结核性胸膜炎的生物标志物诊断研究进展

Progress of diagnostic research in biomarkers tuberculous pleurisy

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。

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.