轻型脊柱结核药物治疗149例临床分析

目的评价药物治疗早期轻型脊柱结核的临床疗效,为完善轻型脊柱结核诊断标准及制定抗结核治疗方案奠定基础。方法回顾性分析2012年1月—2013年12月收治的早期诊断为轻型脊柱结核的149例患者临床资料。所有患者均接受异烟肼(H)、利福平(R)、乙胺丁醇(E)、吡嗪酰胺(Z)、左氧氟沙星(L)方案(6HREZL/6HREZ)抗结核治疗,辅以营养支持并完成2年随访。治疗期间每个月监测肝肾功能、红细胞沉降率(ESR)、C反应蛋白(CRP),治疗开始每隔3个月行影像学检查。随访期间根据临床治愈标准评价疗效,并分析治疗前后患者临床症状、疼痛视觉模拟量表(VAS)评分、病变愈合、ESR、CRP及药物不良反应发生情况及影像学检查变化。结果 138例经药物治疗获得临床治愈,11例在3个月内接受手术治疗。2年随访期间,所有患者疼痛缓解,恢复正常的日常活动,无神经功能障碍,骨质愈合,椎旁脓肿吸收;ESR及CRP恢复正常;抗结核药物不良反应轻微。结论 6HREZL/6HREZ方案治疗早期轻型脊柱结核疗效显著,抗结核药物治疗方案不良反应轻微,安全有效。

Clinical study of drug therapy in 149 patients with mild spinal tuberculosis

Objective To evaluate the outcomes of early diagnosed mild spinal tuberculosis after improved chemotherapy regimen treatment,and to lay a foundation for the diagnosis and chemotherapy of mild spinal tuberculosis. Methods The clinical data of 149 mild spinal tuberculosis patients from January 2012 to December 2013 were retrospectively analyzed. Patients were treated by improved anti-tuberculosis chemotherapy(isoniazide,rifampin,ethambutol,pyrazinamide and levofloxacin)regimens for 12 months(6HREZL/6HREZ) and followed up for at least 2 years upon the completion of treatment. Liver and kidney function,erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were monitored every month during treatment. The imaging examination was performed every 3 months after the treatment began. The curative effect was evaluated according to the clinical cure criteria during the follow-up period,and the clinical symptoms,pain visual analogue scale(VAS) score,lesion healing,ESR,CRP,adverse drug reaction and imaging changes were analyzed before and after the treatment. Results Of the 149 cases,138 cases were cured after drug treatment,and 11 cases received surgical treatment within 3 months. During the 2-year follow-up period,all patients were relieved of pain;resumed normal daily activities,no neurological dysfunction,bone healing,paravertebral abscess absorption;ESR and CRP were restored to normal;adverse reactions of anti-tuberculosis drugs were slight and reversible. Conclusion The 6HREZL/6HREZ regimen is effective in the treatment of early diagnosed light spinal tuberculosis. The anti-tuberculosis treatment regimen is safe and effective with mild adverse effects.