穿刺活检及联合检测提高脊柱感染病原学诊断的准确性

目的 探讨穿刺活检及联合检测在脊柱感染病原学诊断中的应用价值。方法 选取2022年8月至2023年8月山东省公共卫生临床中心脊柱感染外科收治的287例疑似脊柱感染病人，行“C”型臂X线机引导下的穿刺活检，组织标本送联合检测（培养、涂片、基因和病理检查）。以临床结果为金标准，计算并对比单纯培养和联合检测的敏感度、特异度、阳性预测值和阴性预测值，绘制ROC曲线，计算曲线下面积（AUC）。结果 287次活检均穿刺顺利，包含238份椎间盘标本，49份椎骨标本。临床病原学结果：结核分枝杆菌54例，布鲁氏菌59例，一般细菌153例，非结核分枝杆菌5例、真菌3例；联合检测与单纯培养的敏感度分别为92.17%、58.15%，特异度分别为95.56%、91.65%，阳性预测值分别为98.77%、96.32%，阴性预测值分别为51.82%、91.25%。联合检测的敏感度和阴性预测值均高于单纯培养（P＜0.05）。联合检测病原学诊断的AUC明显高于单纯培养（0.87 vs. 0.58），差异有统计学意义（P＜0.05）。结论 “C”型臂X线机引导下穿刺活检是脊柱感染明确病原学诊断的重要手段，单纯培养有一定的漏诊率和误诊率，联合检测可提高诊断效率。

Puncture Biopsy and Combined Testing to Improve the Accuracy of Pathogenic Diagnosis in Spinal Infection

Objective To explore the value of puncture biopsy and combined detection in the pathogenic diagnosis for spinal infection. Methods A total of 287 suspected spinal infection patients admitted from August 2022 to August 2023 in the Department of Spinal Infection Surgery, Shandong Provincial Public Health Clinical Center were selected for C-arm guided puncture biopsy, and tissue samples were sent for combined testing (culture, smear, genetic and pathological examinations). Using clinical results as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of single culture and combined test were calculated and compared, ROC curves were drawn, and the area under the curve (AUC) was calculated. Results A total of 287 biopsies were performed successfully, with 238 intervertebral disc specimens and 49 vertebral bone specimens. Clinical pathogenic results showed there were 54 cases of Mycobacteriumtuberculosis, 59 cases of Brucella, 153 cases of general bacterial infection, 5 cases of nontuberculosis mycobacterium, and 3 cases of fungal infection. The sensitivity of combined detection and culture alone was 92.17% and 58.15%, the specificity was 95.56% and 91.65%, positive predictive value was 98.77% and 96.32%, and negative predictive value was 51.82% and 91.25%, respectively. The sensitivity and negative predictive value of combined detection were higher than those of culture alone (P＜0.05). The AUC of combined test was 0.87, which was significantly higher than that of single cultured (0.58) (P＜0.05). Conclusion C-arm guided puncture biopsy is an important means for clarifying the etiology of spinal infection. Simple culture has a certain rate of missed diagnosis and misdiagnosis, and combined detection can improve diagnostic efficiency.