脊椎結核－南台灣某教學醫院七年經驗

Spinal Tuberculosis-A 7-year Experience at a Teaching Hospital in Southern Taiwan

黃琮輿(Tsung-Yu Huang) ； 林皇伸(Huang-Shen Lin) ； 劉力瑛(Li-Ying Liu) ； 李明勳(Ming-Hsun Lee)

《內科學誌》 20卷4期 (2009/08) Pp. 367-372

https://doi.org/10.6314/JIMT.2009.20(4).11

摘要

脊椎結核是一種慢性進展的疾病。我們共收集26位在嘉義長庚醫院確診脊椎結核的病人，設計了這個七年的回溯性研究。有13位男性和13位女性的病人，平均年紀66.5歲（年齡從33到88歲）。診斷前症狀平均時間為10.5個月，下背痛是最常見的症狀。24(92.3%)位病人都感染二個以上的脊椎骨，平均2.3個，胸椎及腰椎共佔了94.9%。21(80.8%)位病人從脊椎、脊椎旁膿瘍或腰肌膿瘍培養出結核菌，其中8個檢體抗酸性染色抹片(acid-fast smear)陽性。14(53.8%)位病人的胸部X光片有肺結核的徵兆。19位病人有送痰液結核菌培養，其中10(38.5%)位病人培養出結核菌，有4(15.4%)位病人同時檢查的抗酸性染色抹片陽性。23(88.5%)位病人能夠做預後追蹤，18位病人治療成功，5位病人復發。復發的一組年紀較輕、症狀較久。慢性腎衰竭的病人有較高的復發率(OR, 68.000; 95% CI, 3.460~1336.269; p=0.003)。脊椎結核好發於老年人和免疫不全者。常規的胸部X光線檢查，痰液的抗酸菌染色抹片及結核菌培養可以發現併存的肺結核。

關鍵字

脊椎 ； 結核

並列摘要

Spinal tuberculosis (TB) is a slowly progressive disease. We retrospectively reviewed 26 patients with culture- or tissue-proof spinal TB at Chang Gung Memorial Hospital-Chiayi over a 7-year period. There were 13 males and 13 females with a mean age of 66.5 years (range, 33 to 88 years). The mean duration of symptoms and signs before diagnosis was 10.5 months. Low back pain (100%) was the major presentation. Twenty-four (92.3%) patients had more than two adjacent vertebral bodies involved. The average number of vertebral bodies involved per patient was 2.3. Fifty-six (94.9%) of these lesions were located at the thoracic and lumbar spines. Twenty-one patients (80.8%) had positive TB culture of spinal tissue, paraspinal and psoas muscle abscesses. Of which, 8 had positive smear for acid-fast bacilli (AFB). Fourteen (53.8%) patients had röentgenologic evidence of pulmonary TB. Ten of 19 patients with sputum for mycobacterial smear and cultures had positive culture for TB, of which 4 had positive AFB smear simultaneously. Twenty-one patients received post-treatment follow-up. Among them, 18 had treatment success and 5 had relapses. Compared the relapse to the success, the former was younger and had longer symptoms. The relapse seemed to have higher incidence of patients with chronic renal failure (OR, 68.000; 95% CI, 3.460~1336.269; p =0.003)。Spinal TB often occurred in elderly people with immunosuppressant. Routine chest X-ray and sputum for mycobacterial smear and culture could be necessary to find concurrent pulmonary TB.

並列關鍵字

Spine ； Tuberculosis