结核性脑膜炎脑脊液分子检测技术概述

doi:10.3969/j.issn.2096-8493.2021.01.003

摘要/Abstract

摘要：

结核性脑膜炎(tuberculous meningitis,TBM)是常见的中枢神经系统结核病,早期诊断和及时治疗是改善TBM患者预后的关键。由于传统的结核分枝杆菌检测方法阳性率低、耗时长,临床缺乏有效的快速检测手段,导致TBM的早期确诊非常困难。作者针对TBM脑脊液分子检测技术的现状、最新研究进展,以及所面临的问题进行评价和讨论,为指导结核病临床工作提供参考。

关键词: 结核, 脑膜, 脑脊髓液, 分子诊断技术

Abstract:

Tuberculous meningitis (TBM) is a common tuberculosis disease affecting central nervous system. Early diagnosis and timely treatment are key to improve the prognosis of TBM patients. However, traditional detection methods of MTB are usually with poor sensitivity and time-consuming, we lack effective rapid clinic detection methods, thus it is very difficult to make early diagnosis of TBM. In the review, the current situation, latest progress and existing problems of TBM molecular detecting technologies for testing cerebrospinal fluid samples were displayed and discussed, to offer references for clinical practice.

Key words: Tuberculosis, meningeal, Cerebrospinal fluid, Molecular diagnostic techniques

韩利军, 赵雪瑶. 结核性脑膜炎脑脊液分子检测技术概述[J]. 结核与肺部疾病杂志, 2021, 2(1): 8-12. doi: 10.3969/j.issn.2096-8493.2021.01.003

HAN Li-jun, ZHAO Xue-yao. Molecular detection technologies for diagnosing tuberculous meningitis using cerebrospinal fluid[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 8-12. doi: 10.3969/j.issn.2096-8493.2021.01.003

图/表 1

表1

参考文献 34

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比较项目	GeneXpert	GeneXpert MTB/RIF Ultra	LAMP	熔解曲线技术	线性探针技术
检测原理	实时荧光定量PCR	实时荧光定量PCR	等温扩增技术	探针-熔解曲线技术	探针-反向杂交技术
检测位点	rpoB^[3]	IS6110、IS1081、 ropB^[3]	IS6110、gyrB^[3]	rpoB、katG、inhA、oxyR、abpC、gyrA^[3]	rpoB、katG、inhA^[3]
报告时间	2h^[13]	2h^[13]	1h^[16]	72h^[23]	6h^[25]
检测内容	结核分枝杆菌复合群,利福平耐药性^[3]	结核分枝杆菌复合群,利福平耐药性^[3]	结核分枝杆菌复合群^[3]	结核分枝杆菌复合群,异烟肼、利福平、乙胺丁醇、氟喹诺酮类药品耐药性^[3]	结核分枝杆菌复合群,异烟肼、利福平的耐药性(2代还可检测氟喹诺酮类及二线注射类药品的耐药性)^[13]
敏感度	23%~52%^{[5,6,7,8,9,10,11,12]}	89.40%^[15]	43.2%~82%^{[16,17,18,19,20]}	12.9%^[23](数据较少)	96.15%^[24](数据较少)
特点	需专门的仪器,手动操作简便,可检测利福平耐药性,结果可靠^[13]	需专门的仪器,手动操作简便,可检测利福平耐药性,结果可靠,较GeneXpert检测阈值低^[13]	操作简便,对实验室及检测人员要求低^[13],但不能进行耐药性检测,存在一定假阳性^[16]	可检测多种药物耐药性,但脑脊液相关检测数据较少,难以评价其实用性	可检测多种药物耐药性,操作复杂,对实验室及检测人员要求高^[13],脑脊液相关检测数据较少,难以评价其实用性
WHO是否推荐	是^[13]	是^[13]	推荐应用于痰液检测,肺外结核的检测有待进一步研究^[13]	否	仅推荐应用于痰液检测^[13]