Lancet Infect Dis:新型儿童结核病检测技术
2014/09/03
近日,一项新研究发明了一种快速、准确的儿童结核病血液检测技术,称为TAM-TB。 每年全球大约有一百万儿童患结核病,但因儿童结核病无特异性病症,检测工作一直是一大难题。TAM-TB具有良好的敏感性和特异性,取样24小时后便可获得检测结果,在儿童结核病诊断方面取得了巨大的进步。


9月1日,发表在《The Lancet Infectious Diseases》杂志上的一项研究发明了一种快速、准确的用于儿童结核病诊断的血液测试方法。该方法称为TAM-TB化验,是首个用于检测儿童活动性结核病的可靠免疫诊断技术。TAM-TB敏感性非常强,结合了结核杆菌培养检测的灵敏度和血液检测的速度。这项技术是儿童结核病诊断的重大进步,更是结核病流行地区的福音。

儿童结核病是一种严重的公共卫生问题,每年全球大约有一百万儿童患结核病。不幸的是,儿童结核病诊断一直面临重大的挑战。儿童结核病的症状往往不具特异性,类似于常见的儿科疾病,包括肺炎和营养不良等。此外,想要获得足够的呼吸系统的样本来直接检测结核分枝杆菌也很困难。因此,迫切的需要开发一种快速准确的诊断儿童结核病的检测方法。

检测儿童结核病新方法:TAM-TB化验

TAM-TB化验依赖于肺结核发病过程中的免疫学现象。在活动性感染期间,结核分枝杆菌特异性 CD4+ T细胞的表面标记物CD27会消失。通过使用标准的细胞内细胞因子染色程序和多色流式细胞术,在取样24小时后就可以得到检测结果。

这项新的检测方法在结核病流行地区坦桑尼亚的Ifakara卫生研究所和NIMR Mbeya医学研究中心进行评估。用TAM-TB检测有结核病症状的儿童的痰和血液样本,并且与结核杆菌培养检测结果对比,结果发现TAM-TB具有良好的敏感性和特异性。

研究人员表示,这项快速可靠的诊断技术具有巨大的应用潜力。研究团队正在进一步优化该技术的性能,特别是对感染HIV儿童的检测,同时也在努力降低检测的成本。他们的最终目标是将这项快速、准确、强大的检测技术用于肺结核流行却又缺乏诊断技术的地区。

儿童结核病概况

据WHO统计,全球每秒钟就有1人感染结核杆菌,每分钟就有6人死于结核病,全球现有1/3的人群感染结核杆菌。《柳叶刀》杂志报道称,全球约有5300万15岁以下的少年儿童是潜伏性肺结核病感染者,这种情况随时可发展成活性肺结核病。我国每年新增结核病人133万,占全球16%。据2000年全国结核病流行病学调查,我国0~14岁小儿肺结核患病率为91.8/10万。结核病治疗依然任重道远,需要全社会的关注。

儿童结核病的预防

痰中带菌的成人肺结核病人,尤其是家庭中排菌的肺结核病人是儿童结核病的传染源。为了避免儿童患结核病可以通过以下三种方式进行预防。

卡介苗接种:新生儿是主要接种对象;最迟在一岁内完成接种。

药物预防:密切接触开放性结核病人的婴幼儿可通过异烟肼(INH)进行预防。

隔离传染源:发现患有活动性肺结核病人要及时给予隔离和治疗,杜绝传染源。

此外,还有一点全世界可以共同努力的就是不要随地吐痰。

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  • Assessment of the novel T-cell activation marker—tuberculosis assay for diagnosis of active tuberculosis in children: a prospective proof-of-concept study

    Background The diagnosis of paediatric tuberculosis is complicated by non-specific symptoms, difficult specimen collection, and the paucibacillary nature of the disease. We assessed the accuracy of a novel immunodiagnostic T-cell activation marker—tuberculosis (TAM-TB) assay in a proof-of-concept study to identify children with active tuberculosis. Methods Children with symptoms that suggested tuberculosis were prospectively recruited at the NIMR-Mbeya Medical Research Center in Mbeya, and the Ifakara Health Institute in Bagamoyo, Tanzania, between May 10, 2011, and Sept 4, 2012. Sputum and peripheral blood mononuclear cells were obtained for Mycobacterium tuberculosis culture and performance assessment of the TAM-TB assay. The children were assigned to standardised clinical case classifications based on microbiological and clinical findings. Findings Among 290 children screened, we selected a subgroup of 130 to ensure testing of at least 20 with culture-confirmed tuberculosis. 17 of 130 children were excluded because of inconclusive TAM-TB assay results. The TAM-TB assay enabled detection of 15 of 18 culture-confirmed cases (sensitivity 83·3%, 95% CI 58·6—96·4). Specificity was 96·8% (95% CI 89·0—99·6) in the cases that were classified as not tuberculosis (n=63), with little effect from latent tuberculosis infection. The TAM-TB assay identified five additional patients with highly probable or probable tuberculosis, in whom M tuberculosis was not isolated. The median time to diagnosis was 19·5 days (IQR 14-45) for culture. Interpretation The sputum-independent TAM-TB assay is a rapid and accurate blood test that has the potential to improve the diagnosis of active tuberculosis in children. Funding European and Developing Countries Clinical Trials Partnership, German Federal Ministry of Education and Research, and Swiss National Science Foundation.

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