儿童结核病的实验室诊断现状与进展

doi:10.3969/j.issn.1000-6621.2020.02.018

摘要/Abstract

摘要：

儿童结核病是全球结核病防控工作的重要组成部分,诊断儿童结核病主要依靠实验室检查结果,但由于儿童结核病本身和标本的特殊性,实验室准确、快速地诊断儿童结核病仍面临挑战。病原学诊断作为儿童结核病诊断的金标准,其敏感度不佳;以超敏结核分枝杆菌和利福平耐药基因检测(Xpert MTB/RIF Ultra)为代表的新型分子生物学检测技术因其较高的敏感度和较短的检测时间有其应用前景;结核菌素皮肤试验(TST)被WHO推荐用于中低收入国家;直接抗原检测技术在少菌、肺外结核标本中敏感度高,在儿童结核病的检测中具有独特价值;其他免疫学新方法对于区分潜伏和活动性结核感染方面具有重要意义;此外,目前已有检测结核分枝杆菌感染后基因表达、蛋白质产生和生物标志物变化的新方法投入研究。留取多份标本或不同标本类型、不同检测方法联合检测有助于提高儿童结核病的检出率。提高结核病在现有方法和非侵入性、易获取标本中的检出率,以及评估新的生物标志物和新技术的适用性是未来儿童结核病实验室诊断研究的方向。

关键词: 结核, 儿童, 实验室技术和方法, 综述文献

Abstract:

Childhood tuberculosis is an important part of the global tuberculosis prevention and control work. The diagnosis of childhood tuberculosis mainly depends on the results of laboratory tests. However, due to the characteristics of disease and specimens, accurate and rapid diagnosis of tuberculosis in children is still challenging. Pathogenic diagnosis has poor sensitivity regarded as a gold standard for diagnosis, the new molecular biology tests represented by high sensitivity Mycobacterium tuberculosis and rifampin resistant gene detection (Xpert MTB/RIF Ultra) has its prospect due to higher sensitivity and shorter detection time. The tuberculin skin test (TST) is recommended by WHO for low-and middle-income countries. Direct antigen detecting technology has high sensitivity in paucibacillary and extrapulmonary specimens, possessing unique value in the detection of children tuberculosis. Other new immunological methods are important to the diagnosis of childhood tuberculosis when distinguishing latent from active infections. In addition, new methods for detecting the gene expression, protein production, and biomarkers changes after being infected with Mycobacterium tuberculosis have been developed. Retaining multiple specimens or joint testing of different specimen types and methods can help improve the detection rate of tuberculosis in children. Increasing the detection rate of tuberculosis in existing methods and non-invasive and accessible specimens, as well as assessing the applicability of new biomarkers and new technologies are the future direction of laboratory diagnosis in childhood tuberculosis.

Key words: Tuberculosis, Child, Laboratory techniques and procedures, Review literature

吕纯阳,罗晶晶,石华,李明远,江咏梅. 儿童结核病的实验室诊断现状与进展[J]. 中国防痨杂志, 2020, 42(2): 178-184. doi: 10.3969/j.issn.1000-6621.2020.02.018

LYU Chun-yang,LUO Jing-jing,SHI Hua,LI Ming-yuan,JIANG Yong-mei. Tuberculosis in children:Current status and advances in laboratory diagnosis[J]. Chinese Journal of Antituberculosis, 2020, 42(2): 178-184. doi: 10.3969/j.issn.1000-6621.2020.02.018

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