结核病分子病理学诊断技术临床应用进展

doi:10.3969/j.issn.1000-6621.2018.11.014

摘要/Abstract

摘要：

病理学是诊断结核病的重要途径,尤其在痰菌阴性的肺结核及肺外结核等疑难患者的诊断中发挥了重要作用。2017年公布的《中国结核病病理学诊断专家共识》提出病理学确诊结核病必须同时满足两个条件:(1)组织形态学符合结核病病理基本变化;(2)通过分子病理学检测获得明确的病原学依据。近年来,分子病理学诊断技术在结核病的诊断和鉴别诊断中起到越来越重要的作用。作者对分子病理学技术在诊断结核病、非结核分枝杆菌病,以及耐药结核病中的应用进展进行了综述。

关键词: 结核, 病理学, 分子, 诊断技术和方法, 综述文献(主题)

Abstract:

Pathology plays important roles in diagnosis of tuberculosis, especially in intractable cases such as sputum-negative pulmonary tuberculosis and extrapulmonary tuberculosis. “ Chinese Expert Consensus on Pathological Diagnosis of Tuberculosis” published in 2017 pointed out that definite pathological diagnosis of tuberculosis should meet both of the criteria: (1) basic tuberculous histological changes are found, (2) definite etiological evidences are confirmed by molecular pathology. In recent years, molecular pathological techniques play more and more important roles in the diagnosis and differential diagnosis of tuberculosis. The author reviews the progress of molecular pathological techniques in diagnosis of tuberculosis, non-tuberculous mycobacterial diseases, and drug-resistant tuberculosis.

Key words: Tuberculosis, Pathology, Molecular, Diagnostic techniques and procedures, Review litera-ture as topic

宋婧,车南颖. 结核病分子病理学诊断技术临床应用进展[J]. 中国防痨杂志, 2018, 40(11): 1221-1225. doi: 10.3969/j.issn.1000-6621.2018.11.014

SONG Jing,CHE Nan-ying. Progress in clinical application of molecular pathological diagnosis of tuberculosis[J]. Chinese Journal of Antituberculosis, 2018, 40(11): 1221-1225. doi: 10.3969/j.issn.1000-6621.2018.11.014

参考文献 32

[1]	World Health Organization . Global tuberculosis report 2017. Geneva: World Health Organization, 2017.
[2]	张海青, 车南颖 . 我国结核病病理学诊断和研究的现状与展望. 中国防痨杂志, 2014,36(9):793-797. doi: 10.3969/j.issn.1000-6621.2014.09.009 URL
[3]	刘彤华 . 诊断病理学.3版.北京: 人民卫生出版社, 2013: 241-256.
[4]	中华医学会结核病学分会, 结核病病理学诊断专家共识编写组. 中国结核病病理学诊断专家共识. 中华结核和呼吸杂志, 2017,40(6):419-425. doi: 10.3760/cma.j.issn.1001-0939.2017.06.005 URL
[5]	董宇杰, 杨新婷, 闫东杰 , 等. 内科胸腔镜活检在结核性胸膜炎诊断中的临床价值. 中国防痨杂志, 2017,39(11):1157-1161.
[6]	穆晶, 赵丹, 刘子臣 , 等. 荧光定量PCR技术在骨关节结核石蜡包埋标本检测中的应用价值. 中国防痨杂志, 2016,38(4):277-281. doi: 10.3969/j.issn.1000-6621.2016.04.009 URL
[7]	McKew GL, Dubedat SM, Chan RC . Do the eyes have it? Performance of molecular detection of tuberculosis on fresh and paraffin embedded tissues, including those with no visible tissue. J Clin Pathol, 2014,67(12):1104-1105. doi: 10.1136/jclinpath-2014-202464 URL pmid: 25165037
[8]	Seo AN, Park HJ, Lee HS , et al. Performance characteristics of nested polymerase chain reaction vs real-time polymerase chain reaction methods for detecting Mycobacterium tuberculosis complex in paraffin-embedded human tissues. Am J Clin Pathol, 2014,142(3):384-390. doi: 10.1309/AJCP2QZRH4ZNPRDD URL pmid: 25125630
[9]	Fukumoto H, Sato Y, Hasegawa H , et al. Development of a new real-time PCR system for simultaneous detection of bacteria and fungi in pathological samples. Int J Clin Exp Pathol, 2015,8(11):15479-15488. URL pmid: 26823918
[10]	李子玲, 秦卫松, 岳清华 , 等. 应用多重PCR方法检测石蜡包埋组织标本中的分枝杆菌DNA. 微生物学报, 2002,42(1):69-75. doi: 10.3321/j.issn:0001-6209.2002.01.011 URL
[11]	Polepole P, Kabwe M, Kasonde M , et al. Performance of the Xpert MTB/RIF assay in the diagnosis of tuberculosis in formalin-fixed, paraffin-embedded tissues. Int J Mycobacteriol, 2017,6(1):87-93. doi: 10.4103/2212-5531.201892 URL pmid: 28317811
[12]	Pandey S, Congdon J , McInnes B, et al. Evaluation of the GeneXpert MTB/RIF assay on extrapulmonary and respiratory samples other than sputum: a low burden country experience. Pathology, 2017,49(1):70-74. doi: 10.1016/j.pathol.2016.10.004 URL pmid: 27913043
[13]	中华医学会结核病学分会, 《中华结核和呼吸杂志》编辑委员会. 非结核分枝杆菌病诊断与治疗专家共识. 中华结核和呼吸杂志, 2012,35(8):572-580. doi: 10.3760/cma.j.issn.1001-0939.2012.08.006 URL
[14]	Kim YN, Kim KM, Choi HN , et al. Clinical Usefulness of PCR for Differential Diagnosis of Tuberculosis and Nontuberculous Mycobacterial Infection in Paraffin-Embedded Lung Tissues. J Mol Diagn, 2015,17(5):597-604. doi: 10.1016/j.jmoldx.2015.04.005 URL pmid: 26163897
[15]	Sabeti S, Pourabdollah Tootkaboni M, Abdolahi M , et al. Mycobacterium haemophilum: A report of cutaneous Infection in a Patient with end-stage renal disease. Int J Mycobacteriol, 2016,5 Suppl 1: S236. doi: 10.1016/j.ijmyco.2016.09.024 URL pmid: 28043577
[16]	宋艳华, 马丽萍 . 非结核分枝杆菌感染的分子生物学诊断技术研究进展. 临床肺科杂志, 2014,19(3):501-504. doi: 10.3969/j.issn.1009-6663.2014.03.043 URL
[17]	Zhu L, Jiang G, Wang S , et al. Biochip system for rapid and accurate identification of mycobacterial species from isolates and sputum. J Clin Microbiol, 2010,48(10):3654-3660. doi: 10.1128/JCM.00158-10 URL pmid: 2953089
[18]	Munkhdelger J, Wang HY, Choi Y , et al. Identification of Mycobacterium species in FFPE granulomatous lymphadenitis tissue using REBA Myco-ID. Int J Tuberc Lung Dis, 2013,17(7):898-902. doi: 10.5588/ijtld.12.0818 URL pmid: 23621948
[19]	王姣, 尤崇革 . 高分辨率熔解曲线技术及应用新进展. 兰州大学学报(医学版), 2016,42(5):55-61. doi: 10.13885/j.issn.1000-2812.2016.05.011 URL
[20]	Khosravi AD, Hashemzadeh M, Hashemi SA , et al. Differential Identification of Mycobacterial Species Using High-Resolution Melting Analysis. Front Microbiol, 2017,8:2045. doi: 10.3389/fmicb.2017.02045 URL
[21]	Issa R, Abdul H, Hashim SH , et al. High resolution melting analysis for the differentiation of Mycobacterium species. J Med Microbiol, 2014,63(10):1284-1287. doi: 10.1099/jmm.0.072611-0 URL pmid: 25038139
[22]	张俊仙, 王杰, 孙伟民 , 等. 应用荧光定量PCR-探针熔解曲线法快速鉴定分枝杆菌菌种方法的建立及初步评价. 中国医刊, 2016,51(4):74-78. doi: 10.3969/j.issn.1008-1070.2016.04.022 URL
[23]	Bao JR, Clark RB, Master RN , et al. Acid-fast bacterium detection and identification from paraffin-embedded tissues using a PCR-pyrosequencing method. J Clin Pathol, 2017,71(2):148-153. doi: 10.1136/jclinpath-2016-204128 URL pmid: 28735303
[24]	Almeida Da Silva PE, Palomino JC . Molecular basis and mecha-nisms of drug resistance in Mycobacterium tuberculosis: classical and new drugs. J Antimicrob Chemother, 2011,66(7):1417-1430. doi: 10.1093/jac/dkr173 URL pmid: 21558086
[25]	Schaumburg F, Peters G, Wardelmann E , et al. Evaluation of GenoType^® MTBDRplus using extracted DNA from formalin-fixed paraffin-embedded specimens . J Clin Microbiol, 2017,55(11):3300-3302. doi: 10.1128/JCM.01410-17 URL pmid: 28878006
[26]	谭景尹, 韦世录, 李翠萍 , 等. PCR-膜芯片检测石蜡包埋组织中结核杆菌耐药基因突变. 临床与实验病理学杂志, 2012,28(8):895-899. doi: 10.3969/j.issn.1001-7399.2012.08.015 URL
[27]	Guo Y, Zhou Y, Wang C , et al. Rapid, accurate determination of multidrug resistance in M.tuberculosis isolates and sputum using a biochip system. Int J Tuberc Lung Dis, 2009,13(7):914-920. doi: 10.1258/ijsa.2009.009146 URL pmid: 19555544
[28]	Sharma K, Sharma M, Singh S , et al. Real-time PCR followed by high-resolution melting curve analysis: A rapid and pragmatic approach for screening of multidrug-resistant extrapulmonary tuberculosis. Tuberculosis (Edinb), 2017,106:56-61. doi: 10.1016/j.tube.2017.07.002 URL pmid: 28802406
[29]	Liu Q, Luo T, Li J , et al. Triplex real-time PCR melting curve analysis for detecting Mycobacterium tuberculosis mutations associated with resistance to second-line drugs in a single reaction. J Antimicrob Chemother, 2013,68(5):1097-1103. doi: 10.1093/jac/dks509 URL pmid: 23288402
[30]	Luo T, Jiang L, Sun W , et al. Multiplex real-time PCR mel-ting curve assay to detect drug-resistant mutations of Mycobacterium tuberculosis. J Clin Microbiol, 2011,49(9):3132-3138. doi: 10.1128/JCM.02046-10 URL
[31]	Rindi L, Alì G, Fabiani B , et al. Detection of Mycobacterium tuberculosis from paraffin-embedded tissues by GeneXpert MTB/RIF. Tuberculosis (Edinb), 2017,106:53-55. doi: 10.1016/j.tube.2017.06.005 URL pmid: 28802405
[32]	Zignol M, Cabibbe AM, Dean AS , et al. Genetic sequencing for surveillance of drug resistance in tuberculosis in highly endemic countries: a multi-country population-based surveillance study. Lancet Infect Dis, 2018,18(6):675-683. doi: 10.1016/S1473-3099(18)30073-2 URL pmid: 29574065