Mann Theresa N, Davis Johan H, Walzl Gerhard, Beltran Caroline G, du Toit Jacques, Lamberts Robert P, Chegou Novel N
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Stellenbosch, South Africa.
Front Immunol. 2021 Nov 18;12:768040. doi: 10.3389/fimmu.2021.768040. eCollection 2021.
Spinal tuberculosis (TB) may have a variable, non-specific presentation including back pain with- or without- constitutional symptoms. Further tools are needed to aid early diagnosis of this potentially severe form of TB and immunological biomarkers may show potential in this regard. The aim of this study was to investigate the utility of host serum biomarkers to distinguish spinal TB from mechanical back pain.
Patients with suspected spinal TB or suspected mechanical back pain were recruited from a tertiary hospital in the Western Cape, South Africa, and provided a blood sample for biomarker analysis. Diagnosis was subsequently confirmed using bacteriological testing, advanced imaging and/or clinical evaluation, as appropriate. The concentrations of 19 host biomarkers were evaluated in serum samples using the Luminex platform. Receiver Operating Characteristic (ROC) curves and General Discriminant Analysis were used to identify biomarkers with the potential to distinguish spinal TB from mechanical back pain.
Twenty-six patients with spinal TB and 17 with mechanical back pain were recruited. Seven out of 19 biomarkers were significantly different between groups, of which Fibrinogen, CRP, IFN-γ and NCAM were the individual markers with the highest discrimination utility (Area Under Curve ROC plot 0.88-0.99). A five-marker biosignature (CRP, NCAM, Ferritin, CXCL8 and GDF-15) correctly classified all study participants after leave-one-out cross-validation.
This study identified host serum biomarkers with the potential to diagnose spinal TB, including a five-marker biosignature. These preliminary findings require validation in larger studies.
脊柱结核（TB）的表现可能多样且不具特异性，包括伴有或不伴有全身症状的背痛。需要更多工具来辅助早期诊断这种潜在的严重结核病形式，免疫学生物标志物在这方面可能具有潜力。本研究的目的是调查宿主血清生物标志物在区分脊柱结核与机械性背痛方面的效用。
从南非西开普省的一家三级医院招募疑似脊柱结核或疑似机械性背痛的患者，并提供血样进行生物标志物分析。随后根据情况使用细菌学检测、先进成像和/或临床评估来确诊。使用Luminex平台评估血清样本中19种宿主生物标志物的浓度。采用受试者工作特征（ROC）曲线和广义判别分析来识别有可能区分脊柱结核与机械性背痛的生物标志物。
招募了26例脊柱结核患者和17例机械性背痛患者。19种生物标志物中有7种在两组之间存在显著差异，其中纤维蛋白原、CRP、IFN-γ和NCAM是具有最高判别效用的个体标志物（ROC曲线下面积为0.88 - 0.99）。一种五标志物生物特征（CRP、NCAM、铁蛋白、CXCL8和GDF-15）在留一法交叉验证后正确分类了所有研究参与者。
本研究确定了具有诊断脊柱结核潜力的宿主血清生物标志物，包括一种五标志物生物特征。这些初步发现需要在更大规模的研究中进行验证。
