研究布鲁菌病合并脊柱炎的临床表现、治疗及预后。

分析潍坊市益都中心医院2013年1月至2016年5月收治的120例布鲁菌病并脊柱炎患者的临床资料，其中椎体炎患者35例、椎间盘受累患者55例、骨质破坏患者和脓肿患者各15例，椎体炎患者用药方案为多西环素+利福平(DR组)，椎间盘受累组患者治疗方案为多西环素+利福平+复方磺胺新诺明(DRC组)；骨质破坏和脓肿患者治疗方案为多西环素+利福平+复方磺胺新诺明+左氧氟沙星(DRCL组)，记录各组临床资料及其治疗方案、疗效、复发及药物不良反应等。

入组患者脊柱核磁表现为椎体炎、椎间盘受累、骨质破坏周围软组织脓肿。DR组患者2个疗程治愈率、4个疗程治愈率、超过4个疗程治愈率、复发率、药物不良反应发生率分别为14.3%、82.9%、17.1%、28.6%和5.7%；DRC组患者分别为38.2%、94.5%、5.5%、5.5%和1.8%；DRCL组患者分别为0%、20%、80%、0%和3.33%。2个疗程后DRC组患者治愈率显著高于DR组(χ²= 18.26、P <0.001)，4个疗程后DRCL组患者治愈率显著低于DR组和DRC组(P均<0.001)；4个以上疗程后DRCL组患者治愈率显著高于其他两组(P均<0.001)。DRCL组患者复发率显著低于其他两组(χ²= 16.692、P <0.001)；三组患者药物不良反应差异无统计学意义(χ²= 1.008、P= 0.604)。

多药联合长疗程治疗布鲁杆菌病脊柱炎复发率低，可达到理想治疗终点，且不一定增加药物不良反应的发生率。

To investigate the clinical manifestation, treatment and prognosis of brucellosis complicated with spondylitis.

The clinical data of 120 patients with brucellosis and spondylitis treated in Yidu Central Hospital of Weifang from January 2013 to May 2016 were analyzed, including 35 patients with spondylitis, 55 patients with disc involvement, 15 patients with bone destruction and 15 patients with abscess. Patients with spondylitis were treated with doxycycline and rifampicin (DR group) and patients with disc involvement with doxycycline + rifampicin + compound sulfampin plus cotrimoxazole (DRC group), patients with bone destruction and abscess were treated with doxycycline + rifamp Ping + compound sulfamethoxazole +levofloxacin (DRCL group). The clinical data, therapeutic effects, recurrence and adverse drug reactions were recorded, respectively.

The spinal nuclear magnetic fields of the patients presented with spondylitis, disc involvement and soft tissue abscess around bone destruction. The cure rates of 2 courses, 4 courses, longer than 4 courses of treatment, the recurrence rate and adverse drug reaction rate of patients in DR group were 14.3%, 82.9%, 17.1%, 28.6% and 5.7%, respectively; which were 38.2%, 94.5%, 5.5%, 5.5% and 1.8% of patients in DRC group; and 0%, 20%, 80%, 0% and 3.33% of patients in DRCL group, respectively. After two courses of treatment, the cure rate of DRC group was significantly higher than that of DR group (χ²= 18.26,P< 0.001). After 4 courses of treatment, the cure rate in DRCL group was significantly lower than that of DR group and DRC group (allP< 0.001), the cure rate of DRCL group was significantly higher than that of the other two groups after longer than 4 courses of treatment (allP< 0.001). The recurrence rate in DRCL group was significantly lower than that of the other two groups (χ²= 16.692,P < 0.001). There was no significant difference in adverse drug reactions among the three groups (χ²= 1.008,P= 0.604).

The relapse rate of multiple drugs combined with long course of treatment for spondylitis of brucellosis is low, which could reach the ideal end point, and does not necessarily increase the incidence of adverse drug reactions.