宏基因组二代测序技术联合椎间孔镜下扩创治疗腰椎原发性感染

Metagenomic next-generation sequencing technology combined with transforaminal endoscopic debridement for treatment of primary lumbar spine infections

目的观察宏基因组二代测序技术联合椎间孔镜下扩创治疗腰椎原发性感染的临床疗效。方法纳入自2019-01—2020-12应用宏基因组二代测序技术联合椎间孔镜下扩创治疗的24例考虑原发性腰椎感染。术中取出炎症病变组织,分别送细菌培养、抗酸染色、X-pert、宏基因组二代测序技术(Metagenomic next-generation sequencingm,mNGS)、病理检查,术后根据致病菌检测结果选用抗生素。将致病菌的检测分为mNGS组和常规组,常规组包含目前常用的检测方法之和,即血培养、组织细菌培养、布鲁氏杆菌试管凝集试验、T-spot、组织病理TB-DNA阳性、X-pert等,mNGS组采用宏基因组二代测序技术。结果24例中有1例证实为脊柱夏科氏病并予以排除,其余23例均为原发性腰椎感染。术前血培养阳性3例(3/23,13.04%),布鲁氏杆菌试管凝集试验阳性3例(3/23,13.04%),T-spot阳性1例(1/23,4.35%)。术中标本,X-pert阳性1例(1/23,4.35%),组织培养阳性4例(4/23,17.39%),组织病理TB-DNA阳性3例(3/23,13.04%),mNGS阳性20例(20/23,86.96%)。细菌培养、宏基因组二代测序均为阴性3例(3/23,13.04%)。mNGS组的致病菌检测阳性率为86.96%(20/23),常规组为60.87%(14/23),mNGS组致病菌检测阳性率明显高于常规组,差异有统计学意义(χ2=4.059,P=0.044)。所有患者均获得随访,随访时间12~24个月,平均15.4个月,2例治疗无效,其余21例于术后6~12个月治愈。结论致病菌鉴定是腰椎感染的首要问题,在常规检测方法基础上加用宏基因组二代测序技术能提高致病菌检出率,椎间孔镜下扩创治疗腰椎感染不仅同时满足病变组织取材、手术清创,而且不破坏脊柱稳定,治疗效果良好。

Objective To observe the clinical efficacy of metagenomic next-generation sequencing(mNGS)combined with transforaminal endoscopic debridement in the treatment of primary lumbar spine infections.Methods Twenty four cases of primary lumbar spine infection treated with mNGS combined with transforaminal endoscopic debridement from January 2019 to December 2020 were retrospectively analyzed.Inflammatory tissue was removed during surgery and sent for bacterial culture,acid-fast staining,X-pert,mNGS,and pathological examination.Antibiotics were selected based on the results of pathogenic bacteria detection after surgery.The detection of pathogenic bacteria was divided into mNGS group and conventional group.The conventional group included the sum of commonly methods,including blood culture,tissue bacterial culture,Brucella tube ag-glutination test,T-spot,histopathological TB-DNA positive,X-pert,etc.The mNGS group used metagenomic next-generation sequencing technology.Results Among the 24 patients,one case was confirmed to have Charcot's disease of the spine and was excluded,while the remaining 23 cases were confirmed primary lumbar spine infections.Before the operation,three cases were positive for blood culture(3/23,13.04%),three cases were positive for Brucella tube agglutination test(3/23,13.04%),and one case was positive for T-spot(1/23,4.35%).Testing with intraoperative specimen,one case(1/23,4.35%)was positive for Xpert,four cases(4/23,17.39%)were positive for tissue bacterial culture,three cases(3/23,13.04%)were positive for TB-DNA in tissue pathology,and 20 cases(20/23,86.96%)were positive for mNGS.Three cases(3/23,13.04%)were negative either by tissue bacterial culture or by mNGS.The positive rate of pathogenic bacteria detection was 86.96%(20/23)in the mNGS group,while it was 60.87%(14/23)in the conventional group.The positive rate of pathogenic bacteria detection in the mNGS group was significantly higher than that in the conventional group(χ2=4.059,P=0.044).All patients were followed up for 12 months to 24 months,with an average of 15.4 months.Two cases were ineffective,while the remaining 21 cases were cured from 6 to 12 months after operation.Conclusion Identification of pathogenic bacteria is the primary issue for lumbar spine infections.The addition of mNGS to conventional methods can improve the detection rate of pathogenic bacteria.The treatment of lumbar spine infections under transforaminal endoscopy not only meets the requirements of tissue sampling and surgical debridement,but also does not damage the stability of the spinal column,resulting in good therapeutic effects.