分子诊断技术在结核性脊柱炎和布鲁杆菌性脊柱炎早期鉴别诊断中的应用和发展

Application and Development of Molecular Diagnostic Techniques in the Early Differential Diagnosis of Tuberculous Spondylitis and Brucellosis Spondylitis

布鲁杆菌性脊柱炎与结核性脊柱炎都是细菌感染引起的两种特异性感染性疾病,布鲁杆菌性脊柱炎与脊柱结核病在临床表现上和影像学等表现上存在着许多相似性,在布鲁杆菌性脊柱炎发病率较低的地区,临床上容易将布鲁杆菌性脊柱炎误诊为脊柱结核导致患者病程迁延,治疗效果较差。因此,早期、快速、准确地鉴别诊断对该两种疾病的治疗和管理至关重要,虽然血清学检查和细菌培养仍是实验室诊断不可缺少的手段,但存在阳性率低、培养时间长等缺点,易延误诊治。近年来,随着分子诊断技术的进步,有潜力解决这些方法的局限性成为布鲁杆菌性脊柱炎和结核性脊柱炎鉴别诊断最有用的检测方法之一。根据患者的情况个性化选择诊断效能高、成本效益佳的分子检测技术,以及联合应用不同的检测技术进一步提高布鲁杆菌性脊柱炎和结核性脊柱炎早期的检出率是目前亟待解决的问题。

Brucellosis spondylitis and tuberculosis spondylitis are two specific infectious diseases caused by bacterial infections. Brucellosis spondylitis and tuberculosis spondylitis have many similarities in clinical manifestations and imaging, etc. In areas where the incidence rate of brucellosis spondylitis is relatively low, it is easy to misdiagnose brucellosis spondylitis as spinal tuberculosis, resulting in prolonged course of the disease and poorer therapeutic effects. Therefore, early, rapid and accurate differential diagnosis is crucial to the treatment and management of these two diseases. Although serologic examination and bacterial culture are still indispensable means of laboratory diagnosis, they have the shortcomings of low positivity rate and long culture time, which are prone to delay the diagnosis and treatment. In recent years, with advances in molecular diagnostic techniques, there is potential to address the limitations of these methods to become one of the most useful tests for the differential diagnosis of Mycobacterium brucei spondylitis and tuberculous spondylitis. In-dividualized selections of molecular tests with high diagnostic efficacy and cost-effectiveness ac-cording to the patient’s condition, as well as the combined application of different tests to further improve the early detection rate of brucellosis and tuberculous spondylitis, are issues that need to be urgently resolved at the present time.