PDF(Pubmed)
Abstract：
The special blood circulation, anatomy, and tissue structure of the spine may lead to significant differences in pathological features and drug resistance between spinal tuberculosis and pulmonary tuberculosis. Here, we collected 168 spinal tuberculosis cases and 207 pulmonary tuberculosis cases, and compared their clinical and pathological features as well as drug resistance. From the anatomical location, the highest incidence was of lumbar tuberculosis, followed by thoracic tuberculosis. PET-CT scans showed increased FDG uptake in the diseased vertebrae, discernible peripheral soft tissue shadow, visible internal capsular shadow, and an abnormal increase in FDG uptake. MRI showed infectious lesions in the diseased vertebral body, formation of paravertebral and bilateral psoas muscle abscess, and edema of surrounding soft tissues. As with control tuberculosis, the typical pathological features of spinal tuberculosis were chronic granulomatous inflammation with caseous necrosis. The incidence of granulomas was not statistically different between the groups. However, the proportions of caseous necrosis, acute inflammation, abscess, exudation, and granulation tissue formation in the spinal tuberculosis group were all significantly increased relative to the control tuberculosis group. Compared to the control tuberculosis group, the incidences of resistance to rifampicin (RFP) + isoniazid (INH) + streptomycin (STR) and INH + ethambutol (EMB) were lower in the spinal tuberculosis group, while the incidences of resistance to RFP + INH + EMB and RFP + EMB were higher. Moreover, we also found some differences in drug-resistance gene mutations. In conclusion, there are noticeable differences between spinal Mycobacterium tuberculosis and pulmonary tuberculosis in pathological characteristics, drug resistance, and drug resistance gene mutations.
摘要：
特殊的血液循环，解剖学,脊柱的组织结构可能导致脊柱结核和肺结核在病理特征和耐药性方面存在显著差异。这里,我们收集了168例脊柱结核和207例肺结核，并比较了其临床和病理特征以及耐药性。从解剖位置来看，发病率最高的是腰椎结核，其次是胸部结核。PET-CT扫描显示病变椎骨的FDG摄取增加，可辨别的周围软组织阴影，可见的囊内阴影，和FDG摄取异常增加。MRI显示病变椎体有感染性病变,椎旁和双侧腰大肌脓肿的形成，周围软组织水肿。与控制结核病一样，脊柱结核的典型病理特征为慢性肉芽肿性炎症伴干酪样坏死。两组之间肉芽肿的发生率无统计学差异。然而,干酪样坏死的比例，急性炎症，脓肿,渗出,与对照组相比，脊柱结核组的肉芽组织形成均显着增加。与对照组结核病相比，在脊柱结核组中，对利福平（RFP）异烟肼（INH）链霉素（STR）和INH乙胺丁醇（EMB）的耐药性发生率较低，而对RFP+INH+EMB和RFP+EMB耐药的发生率较高。此外，我们还发现了耐药基因突变的一些差异。总之,脊柱结核分枝杆菌与肺结核在病理特征上有明显差异,耐药性,和耐药基因突变。
