关键词: 布鲁杆菌病, 骨关节炎, 二代测序, 诊断

Abstract: Objective To evaluate the application value of targeted next generation sequencing (tNGS) technology in the pathogenic diagnosis of osteoarticular brucellosis. 
Methods Case data of 108 patients with suspected osteoarticular brucellosis were included in Hebei Chest Hospital. The comprehensive clinical diagnosis was primarily based on an analysis of the epidemiologic history, clinical manifestations, imaging findings, results of laboratory and pathogenic examination, and the effect of anti-Brucella treatment. The patients were classified into two groups: the osteoarticular brucellosis group (n=78), and the non-brucellosis group (n=30) based on the final clinical diagnosis. All patients underwent a serum agglutination test (SAT), CT navigational puncture or surgical sampling of lesions for bacteriological culture (culture method) and tNGS after admission to the hospital. The diagnostic efficacy of these three tests for osteoarticular brucellosis was then compared using the final clinical diagnosis as the reference standard. 
Results Among the 108 patients with suspected osteoarticular brucellosis, the positive rate of osteoarticular brucellosis detected by tNGS (60/108, 55.56%) was significantly higher than that of the SAT test (57/108, 52.78%) and culture method (25/108, 23.15%), suggesting significant differences (χ2=24.982, 37.934, P＜0.001). The sensitivity of the tNGS test, SAT test and culture method for detecting osteoarticular brucellosis was 76.92%, 64.10% and 32.05%, respectively, when the final clinical diagnosis was taken as the criterion. The specificity was 100.00%, 76.67% and 100.00%, respectively, and the diagnostic compliance rate was 83.35%, 67.59% and 50.92%, respectively, with a Kappa value of 0.799, 0.590 and 0.504, respectively. 
Conclusion TNG has been demonstrated to have a high pathogen detection rate and sensitivity in the pathogenic diagnosis of patients with osteoarticular brucellosis, thereby providing an important reference for the precise diagnosis and treatment of patients with osteoarticular brucellosis. 

Key words: brucellosis, osteoarthritis, nextgeneration sequencing, diagnosis