郭路明, 于龙, 李力韬, 吴云峰, 李大伟, 鲍达, 罗展鹏, 刘宁, 杨尚杰, 崔旭. 宏基因组二代测序技术对结核性与非结核性脊柱感染疾病的诊断价值研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2024.033
引用本文: 郭路明, 于龙, 李力韬, 吴云峰, 李大伟, 鲍达, 罗展鹏, 刘宁, 杨尚杰, 崔旭. 宏基因组二代测序技术对结核性与非结核性脊柱感染疾病的诊断价值研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2024.033
GUO Luming, YU Long, LI Litao, WU Yunfeng, LI Dawei, BAO Da, LUO Zhanpeng, LIU Ning, YANG Shangjie, CUI Xu. Study about the diagnostic value of metagenomic next-generation sequencing technology for tuberculous and nontuberculous spinal infectious diseases[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2024.033
Citation: GUO Luming, YU Long, LI Litao, WU Yunfeng, LI Dawei, BAO Da, LUO Zhanpeng, LIU Ning, YANG Shangjie, CUI Xu. Study about the diagnostic value of metagenomic next-generation sequencing technology for tuberculous and nontuberculous spinal infectious diseases[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2024.033

宏基因组二代测序技术对结核性与非结核性脊柱感染疾病的诊断价值研究

Study about the diagnostic value of metagenomic next-generation sequencing technology for tuberculous and nontuberculous spinal infectious diseases

  • 摘要:
    背景 结核性脊柱感染是脊柱外科比较棘手的疾病之一,其早期临床症状大多不典型,实验室检查、影像检查及组织病理学检查的特异性都不高。病原学诊断是结核性脊柱感染诊断的金标准,但病原微生物培养存在周期长、阳性率低的缺点。宏基因组二代测序技术目前已应用到临床的诊断中,但关于mNGS与其他常见的临床检测方法之间相比较的相关文献报道较少。
    目的 探讨宏基因组二代测序技术(mNGS)对结核性脊柱感染疾病的诊断价值。
    方法 收集2021年2月至2023年9月收入解放军总医院第八医学中心脊柱外科的脊柱感染患者的病历信息,提取采集血液、脓液及病灶组织标本进行血清学检测、细菌培养、结核菌培养、病理学检查、X-pert和mNGS检测的结果,以临床诊断(病理学结果)为金标准,分析不同检测方式的诊断价值。
    结果 共收集112例脊柱感染患者,男性68例,女性44例,年龄14 ~ 87(58.98 ± 13.70)岁。临床诊断结果为非结核性脊柱感染63例,脊柱结核感染49例。mNGS法检出脊柱感染阳性90例(80.4%),微生物培养法检出阳性51例(45.5%)。判断脊柱感染中的结核性感染方面,mNGS阳性检出34例(69.39%);微生物培养阳性检出仅17例(34.69%)。mNGS法检出病原微生物102例,其中细菌70例。在mNGS、微生物培养、T-spot、X-pert对脊柱结核的临床诊断效能分析结果中,mNGS法效能最高(AUC=0.839),其诊断的准确度最高,甚至高于目前临床常用的方法。mNGS方法和四种方法联合诊断方法的诊断效能最高,ROC-AUC(95% CI)分别为0.846(0.701 ~ 0.971)、0.876(0.773 ~ 0.962),明显高出其它三种单独方法,Delong检验P < 0.05。
    结论 宏基因二代测序技术(mNGS)能够快速、高效地对脊柱感染性疾病的病原微生物进行检测,并且对于结核性脊柱感染疾病有着较高的检出率、灵敏度及特异度。该技术是诊断与鉴别脊柱感染性疾病的较好、较快的方法,可为结核性脊柱感染性疾病的诊断提供指导。

     

    Abstract:
    Background Tuberculous spinal infection is one of the more difficult diseases in spinal surgery, and most of its early clinical symptoms are atypical, and the specificity of laboratory tests, imaging tests and histopathologic examinations are not high. Pathogenetic diagnosis is the gold standard for the diagnosis of tuberculous spinal infection, but the culture of pathogenic microorganisms has the disadvantages of long period and low positive rate. Metagenomic next-generation sequencing technology is currently used in clinical diagnosis, but there are fewer relevant literature reports on the comparison between mNGS and other common clinical detection methods. Objective To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) technology for tuberculous spinal infection disease.
    Methods Patients who were admitted to the Department of Spine Surgery of the Eighth Medical Center of Chinese PLA General Hospital and diagnosed as spine infection from February 2021 to September 2023 were included in this study. Specimens of blood, pus, and lesion tissue were collected for serological testing, bacterial culture, tuberculosis culture, pathological examination, X-pert, and mNGS testing, and the results were compared with clinical diagnosis (gold standard). The diagnostic value of different detection methods was analyzed.
    Results There were 68 males and 44 females included in this study, with age ranged from 14 years to 87 years (58.98 ± 13.70 years). The clinical diagnosis revealed 63 cases of non-tuberculous spinal infection and 49 cases of spinal tuberculosis infection. mNGS detected positive results for spinal infection in 90 cases (80.4%), while microbial culture detected positive results in 51 cases (45.5%). In terms of determining tuberculosis infection in spinal infections, mNGS detected positive results in 34 cases (69.39%), while microbial culture detected positive results in only 17 cases (34.69%). Among the clinical diagnostic efficacy analysis results of mNGS, microbial culture, T-spot, and X-pert for spinal tuberculosis, mNGS showed the highest efficacy (AUC=0.839) with the highest accuracy in diagnosis, surpassing the currently used clinical methods. The combined diagnostic approach of mNGS and the four methods showed the highest diagnostic efficacy, with ROC-AUC (95% CI) values of 0.846 (0.701-0.971) and 0.876 (0.773-0.962) respectively, significantly higher than the other three individual methods, with a Delong test P<0.05.
    Conclusion mNGS enables rapid and efficient detection of pathogenic microorganisms in infectious diseases of the spine, and it has a high detection rate, sensitivity, and specificity for tuberculous spinal infections. This technology is a good and fast method for diagnosing and differentiating infectious diseases of the spine, providing guidance for the diagnosis of tuberculous spinal infections.

     

/

返回文章
返回