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山东大学学报 (医学版) ›› 2026, Vol. 64 ›› Issue (2): 96-103.doi: 10.6040/j.issn.1671-7554.0.2025.1242

• 临床医学 • 上一篇    

改良活检优化宏基因组二代测序腰椎间盘感染早期诊断策略

齐硕1,刘可宇2,徐展望3,谭国庆3,张强4,5   

  1. 1.天津中医药大学中西医结合学院, 天津 301617;2.山东中医药大学第一临床医学院, 山东 济南 250014;3.山东中医药大学附属医院脊柱脊髓科, 山东 济南 250011;4.山东大学附属公共卫生临床中心骨外二科(骨感染), 山东 济南 250102;5.山东省公共卫生临床中心骨外二科(骨感染), 山东 济南 250102
  • 发布日期:2026-02-10
  • 通讯作者: 张强. E-mail:zq-9999@163.com
  • 基金资助:
    山东省自然科学基金面上项目(ZR2024MH251);山东省医药卫生科技项目(202404070869);济南市卫健委科技发展计划(2023-2-3)

Improved biopsy and optimized metagenomic next-generation sequencing strategies for early diagnosis of lumbar disc infection

QI Shuo1, LIU Keyu2, XU Zhanwang3, TAN Guoqing3, ZHANG Qiang4,5   

  1. 1. College of Integrated Traditional Chinese and Western Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China;
    2. First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong, China;
    3. The Department of Spinal and Spinal Cord, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan250011, Shandong, China;
    4. The Second Department of Orthopedics(Bone Infection), Shandong Public Health Clinical Center Affiliated to Shandong University, Jinan 250102, Shandong, China;
    5. The Second Department of Orthopedics(Bone Infection), Shandong Public Health Clinical Center, Jinan 250102, Shandong, China
  • Published:2026-02-10

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摘要： 目的 探讨C臂引导下改良经皮椎间孔穿刺活检联合宏基因组二代测序(metagenomics next-generation sequencing, mNGS)技术在腰椎间盘感染早期诊断中的应用价值。 方法 回顾性分析山东大学附属公共卫生临床中心骨外二科(骨感染)2020年10月至2023年11月疑似腰椎间盘感染患者179例的临床资料。所有患者均在C臂引导下进行穿刺,其中采用传统经皮椎体后凸成形术穿刺系统90例(传统组),采用改良经皮椎间孔穿刺活检系统89例(改良组)。所有患者均行需氧菌、厌氧菌、抗酸菌、真菌培养,常规药敏试验,mNGS及组织病理学检查。比较两组的穿刺组织敏感度、手术时间、透视次数及即时并发症发生率。 结果 两组在性别、年龄、体质量指数、合并高血压及糖尿病比例,以及术前C反应蛋白和血沉等基线临床特征方面差异均无统计学意义(P>0.05),具有良好可比性;但手术节段分布存在显著差异(P=0.027)。在主要效性指标上,两组阳性穿刺组织敏感度差异均无统计学意义(P>0.05),提示改良活检术在病原检出效能方面与传统术式相当。安全性分析显示,两组并发症发生率和手术时间差异均无统计学意义(P>0.05);在操作特征方面,改良组透视次数［(8.04±0.94)次］略高于传统组［(7.53±0.75)次］(P<0.001)。提示改良活检术在早期病原学诊断效能方面可达到与传统术式相当的水平。 结论 改良经皮椎间孔穿刺活检联合mNGS技术是一种微创、高安全性和高获取率的诊断早期椎间盘感染的方法,为临床提供了一种稳健、可靠的诊断优化路径,具有显著的临床应用价值。其有效性通过大样本量和长期随访的研究进一步验证。

关键词: 椎间盘感染, 经皮穿刺, 脊柱活检, 脊柱, 病理, 宏基因组二代测序检测

Abstract: Objective To explore the application value of modified percutaneous intervertebral foraminal biopsy under C-arm guidance combined with metagenomics next-generation sequencing(mNGS)in the early diagnosis of lumbar disc infection. Methods A retrospective analysis was conducted on the clinical data of 179 patients suspected of having lumbar disc infection admitted to the Second Department of Orthopedics(Bone Infection), Shandong Public Health Clinical Center Affiliated to Shandong University from October 2020 to November 2023. All patients underwent puncture under C-arm guidance, with 90 cases employed the conventional percutaneous kyphoplasty puncture system(conventional group)and 89 cases utilized the improved percutaneous transforaminal biopsy system(improved group). Cultures for aerobic and anaerobic bacteria, acid-fast bacilli, and fungi, as well as routine drug susceptibility testing, mNGS, and histopathological examination were performed for each patient. The diagnostic sensitivity of puncture biopsy, operative time, fluoroscopy frequency, and incidence of immediate complications were compared between the two biopsy systems. Results There were no statistically significant differences between the two groups in baseline clinical characteristics such as gender, age, body mass index(BMI), proportion of patients with hypertension and diabetes, and preoperative C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)(P>0.05), indicating good comparability. However, there was a significant difference in the distribution of surgical segments(P=0.027). Regarding the main efficacy indicators, there were no statistically significant differences in the diagnostic sensitivity of puncture biopsy between the two groups(P>0.05), suggesting that the modified biopsy technique was comparable to the traditional technique in terms of pathogen detection efficacy. Safety analysis showed no statistically significant differences in the incidence of complications and operation time between the two groups(P>0.05); however, in terms of procedural characteristics, the modified group(8.04±0.94)overall, had slightly more fluoroscopy sessions than the traditional group(7.53±0.75)(P<0.001). Overall, the modified biopsy technique could achieve a level of efficacy comparable to the traditional method in early etiological diagnosis. Conclusion The improved percutaneous transforaminal biopsy combined with mNGS is a minimally invasive method for diagnosing early lumbar disc infection, characterized by high safety and a high diagnostic yield. It provides a robust and reliable optimized diagnostic pathway for clinical practice and holds significant clinical application value. Its effectiveness warrants further validation through studies with larger sample sizes and longer follow-up periods.

Key words: Intervertebral disc infection, Percutaneous puncture, Spinal biopsy, Spine, Pathology, Metagenomics next-generation sequencing

中图分类号: 

  • R681.5
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