结核分枝杆菌cfDNA在结核病诊断中的发展现状和挑战

为实现“2035终止结核”的目标,开发新的检测方法迫在眉睫。结核分枝杆菌cfDNA(Mycobacterium tuberculosis cfDNA, MTB-cfDNA)可表明病原体的存在,是结核病(tuberculosis,TB)诊断和治疗监测有吸引力的生物标志物。易于获取的尿液和(或)血液中的MTB-cfDNA可实现对任何年龄组的肺结核和肺外结核的检测。在胸腔积液、腹腔积液和脑脊液等体液样本中检测MTB-cfDNA对TB的诊断性能高于GeneXpert MTB/RIF等基因组DNA检测。但cfDNA作为TB生物标志物的研究仍处于起步阶段,未来需要更大型、纳入患者类型更全面的临床研究来评估其在TB诊断中的效用。随着检测方法的进一步优化,cfDNA检测有可能改善TB诊断并成为“游戏规则的改变者”。

Development and challenges of Mycobacterium tuberculosis cfDNA in the diagnosis of tuberculosis

In order to achieve the goal of “End Tuberculosis by 2035”, it is urgent to develop new detection methods. Mycobacterium tuberculosis cfDNA (MTB-cfDNA) can indicate the presence of pathogens and is an attractive biomarker for tuberculosis (TB) diagnosis and treatment monitoring. Easily accessible MTB-cfDNA in urine and/or blood can be used to detect both pulmonary and extrapulmonary TB in any age group. The diagnostic performance of MTB-cfDNA in fluid samples such as pleural effusion, ascites and cerebrospinal fluid is higher than that of genomic DNA assays such as GeneXpert MTB/RIF. Research on cfDNA as a TB biomarker is still in its infancy, larger and clinical studies including more comprehensive patient types are needed to evaluate the utility of cfDNA in TB diagnosis. With further optimization of detection methods, cfDNA testing may improve TB diagnosis and become a “game changer”.