宏基因组二代测序在原发性脊柱感染保守治疗中的价值

Value of metagenomic next-generation sequencing in conservative treatment of primary spinal infection

目的:探讨宏基因组二代测序(mNGS)指导下的原发性脊柱感染保守治疗的效果。方法:回顾性分析2019年12月至2022年2月收治的47例疑似脊柱感染患者的临床资料,所有患者在治疗前完善相关病原学实验室检查,并由脊柱外科医师对感染病灶核心行C型臂X线机引导下的穿刺活检。穿刺标本行病原微生物培养、病理学检查及mNGS检测。穿刺后给予患者经验性感染治疗,并根据各项检测结果及病情变化调整抗生素和治疗方案。观察患者病情转归并对其随访1年。结果:47例患者均临床确诊脊柱感染。胸椎感染17例,腰椎感染30例;化脓性细菌感染30例,布鲁氏菌感染10例,脊柱结核6例,真菌感染1例。微生物培养结果耗时5~7 d,阳性率48.9%;mNGS结果均在48 h内获得,阳性率93.8%;mNGS检测阳性率显著高于病原微生物培养,差异有统计学意义(P<0.01)。97.9%(46/47)患者行保守治疗,2.1%(1/47)患者行手术治疗,均治愈出院。随访1年无复发。结论:原发性脊柱感染保守治疗中,mNGS技术具有较高的诊断能力和较快的诊断效能,结合常规实验室检测并针对性抗感染治疗可获得较高的保守治疗治愈率。

Objective:To investigate the therapeutic effect of primary spinal infection under the guidance of metagenomic nextgeneration sequencing(mNGS).Methods:The clinical data of 47 patients with suspected spinal infections admitted to the hospital between December 2019 and February 2022 were retrospectively analyzed.All patients received laboratory examinations to determine the etiology of the infection before treatment and underwent C-guided needle biopsy of the core infection by a spinal surgeon.The puncture specimens were sent for pathogenic microorganism culture,pathological examination,and mNGS analysis.The empirical infection was treated after the puncture,and the antibiotics and treatment regimen were adjusted according to the test results and changes in the condition.The patients were observed and followed up for one year.Results:All the 47 patients were clinically diagnosed with spinal infections.Of the infections,17 were thoracic and 30 were lumbar.Thirty infections were caused by pyogenic bacteria and 10 by Brucella,with six resulting from spinal tuberculosis and one fungal infection.The pathogenic microorganism culture results took 5-7 d,and the positivity rate was 48.9%.The mNGS results were obtained within 48 h with a positivity rate of 93.8%.There was a significant difference in the positivity rate between mNGS and pathogenic microorganism culture(P<0.01).Overall,97.9%(46/47)patients underwent conservative treatment and 2.1%(1/47)underwent surgery;all were cured and discharged.There was no recurrence after one-year follow-up.Conclusions:In terms of the conservative treatment of primary spinal infections,mNGS has both an extremely high diagnostic capability and rapid diagnostic efficacy and can achieve a high conservative cure rate when combined with routine laboratory testing and targeted anti-infection therapy.