Doherty Mark, Wallis Robert S, Zumla Alimuddin
Department of Infectious Disease Immunology, Statens Serum Institute, Copenhagen, Denmark.
Curr Opin Pulm Med. 2009 May;15(3):181-7. doi: 10.1097/mcp.0b013e328326f42c.
Every year, over 8 million people develop tuberculosis and nearly 1.8 million die from it, despite extensive vaccination and drug treatment programmes. It is increasingly recognized that the diagnosis of tuberculosis, which relies heavily on century-old techniques, is one of the weakest links in the chain of tuberculosis control, hampering not just treatment but also the development of new drugs and vaccines. As a result, recent years have seen the initiation of large-scale studies aiming to identify biomarkers of Mycobacterium tuberculosis infection and disease. This review discusses initial results and future prospects for that work.
The key finding from recent work has been that no one factor seems able to explain the complex course of Mycobacterium tuberculosis infection. Multifactorial analyses have identified a variety of genes and proteins, mostly involved in bacterial persistence or host responses, that offer promise as biomarkers for different disease stages.
The challenge now is to validate the suggested biomarkers being described and then reduce them to clinical practice. If this can be done, it offers the possibility of greatly improved clinical management of tuberculosis, allowing segregation of patients and contacts into appropriate treatment regimens.
尽管有广泛的疫苗接种和药物治疗计划，但每年仍有超过800万人感染结核病，近180万人死于该病。人们越来越认识到，严重依赖百年老技术的结核病诊断是结核病控制链条中最薄弱的环节之一，不仅阻碍治疗，还妨碍新药和疫苗的研发。因此，近年来启动了大规模研究，旨在确定结核分枝杆菌感染和疾病的生物标志物。本综述讨论了该工作的初步结果和未来前景。
近期研究的关键发现是，似乎没有一个因素能够解释结核分枝杆菌感染的复杂过程。多因素分析已经确定了多种基因和蛋白质，它们大多与细菌的持续存在或宿主反应有关，有望作为不同疾病阶段的生物标志物。
现在的挑战是验证所描述的生物标志物，然后将其应用于临床实践。如果能够做到这一点，就有可能大大改善结核病的临床管理，将患者及其接触者分为适当的治疗方案。
