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中华损伤与修复杂志(电子版) ›› 2015, Vol. 10 ›› Issue (02) : 137 -142. doi: 10.3877/cma.j.issn.1673-9450.2015.02.008

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论著

可疑糖尿病足骨髓炎患者骨微生物培养及骨病理资料分析
张妲1,(), 关小宏1, 王晨蕊1, 杨彩哲1, 吴石白1   
  1. 1. 100142 北京,解放军空军总医院内分泌科
  • 收稿日期:2015-02-21 出版日期:2015-04-01
  • 通信作者: 张妲

Bone microbiological and histopathological study in patients with suspected diabetic foot osteomyelitis

Da Zhang1,(), Xiaohong Guan1, Chenrui Wang1, Caizhe Yang1, Shibai Wu1   

  1. 1. Department of Endocrinology, Air Force General Hospital of People′s Liberation Army, Beijing 100142, China
  • Received:2015-02-21 Published:2015-04-01
  • Corresponding author: Da Zhang
  • About author:
    Corresponding author: Zhang Da, Email:
引用本文:

张妲, 关小宏, 王晨蕊, 杨彩哲, 吴石白. 可疑糖尿病足骨髓炎患者骨微生物培养及骨病理资料分析[J/OL]. 中华损伤与修复杂志(电子版), 2015, 10(02): 137-142.

Da Zhang, Xiaohong Guan, Chenrui Wang, Caizhe Yang, Shibai Wu. Bone microbiological and histopathological study in patients with suspected diabetic foot osteomyelitis[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2015, 10(02): 137-142.

目的

分析临床上可疑糖尿病足骨髓炎患者的骨组织微生物学和病理检查的结果,提高对糖尿病足骨髓炎的诊断水平。

方法

取26例符合糖尿病足溃疡合并蜂窝组织炎、可探及骨质或溃疡中有骨暴露的住院糖尿病足患者换药清创的骨组织行骨微生物培养及骨病理检查。分析骨微生物培养及骨组织病理检查的阳性率、菌种及对常见抗生素的敏感情况和患者的临床特点。

结果

骨微生物培养联合骨组织病理检查确诊84.6%(22/26)的患者为糖尿病足骨髓炎。共进行38例次骨微生物培养,培养出20种细菌,1种真菌。13例患者进行了多次的骨微生物培养,10例患者骨微生物培养出多种细菌。行多次骨培养和培养出多种菌种的患者的糖尿病足病程短于一次培养组和一种菌种组,白细胞计数、中性粒细胞绝对值、血沉、C-反应蛋白和D-二聚体水平均高于一次培养组和一种菌种组,而血红蛋白、红细胞压积、白蛋白、血清铁低于一次培养组和一种菌种组。

结论

骨微生物培养和骨病理检查能够确诊糖尿病足骨髓炎。需要行多次骨清创或骨微生物培养出多种细菌的糖尿病足患者糖尿病足感染更严重、营养状态更差。

Objective

To analyze the results of bone microbiological and histopathological study in patients with suspected diabetic foot osteomyelitis in order to improve diagnostic level of diabetic foot osteomyelitis.

Methods

Bone tissue of twenty-six inpatients with diabetic foot according to positive probe-to-bone test or bone exposure in ulcers was debrided for microbiological and histopathological study, and the positive results of microbiological and histopathological study were analyzed which included the positive rates, the species of bacteria, the sensitivity to the common antibiotics and clinical outcomes of patients.

Results

84.6% patients were definitely diagnosed with diabetic foot osteomyelitis according to bone microbiological and histopathological study. Twenty species of bacteria and one specie of fungi were isolated from a total of 38 cases of bone microbiological studies. More than one bone microbiological culture were carried out in 13 patients and more than one sorts of bacteria were isolated from bone microbiological cultures of 10 patients. Compared to control, the patients for more than one bone microbiological culture and infected by more than one sorts of bacteria had shorter duration of diabetic foot, higher level of white cell and neutrophil counts, erythrocyte sedimentation rate, C-reactive protein and D-dimer, lower level of hemoglobin, hematocrit, serum albumin, serum iron.

Conclusions

The gold standard of diagnosis of bone infection in the foot of patients with diabetes is sampling of bone, which is then subjected to both histopathologic and microbiological examination. The diabetic foot infection and nutritional status of the patients for more than one bone debridements and infected by more than one sorts of bacteria is more serious and poorer.

表1 22例糖尿病足骨髓炎患者骨微生物培养菌种
表2 骨微生物培养菌种对常见抗生素的敏感情况
图1 糖尿病足骨髓炎患者骨组织病理镜下观察见骨小梁纤维组织增生伴急性炎细胞浸润(苏木精-伊红染色×200)
表3 一次培养组与多次培养组患者临床资料比较[±s,中位数(四分位数)]
表4 一种菌种组与多种菌种组患者临床资料比较[±s,中位数(四分位数)]
1
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