宏基因组二代测序技术在化脓性脊柱感染病原菌检测中的应用

Application of metagenomic next generation sequencing in the pathogenic diagnosis for pyogenic vertebral osteomyelitis

目的探讨基于宏基因组学的二代测序技术(mNGS)在化脓性脊柱感染病原菌检测中的应用价值。方法分析2018年3月至2022年3月在河南省人民医院诊断为脊柱化脓性感染的43例患者病例资料,其中男28例,女15例,平均年龄51.6岁(21~84岁);感染部位为颈椎4例,胸椎12例,腰椎感染19例,胸腰椎3例,腰骶椎5例。27例经皮穿刺活检获得标本,11例经椎间孔镜下获得标本,5例经开放性手术获得标本;19例送检标本为软组织,24例为骨组织,所有标本均进行细菌培养和mNGS。分析比较细菌培养和mNGS和在本组病例中的病原菌阳性检出率。结果43例患者中,细菌培养检出病原菌检16例,mNGS检出26例;24例骨组织标本中,细菌培养检出病原菌检5例,mNGS检出12例;本组患者及骨组织标本中mNGS的病原菌检出率均高于细菌培养的病原菌检出率,差异有统计学意义[60.5%(26/43)比37.2%(16/43),χ2=8.1,P<0.05;50.0%(12/24)比20.8%(5/24),χ2=5.1,P<0.05];16例细菌培养阳性的病例中,mNGS均检测出完全相一致的病原菌。结论mNGS在化脓性脊柱感染患者的诊断中具有较高的病原菌检出率。

Objective To evaluate the diagnostic value of metagenomic next generation sequencing technology(mNGS)in the detection of pathogenic bacteria for pyogenic vertebral osteomyelitis.Methods From March 2018 to March 2022,the data of 43 patients who diagnosed as pyogenic vertebral osteomyelitis in our hospital were studied.There were 28 males and 15 females,with the average age of 51.6 years(ranged from 21 to 84 years).The localization of the infection was cervical spine in 4 cases,thoracic in 12 cases,lumbar in 19 cases,thoracolumbar in 3 cases,and lumbosacral in 5 cases.Specimens were obtained by percutaneous needle biopsy in 27 cases,by percutaneous transforaminal endoscopic biopsy in 11 cases,and by open operative biopsy in 6 cases.There were 19 soft tissue specimens and 24 bone specimens.Specimens were divided into two parts and were identified via the bacterial culture and mNGS simultaneously.The detection rates of bacterial culture and mNGS in this group patients were calculated and statistically analyzed.Results Among the 43 patients with pyogenic vertebral osteomyelitis,bacteria were detected by bacterial culture in 16 cases,whereas by mNGS in 26 patients.For 24 bone specimens,bacteria were detected by bacterial culture in 5,whereas by mNGS in 12 specimens.Paired chi-square test showed a statistically significant difference in the detection rate[60.5%(26/43)vs.37.2%(16/43),χ2=8.1,P<0.05;50.0%(12/24)vs.20.8%(5/24),χ2=5.1,P<0.05].Among the 16 bacterial culture-positive patients,the culture and mNGS results were completely consistent.Conclusion Compared with bacterial culture,mNGS has a higher positive rate,which may play an important role in pathogenic bacteria detection for pyogenic vertebral osteomyelitis.