Yu Xue, Rao Guo, Zhang Yuxin, Liu Zhaohua, Cai Jun, Wang Xiaoyun, Yang Aixin, He Tao, Zeng Guofen, Liu Jing
Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Spinal Surgery, First People's Hospital of Kashi, Kashi, China.
Infect Dis (Lond). 2025 May;57(5):385-396. doi: 10.1080/23744235.2024.2438826. Epub 2024 Dec 13.
Vertebral osteomyelitis (VO) is an infection of the spine with increasing prevalence due to improved diagnostics and aging populations. Multiple pathogens, including , spp., and pyogenic bacteria, can cause VO, making differential diagnosis complex, especially in regions with endemic brucellosis and tuberculosis. Early and accurate diagnosis is essential for appropriate treatment.
This was a single-center, retrospective, observational study performed between 2019 and 2022 in Kashi, Xinjiang.
In this study, a total of 319 patients were enrolled, comprising 45.5% with tuberculous vertebral osteomyelitis (TVO; 52.4% females), 37.9% with brucellar vertebral osteomyelitis (BVO; 19.8% females), and 16.6% with pyogenic vertebral osteomyelitis (PVO; 52.8% females). Demographically, TVO had a longer mean time to diagnosis compared to BVO and PVO. BVO was more prevalent in male, and PVO patients had higher rates of spinal surgery history (45.3%) and diabetes (13.2%). Clinically, TVO patients presented with fever (72.4%), sweating (83.4%), weight loss (71.7%), and appetite loss (84.8%) more frequently, while BVO patients reported more lower back pain (86.0%). Laboratory investigations revealed significantly higher leucocyte and neutrophil levels in PVO, whereas TVO patients had elevated monocyte-to-lymphocyte and platelet-to-lymphocyte ratios. Radiologically, TVO patients exhibited a higher incidence of thoracic involvement (56.6%) and skip lesions (20%). Microbiologically, BVO and PVO had high positive culture rates (84.3 and 84.9%, respectively), with isolated from only 4.1% of TVO patients.
These findings underscore the distinct clinical, laboratory, and radiological characteristics of TVO, BVO, and PVO.
由于诊断技术的改进和人口老龄化，椎体骨髓炎（VO）的发病率呈上升趋势，它是一种脊柱感染性疾病。多种病原体，包括[此处原文缺失具体病原体名称]、[此处原文缺失具体病原体名称]菌属和化脓性细菌，均可导致VO，这使得鉴别诊断变得复杂，尤其是在布鲁氏菌病和结核病流行的地区。早期准确诊断对于恰当治疗至关重要。
这是一项于2019年至2022年在新疆喀什进行的单中心回顾性观察研究。
本研究共纳入319例患者，其中结核性椎体骨髓炎（TVO；女性占52.4%）患者占45.5%，布鲁氏菌性椎体骨髓炎（BVO；女性占19.8%）患者占37.9%，化脓性椎体骨髓炎（PVO；女性占52.8%）患者占16.6%。从人口统计学角度来看，与BVO和PVO相比，TVO的平均诊断时间更长。BVO在男性中更为常见，PVO患者有脊柱手术史（45.3%）和糖尿病（13.2%）的比例更高。临床上，TVO患者更常出现发热（72.4%）、出汗（83.4%）、体重减轻（71.7%）和食欲减退（84.8%），而BVO患者报告下背部疼痛的更多（86.0%）。实验室检查显示，PVO患者的白细胞和中性粒细胞水平显著更高，而TVO患者的单核细胞与淋巴细胞比值及血小板与淋巴细胞比值升高。影像学方面，TVO患者胸椎受累（56.6%）和跳跃性病变（20%）的发生率更高。微生物学检查中，BVO和PVO的培养阳性率较高（分别为84.3%和84.9%），仅4.1%的TVO患者分离出[此处原文缺失具体病原体名称]。
这些发现强调了TVO、BVO和PVO在临床、实验室及影像学方面的不同特征。
