Department of Paediatric Allergy & Infection, Imperial College London, London, UK.
Curr Opin Infect Dis. 2012 Jun;25(3):250-7. doi: 10.1097/QCO.0b013e3283529af9.
Even in the era of promising molecular diagnostics for tuberculosis, understanding of the immune response remains urgent and fundamental to combating paediatric tuberculosis, given its paucibacillary nature.
Significant advances have been made in unravelling the contributions of previously underappreciated components of the immune response to Mycobacterium tuberculosis. Research into the role of the 'innate' immune system such as neutrophils alongside 'adaptive' cells such as CD4(+), CD8(+), polyfunctional and regulatory T cells has highlighted the complexity of their interactions. Lessons from children with congenital or acquired susceptibility to mycobacterial disease, including HIV, continue to illuminate a broader understanding of the host immune response. The role of vitamin D is becoming apparent and highlights the importance of the environmental and clinical context of patients, especially in high prevalence areas. Several approaches show promise as diagnostic tests and in monitoring treatment response, although distinguishing latent from active disease remains a challenge.
Research into novel immunological biomarkers, and greater understanding of the complex network of interactions between the innate and adaptive immune systems, is key to understanding why following exposure some children are unaffected, others latently infected and yet another group succumb to disease.
目的综述：即使在有希望进行结核病分子诊断的时代，鉴于小儿结核病的菌量少，理解免疫反应仍然是对抗小儿结核病的紧迫且基础的工作。
最近的发现：在揭示以前未被充分认识的对结核分枝杆菌免疫反应成分的作用方面取得了重大进展。对“先天”免疫系统（如中性粒细胞）以及“适应性”细胞（如 CD4(+)、CD8(+)、多功能和调节性 T 细胞）的研究突出了它们相互作用的复杂性。来自对分枝杆菌病（包括 HIV）具有先天性或获得性易感性的儿童的研究继续阐明了宿主免疫反应的更广泛认识。维生素 D 的作用变得明显，突出了患者的环境和临床背景的重要性，尤其是在高流行地区。几种方法显示出作为诊断测试和监测治疗反应的潜力，尽管区分潜伏性和活动性疾病仍然是一个挑战。
总结：对新型免疫生物标志物的研究，以及对先天和适应性免疫系统之间复杂相互作用网络的更好理解，是理解为什么有些儿童接触后未受影响、有些儿童隐性感染而另一组儿童则患病的关键。
