脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险评估与应用研究

蓝常贡　龙丽珍　谢克恭　涂振阳　高子然　唐毓金

【摘要】 目的 探討脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险。方法 研究组（44例）为脊柱结核伴脊髓损害并进行急诊手术治疗的患者;对照组（59例）为脊柱结核伴脊髓损害进行择期手术治疗的患者。分别在术前1天、术后第1天和术后第7天抽取外周血提取结核分枝杆菌DNA（Mycobacterium tuberculosis DNA，MTBDNA），PCR扩增，进行MTBDNA即时荧光定量检测，经对比分析研究，评估脊柱结核伴脊髓损害急诊手术后结核杆菌全身扩散的风险。结果 术前1天、术后第1天和术后第7天外周血结核杆菌的DNA阳性率研究组分别为50.0%（22/44）、56.8%（25/44）和31.8%（14/44），对照组分别为49.1%（29/59）、52.5%（31/59）和33.9%（20/59）;其中，研究组术前1天、术后第1天和术后第7天外周血结核杆菌的含量变化差异无统计学意义（F=0.08，P=0.920）;对照组术前1天、术后第1天和术后第7天外周血结核杆菌的含量变化差异无统计学意义（F=1.29，P=0.084）;研究组和对照组术前1天、术后第1天和术后第7天的结核杆菌DNA含量组间比较差异无统计学意义（t值分别为1.415、0.158、0.144，P值分别为0.078、0.874、0.889）。结论 脊柱结核伴脊髓损害患者，术前没有结核杆菌耐药表现，术后正规抗结核治疗，急诊及择期手术前后外周血结核杆菌DNA含量测定无明显差异，提示脊柱结核伴脊髓损害患者急诊手术并没有造成结核杆菌全身外周血扩散的风险。

【关键词】 脊柱结核;脊髓损害;荧光定量聚合酶链反应;脱氧核糖核酸

中图分类号：R529.2   文献标志码：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.