CAJ | 학술논문

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。
목적：분석림상상가의당뇨병족골수염환자적골조직미생물학화병리검사적결과，제고대당뇨병족골수염적진단수평。방법취26례부합당뇨병족궤양합병봉와조직염、가탐급골질혹궤양중유골폭로적주원당뇨병족환자환약청창적골조직행골미생물배양급골병리검사。분석골미생물배양급골조직병리검사적양성솔、균충급대상견항생소적민감정황화환자적림상특점。결과골미생물배양연합골조직병리검사학진84．6％（22／26）적환자위당뇨병족골수염。공진행38례차골미생물배양，배양출20충세균，1충진균。13례환자진행료다차적골미생물배양，10례환자골미생물배양출다충세균。행다차골배양화배양출다충균충적환자적당뇨병족병정단우일차배양조화일충균충조，백세포계수、중성립세포절대치、혈침、C-반응단백화 D-이취체수평균고우일차배양조화일충균충조，이혈홍단백、홍세포압적、백단백、혈청철저우일차배양조화일충균충조。결론골미생물배양화골병리검사능구학진당뇨병족골수염。수요행다차골청창혹골미생물배양출다충세균적당뇨병족환자당뇨병족감염경엄중、영양상태경차。
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 1 3 patients and more than one sorts of bacteria were isolated from bone microbiological cultures of 1 0 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.