■骨髓炎是一组骨感染性疾病(细菌性骨髓炎-BO)和非感染性炎症性疾病(非细菌性骨髓炎-NBO),具有相似的临床,放射学,和实验室的特点。许多NBO患者被误诊为BO,并接受不必要的抗生素和手术。我们的研究旨在比较儿童NBO和BO的临床和实验室特征,为了定义关键的区分标准,并创建NBO诊断评分(NBODS)。
■回顾性多中心队列研究包括临床,实验室,有关组织学证实的NBO(n=91)和BO(n=31)的仪器信息。变量使我们能够区分用于构建和验证NBODS的两个条件。
■NBO和BO之间的主要区别如下:发病年龄-7.3(2.5;10.6)与10.5(6.5;12.7)年(p=0.03),发烧频率(34.1%vs.90.6%,p=0.0000001),有症状的关节炎(67%vs.28.1%,p=0.0001),单焦点参与(28.6%与100%,p=0.0000001),脊柱(32%vs.6%,p=0.004),股骨(41%vs.13%,p=0.004),脚骨(40%vs.13%,p=0.005),锁骨(11%vs.0%,p=0.05),和胸骨(11%vs.0%,p=0.039)参与。NBODS中包括以下四个标准:CRP≤55mg/l(56分),多病灶参与(27分),股骨受累(17分),中性粒细胞条带≤220个细胞/μl(15分)。>17点的总和允许以89.0%的灵敏度和96.9%的特异性区分NBO与BO。
■诊断标准可能有助于区分NBO和BO,避免过度的抗菌治疗和手术。
UNASSIGNED: Osteomyelitis is a group of bone infectious (bacterial osteomyeilitis-BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis-NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and surgery. Our study aimed to compare clinical and laboratory features of NBO and BO in children, to define key discriminative criteria, and to create an NBO diagnostic score (NBODS).
UNASSIGNED: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about histologically confirmed NBO (n = 91) and BO (n = 31). The variables allowed us to differentiate both conditions used to construct and validate the NBO DS.
UNASSIGNED: The main differences between NBO and BO are as follows: onset age-7.3 (2.5; 10.6) vs. 10.5 (6.5; 12.7) years (p = 0.03), frequency of fever (34.1% vs. 90.6%, p = 0.0000001), symptomatic arthritis (67% vs. 28.1%, p = 0.0001), monofocal involvement (28.6% vs. 100%, p = 0.0000001), spine (32% vs. 6%, p = 0.004), femur (41% vs. 13%, p = 0.004), foot bones (40% vs. 13%, p = 0.005), clavicula (11% vs. 0%, p = 0.05), and sternum (11% vs. 0%, p = 0.039) involvement. The following four criteria are included in the NBO DS: CRP ≤ 55 mg/l (56 points), multifocal involvement (27 points), femur involvement (17 points), and neutrophil bands ≤ 220 cell/μl (15 points). The sum > 17 points allowed to differentiate NBO from BO with a sensitivity of 89.0% and a specificity of 96.9%.
UNASSIGNED: The diagnostic criteria may help discriminate NBO and BO and avoid excessive antibacterial treatment and surgery.