【摘要】 目的 分析脊柱结核(ST)患者耐药特点及不同耐药类型患者术后复发差异，为临床在ST患者的个体化治疗与耐药防控中提供参考。方法 回顾性选取2019年1月～2023年12月就诊于西安市胸科医院的185例病原学阳性ST患者，采用微孔板药敏法检测16种一线及二线抗结核药物(包括异烟肼、利福平等)的敏感性，比较初、复治患者耐药率差异，并分析不同耐药类型对患者术后复发率的影响。结果 185例ST患者耐药率为21.62%(40/185)。其中复治患者耐药率、耐多药率与准广泛耐药率[32.26%(20/62)、17.74%(11/62)、6.45%(4/62)]均高于初治患者[16.26%(20/123)、0.81%(1/123)、0]，差异具有统计学意义(χ~2=6.225、19.485、9.204，均P<0.05)。完成随访的117例ST手术患者，术后复发率为25.64%(30/117)，其中耐多药患者复发率(58.33%,7/12)高于敏感患者(21.59%,19/88)，差异具有统计学意义(χ~2=7.410,P<0.05)。不同手术部位及手术方式患者术后复发率差异无统计学意义(均P>0.05)。结论 ST耐药情况复杂，耐多药患者术后复发率较高，临床医生应及时进行药敏检测，优化治疗方案，以降低复发风险并提高治疗成功率。更多还原

【Abstract】 Objective To analyze the drug resistance profiles and postoperative recurrence rates in spinal tuberculosis patients with different resistance patterns, providing evidence for clinical individualized therapy and drug resistance control. Methods A total of 185 patients with pathogen-positive spinal tuberculosis who were admitted to Xi’an Chest Hospital from January 2019 to December 2023 were included. Drug susceptibility testing(DST) for 16 first-and second-line anti-tuberculosis drugs(including INH, RIF, etc.) was performed using the microplate-based method. Differences in drug resistance rates between newly treated and retreated patients were compared, and the impact of various drug resistance patterns on postoperative recurrence rates was analyzed. Results Among 185 spinal tuberculosis patients, the total drug resistance rate was 21.62%(40/185). The treatment-experienced patients showed significantly higher rates of total drug resistance(32.26%, 20/62), multidrug resistance(17.74%, 11/62), and pre-extensive drug resistance(6.45%, 4/62) compared to treatment-na?ve patients [16.26%(20/123)、0.81%(1/123)、0], with statistically significant differences(χ~2=6.225, 19.485, 9.204, all P<0.05). Among 117 surgically treated patients with complete follow-up, the postoperative recurrence rate was 25.64%(30/117), the multiple-drug resistance patients had a significantly higher recurrence rate was(58.33%,7/12) than drug-sensitive patients(21.59%, 19/88), and the difference was statistically significant(χ~2=7.410, P<0.05). No statistically significant differences in recurrence rates were observed based on surgical approach or anatomical site(P>0.05). Conclusions Spinal tuberculosis exhibits complex drug resistance profiles, with multidrug-resistant(MDR) cases demonstrating significantly higher postoperative recurrence rates. Clinicians should prioritize timely drug susceptibility testing(DST) and optimize treatment regimens to reduce recurrence risk and improve therapeutic success.更多还原