结核分枝杆菌感染的免疫学检测技术研究进展及临床应用现状

结核病仍然是全球和我国重点防控的传染病之一。尽管目前已将结核分枝杆菌核酸检测阳性纳入结核病确诊依据之一,但临床仍然存在大量病原学阴性的结核病患者,需要依靠免疫学检测技术进行辅助诊断。结核分枝杆菌入侵宿主后引发的免疫病理反应及抗结核免疫应答反应是开发免疫学检测技术的基础,参与免疫应答不同阶段的各类细胞、细胞因子、趋化因子、抗体等都是潜在的免疫学诊断靶标。近年来,基于这些靶标开发了多项免疫学检测新技术,包括γ-干扰素释放试验、新型结核菌素皮肤试验、干扰素诱导蛋白-10(IP-10)检测、γ-干扰素/白细胞介素-2(IFN-γ/IL-2)双因子检测等,为结核分枝杆菌感染和结核病的诊断带来了新的希望。此外,尚有一些处在研发过程的新型蛋白标识物、多功能淋巴细胞等也表现出较好的潜在诊断价值。笔者将对已用于临床的免疫学诊断技术的应用现状及优缺点进行综述,并探讨未来可能进入临床应用的标识物和其他潜在靶标。

Progress and clinical application of immunological detection technology for Mycobacterium tuberculosis infection

In the world and China, tuberculosis is still one of the infectious diseases requiring more attention to the prevention and control. Although the positive detection of Mycobacterium tuberculosis nucleic acid has been defined as one of the basis for the diagnosis of tuberculosis, there are still a large number of tuberculosis patients with negative etiology in clinic and need to rely on immunological detection technology for auxiliary diagnosis. The immunopathological response and anti-tuberculosis immune response caused by Mycobacterium tuberculosis infection are the basis for the development of immunological technologies. Various kinds of cells, cytokines, chemokines, and antibodies, etc., involved in different stages of the immune response, are all potential targets for immunological diagnosis. In recent years, a number of new immunological technologies have been developed based on these targets, including interferon-γ release assay, new tuberculin test, IP-10 test and IFN-γ/IL-2 dual release assay, offers new hopes for diagnosis of Mycobacterium tuberculosis infection and tuberculosis. In addition, some new protein biomarkers and poly-functional lymphocytes in the development process also show good potential diagnostic values. Herein, the current application status, advantages and disadvantages of immune diagnostic technologies that have been used in clinical practice are reviewed, and biomarkers and other potential targets that may be used in clinic in the future are discussed.