Glynn J R, Bauer J, de Boer A S, Borgdorff M W, Fine P E, Godfrey-Faussett P, Vynnycky E
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
Int J Tuberc Lung Dis. 1999 Dec;3(12):1055-60.
Many studies of tuberculosis have defined clusters of patients on the basis of shared DNA fingerprint patterns of their Mycobacterium tuberculosis isolates. Clustering has been equated with recent transmission, and factors associated with clustering have been sought as a guide to population subgroups with high rates of ongoing transmission of M. tuberculosis. Considerable caution should be exercised in conducting and interpreting these studies. Groups of strains may be identical for reasons other than recent transmission, depending, for example, on the stability of the marker and the number of strains in the population over time. Cases actually due to recent transmission may not be seen as clustered if they are new immigrants to the population or if not all cases in the population are included in the study. The amount of clustering seen will depend on the duration of the study. Studies should give precise information on the study setting, the proportion of cases included, the recruitment period and the definition of clustering used. The data on clustering should be disaggregated at least by age, sex and immigration status. To be maximally informative, studies should involve a high proportion of all cases in a population, be conducted in conjunction with conventional epidemiological investigations of contacts (if possible), and should provide information on tuberculosis incidence in the population and on patients' age, sex, human immunodeficiency virus status, drug resistance and social and ethnic group.
许多结核病研究根据患者结核分枝杆菌分离株的共享DNA指纹图谱来定义患者群。聚集现象被等同于近期传播，人们一直在寻找与聚集相关的因素，以此作为指导，确定正在进行结核分枝杆菌高传播率的人群亚组。在开展和解读这些研究时应格外谨慎。菌株组可能由于近期传播以外的原因而相同，例如，这取决于标记物的稳定性以及一段时间内人群中菌株的数量。如果是新迁入该人群的病例，或者如果该人群中的所有病例并非都纳入研究，那么实际由近期传播导致的病例可能不会被视为聚集性病例。所观察到的聚集程度将取决于研究的持续时间。研究应提供有关研究背景、纳入病例的比例、招募期以及所使用的聚集定义的精确信息。聚集数据至少应按年龄、性别和移民身份进行分类。为了提供最大信息量，研究应涵盖人群中所有病例的很大比例，（如果可能）应与对接触者的常规流行病学调查同时进行，并且应提供有关该人群中结核病发病率以及患者的年龄、性别、人类免疫缺陷病毒感染状况、耐药性以及社会和种族群体的信息。
