The Public Health Research Institute, New Jersey Medical School, Newark, NJ 07103, USA.
Clin Microbiol Rev. 2011 Oct;24(4):792-805. doi: 10.1128/CMR.00014-11.
Infection with Mycobacterium tuberculosis causes a variety of clinical conditions ranging from life-long asymptomatic infection to overt disease with increasingly severe tissue damage and a heavy bacillary burden. Immune biomarkers should follow the evolution of infection and disease because the host immune response is at the core of protection against disease and tissue damage in M. tuberculosis infection. Moreover, levels of immune markers are often affected by the antigen load. We review how the clinical spectrum of M. tuberculosis infection correlates with the evolution of granulomatous lesions and how granuloma structural changes are reflected in the peripheral circulation. We also discuss how antigen-specific, peripheral immune responses change during infection and how these changes are associated with the physiology of the tubercle bacillus. We propose that a dynamic approach to immune biomarker research should overcome the challenges of identifying those asymptomatic and symptomatic stages of infection that require antituberculosis treatment. Implementation of such a view requires longitudinal studies and a systems immunology approach leading to multianalyte assays.
结核分枝杆菌感染可引起多种临床病症，从终生无症状感染到显性疾病，伴有日益严重的组织损伤和大量细菌负担。免疫生物标志物应随感染和疾病的演变而变化，因为宿主免疫反应是防止结核分枝杆菌感染疾病和组织损伤的核心。此外，免疫标志物的水平通常受抗原负荷的影响。我们回顾了结核分枝杆菌感染的临床谱如何与肉芽肿病变的演变相关，以及肉芽肿结构的变化如何反映在周围循环中。我们还讨论了抗原特异性外周免疫反应在感染过程中如何变化，以及这些变化如何与结核分枝杆菌的生理学相关。我们提出，采用动态方法研究免疫生物标志物应克服确定需要抗结核治疗的无症状和有症状感染阶段的挑战。这种方法的实施需要进行纵向研究和系统免疫学方法，从而进行多分析物检测。
