脊柱结核药物治疗回顾性分析

脊柱结核药物治疗回顾性分析

秦世炳

北京胸科医院北京结核病胸部肿瘤研究所骨科

摘要目的探讨脊柱结核患者的药物治疗方案及时间，以确定脊柱结核的最佳结核药物的治疗方案及最佳用药时间。方法回顾性分析我院收治的890例脊柱结核住院患者的药物治疗方案和用药时间，针对不同的发病、临床表现、不同的手术效果分析其结核药物干扰的表现，同时对初治、复治、复发及耐药的患者的治疗方案的应用，还有合并其它部位结核或合并其它疾病的个性化治疗方案的总结。结果890例脊柱结核中初治596例（67%），复治294例（33%）；其中收治的复发病例110例（12.3%），耐药74例（7.4%）；合并他处结核的273例（30.7%）治疗方案以四联为主（H12/R12/E9/Z5/S3）；复治的以添加二线及左氧氟沙星为主；耐药的以二线及静脉输注抗结核药物等，并根据耐药谱应用个性化治疗或随时更换抗结核药物方案，用药时间12 ~36个月不等，患者均痊愈。结论脊柱结核是结核分枝杆菌感染引起的脊柱骨感染性破坏，结核菌破坏力强，难杀灭，用药时间长，易形成医源性耐药，因此结核药物治疗是治愈结核的关键，有效和规范抗结核菌药物治疗方案，对于脊柱结核的治疗有着重要意义。

关键词脊柱结核，结核药

The retrospective analysis of the chemotherapy

in the spinal tuberculosis

Qin Shibing

Beijing Chest Hospital, The Orthopaedic Department of Beijing

Tuberculosis and Thoracic Tumor Research Institute

Abstract Objective: To explore the plan and time about the chemotherapy in the spinal tuberculosis. To determine the best therapeutic regimen and duration of the spinal anti-tuberculosis. Method :The medication plan and duration of 890 hospitalization patients of spinal tuberculosis in our hospital were retrospectively investigated. We collected the plan of the initial treatment, retreatment, recrudescence and drug resistance. We also studied the individuation therapeutic regimen of the patients with other parts tuberculosis or complications. On the basis of such data, we analyzed the interferential appearance that the anti-tuberculosis drug acted on different onsets, manifestations and operations. Result:In 890 patients of spinal tuberculosis, 596(67%) were initial treatment, 294(33%) were retreatment, recur cases were 110(12.3%), drug resistance cases were 74(7.4%), complicated with other parts tuberculosis were 273(30.7%). The main chemotherapeutic regimen was the usual tetragenous protocol (H12/R12/E9/Z5/S3). The retreatment cases were given second-line drugs such as levofloxacin. The drug resistance cases were also given second-line drugs and intravenous infusion. According to the anti-tubercle bacillus spectrum, individuation treatments were adopted, and the plan was changed in time. The medication duration continued for 12-36 months. All the 890 patients were cured. Conclusion:Spinal

tuberculosis was caused by the tubercle bacillus which infected and demolished the spine. The tubercle bacillus had strong destructive power. And it couldn’t be eliminated easily. Therefore the anti-tuberculosis therapy needed long time chemotherapy and iatrogenic drug resistance formed regularly. The key point of curing the tuberculosis was chemotherapy. For the treatment of spinal tuberculosis, it was significance that standardize the anti-tuberculosis chemotherapy effectively.

Key word spinal tuberculosis, anti-tuberculosis drugs

全球结核发病有明显上升趋势，而作为常见继发结核的脊柱结核的发病也明显增多，结核病治疗的重点是药物治疗，脊柱结核的治愈也是这个问题，没有正确的抗结核药物治疗，手术的效果就不可能保证；但由于发病分布不均，医务工作者对结核药物治疗的认识不够，其治疗的方法和手段存在很多差异，致使一部分患者没有得到很好的彻底的治疗，用药不规范造成复发、耐药的情况逐渐增多，影响了患者的治疗效果和最终的预后，鉴于此种情况，特回顾性分析我院收治病例的用药情况。

一、资料与方法

1、一般资料：

回顾2000年1月-2008年12月间门诊及住院确诊的890例典型脊柱结核病例，初治596例（67%），复治294例（33%）；其中收治的复发病例110例（12.3%），耐药74例（7.4%）；合并他处结核的