脊柱結(jié)核伴脊髓損害急診手術(shù)后結(jié)核桿菌全身擴(kuò)散的風(fēng)險(xiǎn)評(píng)估與應(yīng)用研究

藍(lán)常貢　龍麗珍　謝克恭　涂振陽　高子然　唐毓金

【摘要】 目的 探討脊柱結(jié)核伴脊髓損害急診手術(shù)后結(jié)核桿菌全身擴(kuò)散的風(fēng)險(xiǎn)。方法 研究組（44例）為脊柱結(jié)核伴脊髓損害并進(jìn)行急診手術(shù)治療的患者;對照組（59例）為脊柱結(jié)核伴脊髓損害進(jìn)行擇期手術(shù)治療的患者。分別在術(shù)前1天、術(shù)后第1天和術(shù)后第7天抽取外周血提取結(jié)核分枝桿菌DNA（Mycobacterium tuberculosis DNA，MTBDNA），PCR擴(kuò)增，進(jìn)行MTBDNA即時(shí)熒光定量檢測，經(jīng)對比分析研究，評(píng)估脊柱結(jié)核伴脊髓損害急診手術(shù)后結(jié)核桿菌全身擴(kuò)散的風(fēng)險(xiǎn)。結(jié)果 術(shù)前1天、術(shù)后第1天和術(shù)后第7天外周血結(jié)核桿菌的DNA陽性率研究組分別為50.0%（22/44）、56.8%（25/44）和31.8%（14/44），對照組分別為49.1%（29/59）、52.5%（31/59）和33.9%（20/59）;其中，研究組術(shù)前1天、術(shù)后第1天和術(shù)后第7天外周血結(jié)核桿菌的含量變化差異無統(tǒng)計(jì)學(xué)意義（F=0.08，P=0.920）;對照組術(shù)前1天、術(shù)后第1天和術(shù)后第7天外周血結(jié)核桿菌的含量變化差異無統(tǒng)計(jì)學(xué)意義（F=1.29，P=0.084）;研究組和對照組術(shù)前1天、術(shù)后第1天和術(shù)后第7天的結(jié)核桿菌DNA含量組間比較差異無統(tǒng)計(jì)學(xué)意義（t值分別為1.415、0.158、0.144，P值分別為0.078、0.874、0.889）。結(jié)論 脊柱結(jié)核伴脊髓損害患者，術(shù)前沒有結(jié)核桿菌耐藥表現(xiàn)，術(shù)后正規(guī)抗結(jié)核治療，急診及擇期手術(shù)前后外周血結(jié)核桿菌DNA含量測定無明顯差異，提示脊柱結(jié)核伴脊髓損害患者急診手術(shù)并沒有造成結(jié)核桿菌全身外周血擴(kuò)散的風(fēng)險(xiǎn)。

【關(guān)鍵詞】 脊柱結(jié)核;脊髓損害;熒光定量聚合酶鏈反應(yīng);脫氧核糖核酸

中圖分類號(hào)：R529.2? ?文獻(xiàn)標(biāo)志碼：A? ?DOI：10.3969/j.issn.10031-383.2019.06.003

【Abstract】 Objective To study the risk of systemic diffusion of mycobacterium tuberculosis after emergency operation for spinal tuberculosis with spinal cord injury.Methods 44 cases of spinal tuberculosis with spinal cord lesion who underwent emergency operation were selected as research group，and 59 cases of spinal tuberculosis with spinal cord injury who underwent selective operation were selected as control group.Mycobacterium tuberculosis DNA（MTBDNA） was extracted from peripheral blood on one day before operation，the first day after operation and the seventh day after operation，respectively.Realtime fluorescence quantitative detection of MTBDNA was carried out by PCR amplification.And the risk of systemic diffusion of mycobacterium tuberculosis after emergency surgery for spinal tuberculosis with spinal cord injury was evaluated by comparative analysis.Results The DNA positive rate of mycobacterium tuberculosis in peripheral blood was 50.0%（22/44），56.8%（25/44） and 31.8%（14/44） in the research group on one day before operation，the first day after operation and the seventh day after operation，respectively，and 49.1%（29/59），52.5%（31/59） and 33.9%（20/59） in the control group，respectively.There was no statistically significant difference in the contents of mycobacterium tuberculosis in peripheral blood in the research group on one day before operation，the first day after operation and the seventh day after operation（F=0.08，P=0.920）.There was no statistically significant difference in the contents of mycobacterium tuberculosis in peripheral blood in the control group on one day before operation，the first day after operation and the seventh day after operation（F=1.29，P=0.084）.In addition，there was no statistically significant difference in the contents of mycobacterium tuberculosis between the research group and the control group on one day before operation，the first day after operation and the seventh day after operation（t=1.415，0.158，0.144，P=0.078，0.874，0.889，respectively）.Conclusion There was no drug resistance of mycobacterium tuberculosis in patients with spinal tuberculosis with spinal cord injury before operation，and regular antituberculosis treatment was performed after operation.Difference in the contents of mycobacterium tuberculosis in peripheral blood before and after emergency operation and selective operation was not significant，which shows that emergency operation in patients with spinal tuberculosis with spinal cord injury does not cause the risk of systemic diffusion of mycobacterium tuberculosis.