Department of Clinical Pathology, Medical Faculty, Padjadjaran University, Dr Hasan Sadikin Hospital, Bandung, Indonesia.
Lancet Infect Dis. 2010 Feb;10(2):103-11. doi: 10.1016/S1473-3099(09)70330-5.
The wide geographic distribution of one clade of Mycobacterium tuberculosis, the Beijing genotype family, and its genetic homogeneity, suggests that strains belonging to this grouping might have a selective advantage over other M tuberculosis strains. This hypothesis was addressed by reviewing molecular-epidemiological, experimental, and clinical studies. Beijing strains represent about 50% of strains in east Asia and at least 13% of strains worldwide. Their emergence might be linked to escape from BCG vaccination, and to multidrug resistance, which is associated with the Beijing genotype in many areas. Different animal models have shown Beijing strains to be more virulent, and to cause more histopathological changes, higher outgrowth, and increased mortality. At a molecular level, Beijing strains have specific properties in terms of protein and lipid structures and their interaction with the human immune system. Finally, the Beijing genotype has been linked to polymorphisms in immune genes, suggesting the possibility of human-mycobacterial co-evolution. The emergence of the Beijing genotype family might represent an evolutionary response of M tuberculosis to vaccination or antibiotic treatment, with an important negative impact on tuberculosis control. More research is needed to further unravel the mechanisms underlying the emergence of M tuberculosis Beijing genotype strains, and examine the implications for future control strategies.
结核分枝杆菌一个分支（北京基因型家族）的广泛地理分布及其遗传同质性表明，属于该群组的菌株可能比其他结核分枝杆菌菌株具有选择优势。通过回顾分子流行病学、实验和临床研究，对这一假设进行了探讨。北京株约占东亚地区菌株的 50%，占全球菌株的至少 13%。它们的出现可能与逃避卡介苗接种以及与北京基因型相关的多药耐药有关，而多药耐药在许多地区都与北京基因型有关。不同的动物模型表明，北京株的毒力更强，会引起更严重的组织病理学变化、更高的生长速度和更高的死亡率。在分子水平上，北京株在蛋白质和脂质结构及其与人体免疫系统的相互作用方面具有特定的特性。最后，北京基因型与免疫基因的多态性有关，这表明人类-分枝杆菌共同进化的可能性。北京基因型家族的出现可能代表了结核分枝杆菌对疫苗或抗生素治疗的一种进化反应，对结核病控制产生了重要的负面影响。需要进一步研究以进一步阐明结核分枝杆菌北京基因型菌株出现的机制，并探讨对未来控制策略的影响。
