感染性脊椎椎间盘炎分析：7年数据。
Analysis of infectious spondylodiscitis: 7-years data.
作者信息
Okay Gulay, Akkoyunlu Yasemin, Bolukcu Sibel, Durdu Bulent, Hakyemez Ismail Necati, Koc Meliha Meric
机构信息
Gulay Okay, MD. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey.
Yasemin Akkoyunlu, Associate Professor. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey.
出版信息
Pak J Med Sci. 2018 Nov-Dec;34(6):1445-1451. doi: 10.12669/pjms.346.15717.
OBJECTIVE
Infectious spondylodiscitis (SD) is an infectious disease that is rare and difficult to diagnose due to its non-specific clinical features. In this study, we aimed to describe the clinical and diagnostic features of infectious spondylodiscitis.
METHODS
All patients who were diagnosed with SD at our hospital during a 7-year period from January 1, 2011 through December 31, 2017 were included in the study. Spondylodiscitis is divided into the following three types: pyogenic, tuberculous, and brucellar. Clinical and laboratory data were collected retrospectively from the medical records of the patients.
RESULTS
Of the 118 patients, 66 (55.9%) were female, 81 (68.6%) had pyogenic SD (PSD), 21 (17.8%) had tuberculous SD (TSD), and 16 (13.6%) had brucellar SD (BSD). The mean age was 59.3 ± 14.6 years. Leucocytosis was significantly higher in patients with PSD (p=0.01) than in patients with other types of SD. Thoracic involvement (47.6%) was significantly higher in patients with TSD (p=0.005) than in other patients. Sacral involvement (12.5%) was significantly higher in patients with BSD (p=0.01) than in other patients. Paravertebral abscess formation (42.8%) occurred most frequently in patients with TSD. Microbiologic agents were defined in 50% (18/36) of the surgical specimens and in 12.5% of the fine needle aspiration biopsy (FNAB) specimens. Staphylococcus aureus was the most common microbiological agent in patients with PSD. Spinal surgery was defined as a risk factor for PSD (p = 0.0001). Binary logistic regression analysis revealed that female gender, thoracic involvement and night sweats were the predictive markers for TSD (OR 4.5 [95% CI 1.3-15.3] and OR 5 [95% CI 1.7-14.6]).
CONCLUSION
PSD is the most frequent form of SD. Leucocytosis is most common in patients with PSD. Thoracic involvement and paraspinal abscess were prominent in patients with TSD. Sacral involvement was most common in patients with BSD. Thoracic involvement, female gender and night sweats were the predictive markers for TSD. The microbiological culture positivity rate was higher in surgical specimens compared to FNAB specimens. The need for surgical treatment was most common in patients with TSD.
目的
感染性脊椎椎间盘炎（SD）是一种因临床特征不特异而罕见且难以诊断的传染病。在本研究中，我们旨在描述感染性脊椎椎间盘炎的临床和诊断特征。
方法
纳入2011年1月1日至2017年12月31日这7年间在我院被诊断为SD的所有患者。脊椎椎间盘炎分为以下三种类型：化脓性、结核性和布鲁氏菌性。从患者病历中回顾性收集临床和实验室数据。
结果
118例患者中，66例（55.9%）为女性，81例（68.6%）患有化脓性SD（PSD），21例（17.8%）患有结核性SD（TSD），16例（13.6%）患有布鲁氏菌性SD（BSD）。平均年龄为59.3±14.6岁。PSD患者的白细胞增多症显著高于其他类型SD患者（p=0.01）。TSD患者的胸椎受累（47.6%）显著高于其他患者（p=0.005）。BSD患者的骶骨受累（12.5%）显著高于其他患者（p=0.01）。椎旁脓肿形成（42.8%）在TSD患者中最常见。50%（18/36）的手术标本和12.5%的细针穿刺活检（FNAB）标本中确定了微生物病原体。金黄色葡萄球菌是PSD患者中最常见的微生物病原体。脊柱手术被确定为PSD的一个危险因素（p = 0.0001）。二元逻辑回归分析显示，女性、胸椎受累和盗汗是TSD的预测指标（OR 4.5 [95% CI 1.3 - 15.3]和OR 5 [95% CI 1.7 - 14.6]）。
结论
PSD是SD最常见的形式。白细胞增多症在PSD患者中最常见。胸椎受累和椎旁脓肿在TSD患者中突出。骶骨受累在BSD患者中最常见。胸椎受累、女性和盗汗是TSD的预测指标。与FNAB标本相比，手术标本的微生物培养阳性率更高。TSD患者最常需要手术治疗。
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