结核病非痰筛查的理性回归:舌拭子的固有局限与定位再思考

doi:10.19982/j.issn.1000-6621.20260110

摘要/Abstract

摘要：

舌拭子作为非痰检测技术,被寄予突破结核病大规模筛查瓶颈的厚望。然而,现有相关研究存在场景侧重差异:多数研究聚焦医院内疑似肺结核患者的辅助诊断效能评估,面向社区人群的筛查验证数据很少,现有部分研究结果难以达到世界卫生组织推荐筛查的判定标准。受限于舌拭子生物学特征,该技术较难满足大规模人群筛查所需的高敏感度要求。因此,未来研究需要优化研发方向,在病原特异性标识物检测之外,探索基于宿主非特异性标识物的高敏感筛查新技术。

关键词: 结核, 舌拭子, 筛查, 述评

Abstract:

As a non-sputum testing method, tongue swab detection is expected to break through bottlenecks in large-scale tuberculosis screening. Nevertheless, relevant current studies differ markedly in research scenarios: most focus on evaluating its auxiliary diagnostic performance among clinically suspected patients, while validation data for community population screening remain scarce, with findings from several existing studies failing to meet WHO-recommended screening benchmarks. Restricted by the biological properties of tongue swabs, this technique struggles to satisfy the high-sensitivity requirements for mass population screening. Accordingly, future research shall adjust developmental priorities and explore novel high-sensitivity screening assays based on host non-specific biomarkers alongside pathogen-specific biomarker detection.

Key words: Tuberculosis, Tongue swab, Screening, Editorial

中图分类号:

R446

高谦. 结核病非痰筛查的理性回归:舌拭子的固有局限与定位再思考[J]. 中国防痨杂志, 2026, 48(8): 1120-1123. doi: 10.19982/j.issn.1000-6621.20260110

Gao Qian. Rational return to non-sputum screening for tuberculosis: inherent limitations and reconsideration of the position of tongue swabs[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1120-1123. doi: 10.19982/j.issn.1000-6621.20260110

参考文献 22

[1]	Gaeddert M, Papadopoulou P, Habbes J, et al. Sputum scarcity among adolescents and adults with presumptive tuberculosis: a systematic review and meta-analysis[J]. MedRxiv, 2025,2025.11.02.25339326. doi:10.1101/2025.11.02.25339326.
[2]	Jiang Q, Li J, Qiu Y, et al. A randomized controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis[J]. Int J Tuberc Lung Dis, 2019, 23(6):685-691. doi:10.5588/ijtld.18.0524. pmid: 31315700
[3]	Savage H, Rickman H M, Burke R M, et al. Accuracy of upper respiratory tract samples to diagnose Mycobacterium tuberculosis: a systematic review and meta-analysis[J]. Lancet Microbe, 2023, 4(10):e811-e821. ddoi:10.1016/S2666-5247(23)00190-8. doi: 10.1016/S2666-5247(23)00190-8 URL
[4]	Church E C, Steingart K R, Cangelosi G A, et al. Oral swabs with a rapid molecular diagnostic test for pulmonary tuberculosis in adults and children: a systematic review[J]. Lancet Glob Health, 2024, 12(1):e45-e54. doi:10.1016/S2214-109X(23)00469-2. pmid: 38097297
[5]	Wang Y, Cui J, Li Y, et al. Rapid quantitative PCR on tongue swabs for pulmonary tuberculosis in adults: a prospective multicentre study[J]. Eur Respir J, 2025, 65(1):2401493. doi:10.1183/13993003.01493-2024.
[6]	Wu Z, Yan L, Lai X, et al. Diagnostic accuracy of a novel point-of-care tongue swab assay for pulmonary tuberculosis: a multicentre prospective study[J]. Clin Microbiol Infect, 2026, 32(2):331-336. doi:10.1016/j.cmi.2025.11.010.
[7]	陈纪飞, 黄丽花, 罗兰波, 等. 舌拭子-PCR 荧光探针法对肺结核诊断效能的评价[J]. 中国防痨杂志, 2025, 47(1):51-60. doi:10.19982/j.issn.1000-6621.20240324.
[8]	World Health Organization. Target product profiles for tuberculosis screening tests[R]. Geneva: World Health Organization, 2025.
[9]	Wood R, Olson A M, Lochner K A, et al. Tongue swab Mycobacterium tuberculosis qPCR for community screening of asymptomatic TB vs. clinic-based triage of symptomatic TB[J]. MedRxiv, 2026,2026.02.12.26346160. doi:10.64898/2026.02.12.26346160.
[10]	Rockman L, Abdulgader S, Minnies S, et al. Oral Washes and Tongue Swabs for Xpert MTB/RIF Ultra-Based Tuberculosis Diagnosis in People With and Without the Ability to Make Sputum[J]. Clin Infect Dis, 2025, 81(6):e632-e642. doi:10.1093/cid/ciaf397.
[11]	Wang Y, Li R, Cai L, et al. Accuracy of rapid quantitative PCR on tongue swabs for pulmonary tuberculosis in sputum-scarce patients: a prospective multicenter diagnostic study[J]. Clin Infect Dis, 2026: ciag071. doi:10.1093/cid/ciag071.
[12]	Song Y, Ma Y, Liu R, et al. Diagnostic Yield of Oral Swab Testing by TB-LAMP for Diagnosis of Pulmonary Tuberculosis[J]. Infect Drug Resist, 2021: 14:89-95. doi:10.2147/IDR.S284157. pmid: 33469323
[13]	Rigouts L, Conde M, Hassane-Harouna S, et al. Successful Mycobacterium tuberculosis culture isolation from tongue swabs: Results from both experimentally infected and clinical swabs from pulmonary tuberculosis patients[J]. Diagn Microbiol Infect Dis, 2024, 110(2):116423. doi:10.1016/j.diagmicrobio.2024.116423.
[14]	Yang Z, Liang Q, Dong Y, et al. An optimal processing method for recovery of tuberculosis in the tongue swab using the Mycobacterium growth indicator tube method[J]. Microbiol Spectr, 2026, 14(7):e0265725. doi:10.1128/spectrum.02657-25.
[15]	Vargas D A, Fuertes-Bucheli J F, Sanchez-Hidalgo A, et al. Diagnostic Accuracy of Molecular Testing on Saliva and Oral Swabs for Pulmonary Tuberculosis[J]. Clin Infect Dis, 2026:ciag055. doi:10.1093/cid/ciag055.
[16]	Gordhan B, Sewcharran A, Waja Z, et al. Oral Rinse as an Alternative Diagnostic Specimen for Detection of Tuberculosis[J]. Am J Respir Crit Care Med, 2025, 211(11):2136-2139. doi:10.1164/rccm.202503-0723RL.
[17]	Moe C A, Luswata R K, Barrameda A J, et al. Diagnostic yield of tongue swab-compared to sputum-based molecular testing for tuberculosis in four high-burden countries[J]. Clin Infect Dis, 2026:ciag077. doi:10.1093/cid/ciag077.
[18]	Mann T, Gupta R K, Reeve B W P, et al. Blood RNA biomarkers for tuberculosis screening in people living with HIV before antiretroviral therapy initiation: a diagnostic accuracy study[J]. Lancet Glob Health, 2024, 12(5):e783-e792. doi:10.1016/S2214-109X(24)00029-9. pmid: 38583459
[19]	Gaeddert M, Glaser K, Chendi B H, et al. Host blood protein biomarkers to screen for tuberculosis disease: a systematic review and meta-analysis[J]. J Clin Microbiol, 2024, 62(11):e0078624. doi:10.1128/jcm.00786-24.
[20]	Farr K, Ravindran R, Strnad L, et al. Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV[J]. PLoS One, 2018, 13(10):e0206119. doi:10.1371/journal.pone.0206119.
[21]	Saktiawati A M I, Putera D D, Setyawan A, et al. Diagnosis of tuberculosis through breath test: A systematic review[J]. EBioMedicine, 2019, 46:202-214. doi:10.1016/j.ebiom.2019.07.056. pmid: 31401197
[22]	Jaganath D, Sieberts S K, Raberahona M, et al. Accelerating Cough-Based Algorithms for Pulmonary Tuberculosis Screening: Results From the CODA TB DREAM Challenge[J]. Open Forum Infect Dis, 2025, 12(10):ofaf572. doi:10.1093/ofid/ofaf572.