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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/ALERT3D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42d(30～58d)。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 carry out personalized chemotherapy of spinal tuberculosis under the guidance of drug sensitivity test of Mycobacterium tuberculosis to explore its effectiveness and safety. Methods 46 patients with spinal tuberculosis underwent surgery. Pus and casein-like tissues were collected during operation. Liquid culture medium was inoculated routinely. BACT / ALERT3D system was used for rapid culture of Mycobacterium tuberculosis. Positive cultures were inoculated into modified Roche medium , According to the absolute concentration method of drug susceptibility testing of 11. According to drug susceptibility test results to develop 4-5 drug combination anti-TB drug treatment. The patients were followed up regularly (1, 3, 6, 9 and 12 months, every 6 months thereafter). The ESR, plain radiography and CT three-dimensional reconstruction were observed. The tuberculosis activity, bone fusion and deformity were evaluated. Results The positive rate of culture was 41.3% (19/46), and the average time was 42 days (30 ~ 58 days). The resistance rate was 21.7%, of which 10.8% was resistant to isoniazid, 2.1% resistant to rifampicin and ethambutol, 6.52% resistant to streptomycin, 4.34% resistant to Lectobacillus pleuropneumoniae and 17.39% resistant to levofloxacin. In addition to 4 cases of significant gastrointestinal reactions, 1 case of drug-induced hepatitis patients completed 12-month course of treatment, the remaining 18 months. All the patients were followed up for 18 to 44 months with an average of 25 months. The incisions healed within 2 weeks. Intervertebral bone graft were grade Ⅰ bone fusion, fusion time of 9 to 12 months. Conclusion According to the result of drug susceptibility test, the personalized chemotherapy combined with chemotherapy for 12 to 18 months with spinal tuberculosis has good efficacy and safety.