耐药脊柱结核术后并发窦道患者实施个体化治疗的临床效果(附24例短期疗效分析)

目的分析术后并发窦道的耐药脊柱结核患者个体化化疗的短期疗效。方法收集2015年1月至2017年1月于西安市胸科医院治疗的耐药脊柱结核术后并发皮肤窦道患者24例,均符合纳入标准。参考既往抗结核化疗史、一线抗结核药物表型药物敏感性试验(简称“药敏试验”)结果,以及按照我国《耐药结核病化学治疗指南(2015)》的相关化疗方案,制定个体化抗结核药物治疗方案并定期进行换药、随访。其中男15例,女9例;年龄21~69岁,平均(41.5±12.4)岁。记录患者窦道愈合时间、定期复查血红细胞沉降率(ESR)、C反应蛋白的变化;观察患者窦道外观与窦道CT表现的变化。结果单耐药组愈合时间为18~52d,平均(36.7±10.3)d;多耐药组为53~96d,平均为(71.7±13.6)d;耐多药组为68~260d,平均为(141.2±39.7)d。所有患者的ESR和C反应蛋白末次随访检测时基本正常,分别为(14.6±5.5)mm/1h 和(2.8±1.3)mg/L。24例患者随访12~24个月,平均(19.8±4.5)个月;末次随访时21例患者窦道已经愈合,3例明显好转,未愈合,但无再次窦道形成,未见结核复发。结论采用基于药敏试验的个体化抗结核药物治疗方案,联合窦道的换药,耐药脊柱结核术后并发皮肤窦道是可以治愈的,临床效果满意。

Clinical effect of individualized treatment for patients with drug-resistant spinal tuberculosis complicated with sinus tract after operation (analysis of short-term efficacy of 24 cases)

Objective To analysis the short-term efficacy of individualized chemotherapy of drug-resistant spinal tuberculosis complicated with sinus after operation. Methods 24 patients who met the inclusion criteria with drug-resistant spinal tuberculosis complicated with sinus after operation were enrolled from January 2015 to January 2017 in Xi’an Chest Hospital. Referring to the past history of anti-tuberculosis chemotherapy, the results of first-line anti-tuberculosis drug phenotype susceptibility test (referred to as “drug sensitivity test”) and the relevant chemotherapy schemes in accordance with the “Guidelines for Chemotherapy of Drug-resistant Tuberculosis (2015)”, individualized anti-tuberculosis drug treatment schemes were formulated and the effective dressing was changed regularly and the patients were followed up. There were 15 males and 9 females; aged 21-69 years, mean (41.5±12.4) years old. The healing time of tuberculous sinus were observed. The changes of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. The changes of sinus appearance and CT findings were observed. Results The healing time of the monodrug-resistant group was 18-52 days, with an average of (36.7±10.3) days. The healing time of the polydrug-resistant group was 53-96 days, with an average of (71.7±13.6) days. The healing time of the multidrug-resistant group was 68-260 days, with an average of (141.2±39.7) days. ESR and CRP were normal at the last follow-up, which were (14.6±5.5)mm/1h and (2.8±1.3) mg/L, respectively. 24 patients were followed up for 12-24 months, with an average of (19.8±4.5) months. 21 cases were healed, 3 cases were obviously improved and did not healed, but no re-formation of sinus tract and no recurrence of tuberculosis were found at the last follow-up. Conclusion According to the individualized anti-tuberculosis therapy based on drug sensitivity test and combined with the effective dressing change of sinus, the cutaneous sinus after drug-resistant spinal tuberculosis can be cured and the clinical effect is satisfactory.