Tuberculosis 4 Biomarkers and diagnostics for tuberculosis: progress, needs, and translation into practice
Tuberculosis 4 Biomarkers and diagnostics for tuberculosis: progress, needs, and translation into practice
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DOI：
10.1016/s0140-6736(10)60359-5
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发表时间：
2010-05-01
期刊：
影响因子：
168.9
通讯作者：
Zumla, Alimuddin
中科院分区：
文献类型：
--
作者：
Wallis, Robert S.;Pai, Madhukar;Zumla, Alimuddin
人类感染结核分枝杆菌可进展为活动性疾病，或被控制为潜伏感染，或被宿主反应根除。结核病诊断学将患者分为以下几类之一。这些不是固定的、不同的状态，而是患者可以移动的连续状态，并受到艾滋病毒感染、免疫抑制治疗、抗结核病治疗和其他知之甚少的因素的影响。结核病生物标记物宿主或病原体特异性为个体患者或研究队列提供关于这些结果的预后信息。结核病病例的检测仍然很困难，部分原因是诊断方法不准确。投资在开发新的诊断方法方面取得了一些进展，尽管现有的管道仅限于对痰涂片阴性病例、儿童结核病和对潜在结核病重新激活的准确预测。尽管新的、灵敏的、自动化的分子平台用于检测结核病和耐药性，但简单、廉价的医疗点检测仍然不可用。任何新检测的效果将取决于引进的方法和程度、实验室的实力以及在获得诊断后获得适当治疗的程度。通过政治承诺、增加资金和所有利益攸关方的参与，将生物标志物和诊断方面的科学进展转化为临床和公共卫生方案是可能的。
Human infection with Mycobacterium tuberculosis can progress to active disease, be contained as latent infection, or be eradicated by the host response. Tuberculosis diagnostics classify a patient into one of these categories. These are not fixed distinct states, but rather are continua along which patients can move, and are affected by HIV infection, immunosuppressive therapies, antituberculosis treatments, and other poorly understood factors. Tuberculosis biomarkers host or pathogen-specific provide prognostic information, either for individual patients or study cohorts, about these outcomes. Tuberculosis case detection remains difficult, partly because of inaccurate diagnostic methods. Investments have yielded some progress in development of new diagnostics, although the existing pipeline is limited for tests for sputum-smear-negative cases, childhood tuberculosis, and accurate prediction of reactivation of latent tuberculosis. Despite new, sensitive, automated molecular platforms for detection of tuberculosis and drug resistance, a simple, inexpensive point-of-care test is still not available. The effect of any new tests will depend on the method and extent of their introduction, the strength of the laboratories, and the degree to which access to appropriate therapy follows access to diagnosis. Translation of scientific progress in biomarkers and diagnostics into clinical and public health programmes is possible with political commitment, increased funding, and engagement of all stakeholders.