XU Jian-zhong,ZHANG Ze-hua,WAN Dong-yong,et al.Drug susceptibility-guided individual anti-tuberculous chemotherapy for spinal tuberculosis: report of 46 cases[J].J Third Mil Med Univ,2009,31(20):1926-1928.

药敏试验指导下脊柱结核个体化药物治疗(/HTML )




Drug susceptibility-guided individual anti-tuberculous chemotherapy for spinal tuberculosis: report of 46 cases
XU Jian-zhong ZHANG Ze-hua WAN Dong-yong ZHOU Qiang LIAO Chuan-yu ZHAO Xiao-li HE Qing-yi DAI Fei
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038; Department of Clinical Laboratory, Thoracic Hospital of Chongqing City, Chongqing 400036, China
spinal tuberculosis drug resistance drug susceptibility testing individual antit-uberculous chemotherapy
目的   实施结核分枝杆菌药敏试验指导下脊柱结核个体化化疗,探讨其有效性及安全性。   方法   46例脊柱结核患者接受手术治疗,术中收集脓液、干酪样组织,常规处理后接种液体培养基,使用BACT/ALERT 3D系统进行结核分枝杆菌快速培养,培养阳性者接种至改良罗氏培养基,按绝对浓度法进行11种药物药敏试验。根据药敏试验结果制定4-5药联合抗结核药物治疗方案。定期(1、3、6、9、12个月,以后每6个月1次)随访,观察血沉、平片、CT三维重建,评估结核活动、骨块融合和畸形矫正情况。   结果   培养阳性率41.3%(19/46),全程平均耗时42 d(30~58 d)。耐药率21.7%,其中异烟肼耐药10.8%,利福平和乙胺丁醇耐药2.1%,链霉素耐药6.52%,力克肺疾耐药4.34%,左氧氟沙星耐药17.39%。除4例明显胃肠道反应、1例药物型肝炎患者完成12个月疗程,其余18个月。随访18~44个月,平均25个月,切口均2周内愈合。椎间植骨均获Ⅰ级骨性融合,融合时间9~12个月。   结论   根据药敏试验结果组成脊柱结核12~18个月个体化联合化疗方案具有较好的有效性和安全性。
Objective   To investigate the efficacy and safety of individual anti-tuberculous chemotherapy guided by drug susceptibility testing for spinal tuberculosis by analyzing the post-operative follow-up outcomes.    Methods   In this series, the diagnoses of spinal tuberculosis were established based on clinical, radiological and histological arguments in 46 patients who were admitted from August 2005 to March 2009. Their specimens (pus or caseous tissue) were collected during surgery. After processed in a routine mycobacteriology laboratory procedure, the specimens were inoculated into vials of the BACT/ALERT 3D system. The drug susceptibility testing was performed using absolute concentration method, which included 11 first and second line drugs. Four or five anti-tuberculous drug regimen was chosen according to the results of drug susceptibility testing. All the patients were followed up regularly a month later, and then every 3 months for the following 11 months, and subsequently at intervals of half a year. The clinical status, erythrocyte sedimentation rate (ESR), roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis. Radiographs were analyzed before surgery, immediately after surgery, and at the final follow-up examination to assess the result of anterior fusion and maintenance of correction.    Results   Nineteen of the total 46 specimens were culture positive (41.3%). The average detection time to report drug susceptibility was 42 d (ranging from 30 to 58 d). The drug susceptibility testing showed a resistance level of 10.8% for isoniazid, 2.1% for rifampicin and ethambutol, 6.52% for streptomycin, 4.34% for dipasic and 17.396% for levofloxacin. Four patients with gastrointestinal reaction and 1 with anti-tuberculosis drug-induced hepatitis completed a 12 months’ therapy, and the others received a 18 month’ therapy. The mean follow-up period was 25 months (ranging from 18 to 44 months), and no obvious loss of deformity correction was observed. According to Bridwell criteria, grade Ⅰbony fusion was obtained in all patients in 9 to 12 months.    Conclusion   If guided by drug susceptibility testing, individual anti-tuberculous chemotherapy for 12 to 18 months is effective and safe for spinal tuberculosis.


许建中, 张泽华, 万东勇, 等. 药敏试验指导下脊柱结核个体化药物治疗[J]. 第三军医大学学报,2009,31(20):1926-1928.


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更新日期/Last Update: 2009-10-21