目的 探讨高压氧(hyperbaric oxygen,HBO)联合药物治疗布鲁杆菌病性脊椎炎的临床疗效,为临床应用提供依据.方法 108例布鲁杆菌病性脊椎炎患者,经河北北方学院附属第一医院伦理委员会授权和患者知情同意后,按患者入院号奇偶数分为对照组和治疗组,每组54例,对照组采用常规药物治疗,研究组在此基础上行HBO治疗4个疗程.依研究组的时间点为标准,于治疗前及第1、2、3、4个疗程结束时监测和评价2组各项指标.评价指标包括疼痛评分、日常生活能力评价、试管滴凝聚法试验(SAT)滴度检测及C反应蛋白(CRP)检测,且第2、4个疗程结束时行MRI检查及临床疗效评价.结果 (1)第1、2、3、4个疗程疼痛视觉模拟(VAS)评分,对照组得分分别为(9.0±0.2)、(8.4±0.3)、(7.3±0.5)、(6.2±0.4)分,治疗组分别为(8.1±0.4)、(6.5±0.5)、(5.0±0.2)、(3.3±0.3)分,2组比较差异均有统计学意义(P＜0.05)；(2)SAT滴度:SAT滴度＞1∶320、＞1∶160、＜1∶80区域内,随着时间推移,各疗程治疗组SAT滴度值降低的患者数明显多于对照组(P＜0.05)；(3)CRP检测:在CRP≥30 mg/L、5 mg/L＜ CRP＜ 30 mg/L、CRP≤5 mg/L区域内,随着时间推移,各疗程治疗组CRP降低的患者数明显多于对照组(P＜0.05)；(4)第2、4个疗程结束时MRI影像学量化评分,对照组分别为(3.04±0.02)、(3.96±0.06),治疗组分别为(4.03±0.05)、(4.72±0.08),2组比较差异均有统计学意义(P＜0.05)；(5)临床疗效评价:第2个疗程,对照组改善17例,治疗组改善28例,差异有统计学意义(P＜0.05),但2组均无治愈病例；第4个疗程,对照组改善19例、治愈25例,治疗组改善11例、治愈41例,2组比较差异均有统计学意义(P＜0.05).结论 HBO联合药物治疗布鲁杆菌病性脊椎炎的临床疗效好于单纯药物治疗,能明显提高治愈率,为临床开辟了一种新的实用方法.%Objective To investigate clinical effect of hyperbaric oxygen (HBO) coupled with drug therapy on brucellosis spondylitis,so as to provide evidence for its clinical application.Methods With the authority of the Ethics Committee of the First Affiliated Hospital of Hebei North University and with the knowledge and consent of the patients,108 cases of brucellosis spondylitis were randomly divided into 2 groups:the control group (group A) and the treatment group (group B),each consisting of 54 cases.The patients in group A were given routine drug therapy,while patients in group B received HBO therapy for 4 treatment courses in addition to routine drug therapy.With the time points as the evaluation standards,detection and evaluation were made before HBO therapy and after termination of 4 treatment courses.Evaluation indicators include:pain scores,evaluation of daily life activities,STA titer and C reaction protein (CRP) test.Furthermore,MRI scanning and evaluation of clinical therapeutic effects were made,following termination of the second and fourth treatment courses.Results Upon completion of the 1 st,2nd,3rd and 4th treatment courses,VAS scores for group A were (9.0 ± 0.2),(8.4 ± 0.3),(7.3 ± 0.5)and (6.2 ± 0.4) respectively,while scores for group B were (8.1 ± 0.4),(6.5 ± 0.5),(5.0 ± 0.2) and (3.3 ± 0.3) respectively.Statistical significance could be seen,when comparisons were made between them (P ＜ 0.05).With respect to SAT titer,SAT titer ＞ 1 ∶ 320,SAT titer ＞ 1 ∶ 160,SAT titer ＜ 1 ∶ 80.With the passing of time,the number of patients in group B with decreased SAT titer in different treatment courses was obviously higher than that of the patients in group A (P ＜ 0.05).With regard to CRP detection,CRP ＞ 30 mg/L,5 mg/L ＜ CRP ＜ 30 mg/L,CRP ≤ 5 mg/L.With the passing of time,the number of patients with decreased CRP in different treatment courses was obviously higher than that in group A (P ＜ 0.05).Upon completion of the 2nd and 4th treatment courses,quantitative MRI imaging scores were (3.04 ±0.02) and (3.96 ± 0.06) respectively for group A,while scores for group B were (4.03 ± 0.05) and (4.72 ± 0.08) respectively.Statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).Such were evaluations of clinical efficacy.When the 2nd treatment course was terminated,17 cases in group A were improved,while 28 cases in group B were improved,but without any cure cases.When the 4th treatment course was completed,19 cases in group A were improved and 25 cases were cured,while 11 cases in group B were improved and 41 cases were cured.Statistical significance could clearly be seen,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions HBO coupled with drug therapy could not only produce better clinical effect on brucellosis spondylitis than simple drug therapy,but could significantly increase the cure rate,and it would offer us a new practical method for the treatment of the disease.
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