摘要
背景:脊柱真菌感染十分罕见,临床和影像学无特征性表现,容易误诊。目的:分析脊柱真菌感染患者的诊断过程,提高对该疾病的认识和诊断能力。方法:回顾性分析2015年1月至2020年1月确诊的11例脊柱真菌感染患者的临床资料。包括症状及症状持续时间,有无发热以及引起免疫力降低的前置性因素;血常规、红细胞沉降率(ESR)、C反应蛋白(CRP)、降钙素原(PCT)、1,3-β-D葡聚糖抗原(G试验)和半乳糖甘露醇聚糖(GM试验)等实验室检查;脊柱X线片、CT、MRI等影像学检查。通过CT引导下穿刺活检或手术获取组织进行真菌培养或(和)病理学检查明确致病菌。结果:全部患者表现为病变节段的疼痛,病史1~16周。1例合并高热,4例合并根性刺激痛,4例合并前置性因素。所有患者的ESR明显升高;CRP和PCT轻度升高;白细胞计数无升高。1例GM试验阳性、2例G试验阳性;G试验和GM试验可疑阳性各1例。影像学检查显示病灶累及胸椎2例,腰椎9例。致病菌包括曲霉菌6例,念珠菌4例,隐球菌1例。结论:对存在免疫功能受损并表现为慢性脊柱感染的患者,应考虑真菌感染可能。获取病变组织进行培养和病理学检查是明确脊柱真菌感染的金标准,为防止诊断和治疗的延误,应争取尽早进行。
Background:Spinal fungal infection is very rare and has no typical clinical or imaging features,so it is easy to be misdiagnosed.Objective:To analyze the diagnostic procedure of patients with spinal fungal infection and to improve the understanding and diagnostic ability for this disease.Methods:Clinical data of 11 patients with spinal fungal infection definitely diagnosed from January 2015 to January 2020 were analyzed retrospectively.Symptoms,duration,fever,and antecedent factors that lead to decreased immunity were observed.Laboratory examination included blood routine,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),procalcitonin(PCT),1,3-β-D glucan antigen(G test)and galactose mannose glycan(GM test).Imaging examination included spinal X-ray film,computed tomography(CT)and magnetic resonance imaging(MRI).Pathogenic bacteria were identified by CT-guided biopsy or surgery to obtain tissues for fungal culture or pathological examination.Results:All patients showed pain in the involved segments.The medical history ranged from 2 to 15 weeks.There were one patient with high fever,4 patients with root irritation pain,and 4 patients with antecedent factors that lead to decreased immunity.Laboratory examination showed that ESR significantly increased,CRP and PCT slightly increased,while white blood cells were not significantly increased in any patients.GM test was positive in one patient,and G test was positive in two patients.GM test was positively suspected in one patient.So was the G test result.Imaging examination showed that the lesions involved thoracic vertebrae in 2 cases and lumbar vertebrae in 9 cases.The pathogenic bacteria included 6 cases of Aspergillus,4 cases of Candida and 1 case of Cryptococcus.Conclusions:For patients with impaired immune function and chronic spinal infection,the possibility of fungal infection should be considered.The golden standard of spinal fungal infection is diseased tissue culture and pathological examination.In order to prevent the delay of diagnosis and treatment,it should be carried out as soon as possible.
作者
杜春艳
李其一
王志超
王亭
殷楚强
李书忠
孙元亮
王杰
DU Chunyan;LI Qiyi;WANG Zhichao;WANG Ting;YIN Chuqiang;LI Shuzhong;SUN Yuanliang;WANG Jie(Department of Spine Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《中华骨与关节外科杂志》
2020年第10期819-824,共6页
Chinese Journal of Bone and Joint Surgery
关键词
脊柱
深部真菌感染
诊断
Spine
Deep Fungal Infection
Diagnosis
