and treatment of brucellosis spondylitis. Methods The diagnosis and treatment process and prognosis of 46 patients with brucella spondylitis admitted in our hospital from September 2013 to September 2016 were respectively analyzed. Their age was 36-68 years old. And the patients were diagnosed through epidemiology, clinical manifestations, imaging examination, laboratory examination and pathological examination. And the patients were treated with anti-brucella drug and other symptomatic support treatment. The treatment method,treatment effect and treatment course were observed. Results Doxycycline, rifampicin and cephalosporin or levofloxacin triple antibiotics against brucella and symptomatic treatment were given preferentially. The total treatment course of patients who were successfully cured was more than half a year, and the success rate was 84.80%(39/46), and the recurrence rate was 13.04%(6/46). Conclusion Through epidemiology, clinical symptoms, combined with imaging, laboratory examination and pathological examination, the disease can be diagnosed clearly, following the principles of "early period, long-term, adequate dose, combination". Surgery can be taken on the basis of anti-infection if serious complications such as neurological damage occur.
Objective To investigate the diagnosis and treatment of brucellosis spondylitis. Methods The diagnosis and treatment process and prognosis of 46 patients with brucella spondylitis admitted in our hospital from September 2013 to September 2016 were respectively analyzed. Their age was 36-68 years old. And the patients were diagnosed through epidemiology, clinical manifestations, imaging examination, laboratory examination and pathological examination. And the patients were treated with anti-brucella drug and other symptomatic support treatment. The treatment method,treatment effect and treatment course were observed. Results Doxycycline, rifampicin and cephalosporin or levofloxacin triple antibiotics against brucella and symptomatic treatment were given preferentially. The total treatment course of patients who were successfully cured was more than half a year, and the success rate was 84.80%(39/46), and the recurrence rate was 13.04%(6/46). Conclusion Through epidemiology, clinical symptoms, combined with imaging, laboratory examination and pathological examination, the disease can be diagnosed clearly, following the principles of "early period, long-term, adequate dose, combination". Surgery can be taken on the basis of anti-infection if serious complications such as neurological damage occur.
引文
[1]中华人民共和国卫生部.布鲁氏菌病诊疗指南(试行)[J]传染病信息,2012,25(6):323-324.
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[3]高彦辉,赵丽军,孙殿军,等.布鲁氏菌病防治基础研究现状与展望[J].中国科学(生命科学),2014,44(6):628-635.
[4]张俊辉,杨超,叶运莉.我国人间布鲁菌病流行特征变化及防控策略[J].寄生虫与感染性疾病,2011,6(9):101-103.
[5]杨新明,张磊,刘肃,等.脊柱疾病[M].第6版.北京:科学技术文献出版社,2011:271-275.
[6]Merih IS,Ferruh Gezen.Brucellar lumbar epidural abscess:Case report and review[J].Neurosurg,2006,16(2):100-103.
[7]Solera J,Lozano E,Alfaro EM,et al.Brucellar spondylitis:Review of 35 cases and literature suvery[J].Clin Infect Dis,1999,29(4):1440-1449.
[8]韦嘉.布氏菌病[M]//杨绍基,任红.传染病学[M].第7版.北京:人民卫生出版社,2008:179-182.
[9]Erdem H,ULu-Kilic A,Kilic S,et al.Efficacy and tolerability of antibiotic in neurobrucellosis:Results of the istanbul study[J].Antimocrob Angents Chemother,2012,56(3):1523-1528.
[10]Gul HC,Erdem H,Bek S.Overview of the neurobrucellosis:A pooled analysis of 187 cases[J].Int J Infect Dis,2009,13(6):e339-343.
[11]杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎临床影像学及病理学表现[J].实用放射学杂志,2008,4(24):522-525.
[12]Ekici MA,Zbek Z,Gkolu A,et al.Surgical management of cervical spinal epidural abscess caused by Brucella melitensis:Report of the two cases and review of the literature[J].Journal of Korean Neurosurgical Soiety,2012,51(6):383-387.
[13]何剑南,姚猛.布氏杆菌性脊柱炎的诊断及治疗进展[J].颈腰痛杂志,2016,37(2):147-149.
[14]Alp E,Koe RK,Durak AC,et al.Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis[J].BMC Infect Dis,2006,6(1):72.
[15]Ariza J,Bosilkovaki M,Cascio A,et al.Perspectives for the treatment of brucellosis in the 21st century:The ioanaina recommendations[J].PLoS Med,2007,15(4):317.
[16]Ulu-Kilic A,Suyar MS,Tutuncae,et al.Complicated brucellar spondylodiscitis:Experience from an endemic area[J].Rheumatol Int,2013,33(11):2909-2912.
[2]De Figueiredo P,Ficht TA,Rice-Ficht A,et al.Pathogenesis immunobiology of brucellosis of Brucella-host interaction[J].Am J Pathol,2015,185(6):1505-1517.
[3]高彦辉,赵丽军,孙殿军,等.布鲁氏菌病防治基础研究现状与展望[J].中国科学(生命科学),2014,44(6):628-635.
[4]张俊辉,杨超,叶运莉.我国人间布鲁菌病流行特征变化及防控策略[J].寄生虫与感染性疾病,2011,6(9):101-103.
[5]杨新明,张磊,刘肃,等.脊柱疾病[M].第6版.北京:科学技术文献出版社,2011:271-275.
[6]Merih IS,Ferruh Gezen.Brucellar lumbar epidural abscess:Case report and review[J].Neurosurg,2006,16(2):100-103.
[7]Solera J,Lozano E,Alfaro EM,et al.Brucellar spondylitis:Review of 35 cases and literature suvery[J].Clin Infect Dis,1999,29(4):1440-1449.
[8]韦嘉.布氏菌病[M]//杨绍基,任红.传染病学[M].第7版.北京:人民卫生出版社,2008:179-182.
[9]Erdem H,ULu-Kilic A,Kilic S,et al.Efficacy and tolerability of antibiotic in neurobrucellosis:Results of the istanbul study[J].Antimocrob Angents Chemother,2012,56(3):1523-1528.
[10]Gul HC,Erdem H,Bek S.Overview of the neurobrucellosis:A pooled analysis of 187 cases[J].Int J Infect Dis,2009,13(6):e339-343.
[11]杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎临床影像学及病理学表现[J].实用放射学杂志,2008,4(24):522-525.
[12]Ekici MA,Zbek Z,Gkolu A,et al.Surgical management of cervical spinal epidural abscess caused by Brucella melitensis:Report of the two cases and review of the literature[J].Journal of Korean Neurosurgical Soiety,2012,51(6):383-387.
[13]何剑南,姚猛.布氏杆菌性脊柱炎的诊断及治疗进展[J].颈腰痛杂志,2016,37(2):147-149.
[14]Alp E,Koe RK,Durak AC,et al.Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis[J].BMC Infect Dis,2006,6(1):72.
[15]Ariza J,Bosilkovaki M,Cascio A,et al.Perspectives for the treatment of brucellosis in the 21st century:The ioanaina recommendations[J].PLoS Med,2007,15(4):317.
[16]Ulu-Kilic A,Suyar MS,Tutuncae,et al.Complicated brucellar spondylodiscitis:Experience from an endemic area[J].Rheumatol Int,2013,33(11):2909-2912.