结核性胸膜炎的生物标志物诊断研究进展

doi:10.3969/j.issn.2096-8493.2021.01.016

摘要/Abstract

摘要：

结核性胸膜炎是成人肺外结核最常见的类型。胸腔积液中难以检测出结核分枝杆菌,临床需要结合细菌学、病理学、分子生物学、细胞免疫学及综合性诊断策略来实现,且与恶性胸膜疾病及其他感染性胸膜疾病的鉴别诊断存在困难。近年来,针对结核性胸腔积液生物标志物的研究众多,核酸检测技术的进步及在结核病领域的广泛应用亦为结核性胸膜炎提供新的诊断方法。腺苷脱氨酶(adenosine deaminase,ADA)和γ干扰素(interferon gamma,IFN-γ)具有较高的敏感度和特异度,可作为结核性胸膜炎的特定生物标志物;白细胞介素-27(interleukin-27,IL-27)是一种很有前途的生物标志物;核酸扩增试验(acid amplification assay,NAATs)及miRNA等分子检测技术发展迅速,但它们在结核性胸膜炎诊断方面的性能还不尽如人意,多种方法的联合应用可极大提高诊断的准确性。

关键词: 结核, 胸膜, 生物学标记, 胸腔积液

Abstract:

Tuberculous pleurisy is the most common type of adult extra-pulmonary tuberculosis. To detect Mycobacterium tuberculosis in pleural effusion is difficult, and in clinic, it requires a combination of bacteriology, pathology, molecular biology, cellular immunology and a comprehensive diagnostic strategy. Moreover, it is difficult to differentiate with malignant pleural diseases and other infectious pleural diseases. Recently, there have been many studies on the biomarkers of tuberculous pleural effusion. The progress of nucleic acid detection technology and its wide application in the field of tuberculosis have also provided a new diagnostic method for tuberculous pleurisy. Both adenosine deaminase (ADA) and interferon gamma (IFN-γ) have high sensitivity and specificity, they can be used as specific biomarkers of tuberculous pleurisy. Interleukin-27 (IL-27) is a promising biomarker. Acid amplification assay (NAATS) and miRNA have developed rapidly, but the property in the diagnosis of tuberculous pleurisy is not satisfactory. The combined application of multiple methods can greatly improve the diagnostic accuracy.

Key words: Tuberculosis, pleural, Biomarkers, Pleural effusion

桂徐蔚, 柯荟, 顾瑾. 结核性胸膜炎的生物标志物诊断研究进展[J]. 结核与肺部疾病杂志, 2021, 2(1): 73-77. doi: 10.3969/j.issn.2096-8493.2021.01.016

GUI Xu-wei, KE Hui, GU Jin. Progress of diagnostic research in biomarkers tuberculous pleurisy[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 73-77. doi: 10.3969/j.issn.2096-8493.2021.01.016

参考文献 42

[1]	World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
[2]	Peto HM, Pratt RH, Harrington TA, et al. Epidemiology of Extra pulmonary Tuberculosis in the United States, 1993—2006. Clin Infect Dis, 2009,49(9):1350-1357. doi: 10.1086/605559. doi: 10.1086/605559 URL pmid: 19793000
[3]	Seiscento M, Vargas FS, Rujula MJ, et al. Epidemiological aspects of pleural tuberculosis in the state of Sao Paulo, Brazil (1998—2005). J Bras Pneumol, 2009,35(6):548-554. doi: 10.1590/s1806-37132009000600008. doi: 10.1590/s1806-37132009000600008 URL pmid: 19618035
[4]	Wang X, Yang Z, Fu Y, et al. Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006—2011. PLoS One, 2014,9(12):e112213. doi: 10.1371/journal.pone.0112213. doi: 10.1371/journal.pone.0112213 URL pmid: 25494360
[5]	Pang Y, An J, Shu W, et al. Epidemiology of Extra pulmonary Tuberculosis among Inpatients, China, 2008—2017. Emerging Infectious Diseases, 2019,25(3):457-464. doi: 10.3201/eid2503.180572. doi: 10.3201/eid2503.180572 URL pmid: 30789144
[6]	Cases Viedma E, Lorenzo Dus MJ, González-Molina A, et al. A study of loculated tuberculous pleural effusions treated with intrapleural urokinase. Respir Med, 2006,100(11):2037-2042. doi: 10.1016/j.rmed.2006.02.010. doi: 10.1016/j.rmed.2006.02.010 URL pmid: 16580190
[7]	Valdés L, Ferreiro L, Cruz-Ferro E, et al. Recent epidemiological trends in tuberculous pleural effusion in Galicia, Spain. Eur J Intern Med, 2012,23(8):727-732. doi: 10.1016/j.ejim.2012.06.014. doi: 10.1016/j.ejim.2012.06.014 URL
[8]	IShaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology, 2019,24(10):962-971. doi: 10.1111/resp.13673. doi: 10.1111/resp.13673 URL pmid: 31418985
[9]	Saks AM, Posner R. Tuberculosis in HIV positive patients in South Africa: a comparative radiological study with HIV negative patients. Clin Radiol, 1992,46(6):387-390. doi: 10.1016/s0009-9260(05)80684-1. doi: 10.1016/s0009-9260(05)80684-1 URL pmid: 1493651
[10]	Zhai K, Lu Y, Shi HZ. Tuberculous pleural effusion. J Thorac Dis, 2016,8(7):E486-E494. doi: 10.21037/jtd.2016.05.87. doi: 10.21037/jtd.2016.05.87 URL pmid: 27499981
[11]	Udwadia ZF, Sen T. Pleural tuberculosis: an update. Curr Opin Pulm Med, 2010,16(4):399-406. doi: 10.1097/MCP.0b013e328339cf6e. doi: 10.1097/MCP.0b013e328339cf6e URL pmid: 20531085
[12]	杨泽西, 张泽明, 王震, 等. 结核性胸膜炎实验室诊断方法的研究进展. 实用心脑肺血管病杂志, 2015,23(8):7-10. doi: 10.3969/j.issn.1008-5971.2015.08.003.
[13]	Piras MA, Gakis C, Budroni M, et al. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J, 1978,2(6154):1751-1752. doi: 10.1136/bmj.2.6154.1751-a. doi: 10.1136/bmj.2.6154.1751 URL pmid: 367517
[14]	Aggarwal AN, Agarwal R, Sehgal IS, et al. Meta-analysis of Indian studies evaluating adenosine deaminase for diagnosing tuberculous pleural effusion. Int J Tuberc Lung Dis, 2016,20(10):1386-1391. doi: 10.5588/ijtld.16.0298. doi: 10.5588/ijtld.16.0298 URL pmid: 27725052
[15]	Palma RM, Bielsa S, Esquerda A, et al. Diagnostic Accuracy of Pleural Fluid Adenosine Deaminase for Diagnosing Tuberculosis. Meta-analysis of Spanish Studies. Arch Bronconeumol, 2019,55(1):23-30. doi: 10.1016/j.arbres.2018.05.007. doi: 10.1016/j.arbres.2018.05.007 URL pmid: 30612601
[16]	Skouras VS, Kalomenidis I. Pleural fluid tests to diagnose tuberculous pleuritis. Curr Opin Pulm Med, 2016,22(4):367-377. doi: 10.1097/MCP.0000000000000277. doi: 10.1097/MCP.0000000000000277 URL pmid: 27064428
[17]	Zemlin AE, Burgess LJ, Carstens ME. The diagnostic utility of adenosine deaminase isoenzymes in tuberculous pleural effusions. Int J Tuberc Lung Dis, 2009,13(2):214-220. URL pmid: 19146750
[18]	Sivakumar P, Marples L, Breen R, et al. The diagnostic utility of pleural fluid adenosine deaminase for tuberculosis in a low prevalence area. Int J Tuberc Lung Dis, 2017,21(6):697-701. doi: 10.5588/ijtld.16.0803. doi: 10.5588/ijtld.16.0803 URL pmid: 28482965
[19]	Mollo B, Jouveshomme S, Philippart F, et al. Biological markers in the diagnosis of tuberculous pleural effusion. Ann Biol Clin (Paris), 2017,75(1):19-27. doi: 10.1684/abc.2016.1201.
[20]	Wang J, Liu J, Xie X, et al. The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions. BMC Pulm Med, 2017,17(1):168. doi: 10.1186/s12890-017-0526-z. doi: 10.1186/s12890-017-0526-z URL pmid: 29202740
[21]	Jiang J, Shi HZ, Liang QL, et al. Diagnostic value of interferon-gamma in tuberculous pleurisy: a meta-analysis. Chest, 2007,131:1133-1141. doi: 10.1378/chest.06-2273. doi: 10.1378/chest.06-2273 URL pmid: 17426220
[22]	Greco S, Girardi E, Masciangelo R, et al. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberc Lung Dis, 2003,7(8):777-786. URL pmid: 12921155
[23]	Thillai M, Pollock K, Pareek M, et al. Interferon-gamma release assays for tuberculosis: current and future applications. Expert Rev Respir Med, 2014,8(1):67-78. doi: 10.1586/17476348.2014.852471. doi: 10.1586/17476348.2014.852471 URL pmid: 24308653
[24]	Aggarwal AN, Agarwal R, Gupta D, et al. Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis. J Clin Microbiol, 2015,53(8):2451-2459. doi: 10.1128/JCM.00823-15. doi: 10.1128/JCM.00823-15 URL pmid: 25994163
[25]	Pang CS, Shen YC, Tian PW, et al. Accuracy of the interferon-gamma release assay for the diagnosis of tuberculous pleurisy: an updated meta-analysis. Peer J, 2015,3:e951. doi: 10.7717/peerj.951. doi: 10.7717/peerj.951 URL pmid: 26038718
[26]	Zhang M, Li D, Hu ZD, et al. The diagnostic utility of pleural markers for tuberculosis pleural effusion. Ann Transl Med, 2020,8(9):607. doi: 10.21037/atm.2019.09.110. doi: 10.21037/atm.2019.09.110 URL pmid: 32566633
[27]	Wang W, Zhou Q, Zhai K, et al. Diagnostic accuracy of interleukin 27 for tuberculous pleural effusion: two prospective studies and one meta-analysis. Thorax, 2018,73(3):240-247. doi: 10.1136/thoraxjnl-2016-209718. doi: 10.1136/thoraxjnl-2016-209718 URL pmid: 28844060
[28]	Liu Q, Yu YX, Wang XJ, et al. Diagnostic Accuracy of Interleukin-27 between Tuberculous Pleural Effusion and Malignant Pleural Effusion: A Meta-Analysis. Respiration, 2018,95(6):469-477. doi: 10.1159/000486963. doi: 10.1159/000486963 URL pmid: 29539604
[29]	Wu YB, Ye ZJ, Qin SM, et al. Combined detections of interleukin 27, interferon-γ, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy. Chin Med J (Engl), 2013,126(17):3215-3221.
[30]	李芳, 张坚, 郝雪琦, 等. 胸腔积液中IL-27和IFN-γ检测对结核性胸膜炎的诊断价值. 吉林大学学报(医学版), 2019,45(2):353-358. doi: 10.13481/j.1671-587x.20190224.
[31]	Carnevale GG, Vargas FS, Caiaffa-Filho HH, et al. Pre analytical conditions can interfere with M. tuberculosis detection by PCR in respiratory samples. Clinics (Sao Paulo), 2018,73:e410. doi: 10.6061/clinics/2017/e410.
[32]	Moon JW, Chang YS, Kim SK, et al. The Clinical Utility of Polymerase Chain Reaction for the Diagnosis of Pleural Tuberculosis. Clin Infect Dis, 2005,41(5):660-666. doi: 10.1086/432474. doi: 10.1086/432474 URL pmid: 16080088
[33]	Steingart KR, Schiller I, Horne DJ, et al. Xpert MTB/RIF assay for pulmonary tuberculosis and rifampicina resistance in adults. Cochrane Database Syst Rev, 2014, 2014(1):CD009593.
[34]	Penz E, Boffa J, Roberts DJ, et al. Diagnostic accuracy of the Xpert^® MTB/RIF assay for extra-pulmonary tuberculosis: a meta-analyisis. Int J Tuberc Lung Dis, 2015, 19(3):278-284, i-iii. doi: 10.5588/ijtld.14.0262. doi: 10.5588/ijtld.14.0262 URL pmid: 25686134
[35]	Sehgal IS, Dhooria S, Aggarwal AN, et al. Diagnostic Performance of Xpert MTB/RIF in Tuberculous Pleural Effusion: Systematic Review and Meta-analysis. J Clin Microbiol, 2016,54(4):1133-1136. doi: 10.1128/JCM.03205-15. doi: 10.1128/JCM.03205-15 URL pmid: 26818675
[36]	Meldau R, Peter J, Theron G, et al. Comparison of same day diagnostic tools including GeneXpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study. BMC Pulm Med, 2014,14:58. doi: 10.1186/1471-2466-14-58. doi: 10.1186/1471-2466-14-58 URL pmid: 24708530
[37]	Kohli M, Schiller I, Dendukuri N, et al. Xpert^® MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resis-tance. Cochrane Database Syst Rev, 2018, 8(8): CD012768. doi: 10.1002/14651858.
[38]	焦昕, 刘宁. microRNA-29a在结核性与恶性胸腔积液鉴别诊断和疗效预测中的价值. 现代肿瘤医学, 2019,27(4):595-598. doi: 10.3969/j.issn.1672-4992.2019.04.013.
[39]	Lv Y, Guo S, Li XG, et al. Sputum and serum microRNA-144 levels in patients with tuberculosis before and after treatment. Int J Infect Dis, 2016,43:68-73. doi: 10.1016/j.ijid.2015.12.014. doi: 10.1016/j.ijid.2015.12.014 URL pmid: 26724775
[40]	Ndzi EN, Nkenfou CN, Mekue LM, et al. MicroRNA has-miR-29a-3p is a plasma biomarker for the differential diagnosis and monitoring of tuberculosis. Tuberculosis (Edinb), 2019,114:69-76. doi: 10.1016/j.tube.2018.12.001. doi: 10.1016/j.tube.2018.12.001 URL
[41]	董静, 贾红彦, 潘丽萍, 等. 胸腔积液miRNA检测用于结核性胸膜炎诊断的研究进展. 中华结核和呼吸杂志, 2020,43(8):685-687. doi: 10.3760/cma.j.cn112147-20191030-00723.
[42]	Pan L, Liu F, Zhang J, et al. Genome-Wide miRNA Analysis Identifies Potential Biomarkers in Distinguishing Tuberculous and Viral Meningitis. Front Cell Infect Microbiol, 2019,9:323. doi: 10.3389/fcimb.2019.00323. doi: 10.3389/fcimb.2019.00323 URL pmid: 31572691