Clinical And Basic Research In Individualized Treatment Pattern Of Drug-resistant Spinal Tuberculosis

Objective To observe the clinical effect of individualized treatment pattern of drug-resistant spinal tuberculosis. By ELISPOT and reverse hybridization with PCR-oligonucleotide probes techniques on the diagnosis of spinal tuberculosis,to evaluate the application of individualized treatment pattern of drug-resistant spinal tuberculosis.Methods From March 2005 to April 2009 the clinical datas of 60 patients with drug resistant spinal tuberculosis were reviewed. Individualized treatment pattern was used.There were 36 males and 24 females with an average age of 47.3 years(from 5 to 79). According to the severity and location of the infection,the surgical procedures included:anterior,posterolateral costotransversectomy or posterior debridement and bony grafting with instrumentation fixation.The antituberculous chemotherapy for a total of 18 to 24 months was guided by conventional and genotypic drug susceptibility testing. The mean followed up period was 3.1 years(from 1 to 5 years). Through a tuberculin skin test (TST) as control, enzyme-linked immunosorbent spot (ELISPOT) were used to detect peripheral blood samples of 52 cases of spinal tuberculosis and 49 cases of spinal degeneration deseases. Through traditional susceptibility test as control, isoniazid, rifampicin, streptomycin and ethambutol resistance in mycobacterium tuberculosis gene:katG, rpoB, rpsL/rrs and embB from 50 tuberculosis clinical isolates were analyzed by a reverse hybridization with PCR-oligonucleotide probes.Results Postoperative clinical symptoms were significantly improved. Two recurrenced,and another operations were done。Bone fusion was achieved in 57 patients. ASIA grade were improved from A to C in 2 cases,B to D in 5 cases, C to E in 11 cases,C to D in 2 cases,D to E in 14 cases,The average Cobb's angle was corrected 19°. ELISPOT and TST results of 52 cases of tuberculosis patients were strongly positive in 42, positive in 5, negative in 3;strongly positive in 13, positive in 19, negative in 20. Results of 49 cases of Spinal degeneration patients were negative in 43, positive in 4,strongly positive in 2; negative in 23, positive in 16,strongly positive in 10. The rpoB, rpsL, rrs, katG and embB genes from 23 drug-sensitive tuberculosis isolates were all wild types. Of 27 drug-resistant tuberculosis isolates,77.8% (21/27) isoniazid-resistant isolates had katG gene mutations,88.9% (24/27)rifampicin-resistant isolates had rpoB gene mutations, 40.7% and 7.4% (13/27) streptomycin-resistant isolates had rpsL and rrs gene mutations,33.3% (9/27) ethambutol-resistant isolates had embB gene mutations.Conclusions According to the severity and location of the infection,the individualized surgical treatment of drug-resistant spinal tuberculosis provides promote recovery with antituberculous which is guided by chemotherapy conventional and genotypic drug susceptibility testing. ELISPOT technology is better than TST, can be used as indicators of spinal tuberculosis screening.Reverse hybridization with PCR-oligonucleotide probes can analyze drug resistance genes in Mycobacterium tuberculosis and drug resistance. By ELISPOT and reverse hybridization with PCR-oligonucleotide probes techniques on the diagnosis of spinal tuberculosis,individualized treatment pattern of drug resistance spinal tuberculosis has better prospects.