结核分枝杆菌抗原检测研究进展

结核病仍然是一个严重的全球性公共卫生问题,有效控制结核病的障碍在于缺乏早期、准确的诊断方法。机体受到结核分枝杆菌感染后,体内首先出现的是结核分枝杆菌特异性抗原。因此,结核分枝杆菌抗原检测作为结核病早期诊断的方法可能具有很高的诊断价值。我们简要综述了结核分枝杆菌抗原检测的相关研究进展。     

人结核分枝杆菌特异性核酸探针制备及结核病PCR检测技术的初步临床应用

采用人结核分枝杆菌(Mycobacterium tuberculosis TB)染色体DNA为模板,选择位于插入片段IS6110中884～865和568～588碱基对处的两个片段为引物,扩增出317bp的特异性片段．将其克隆进pUCl9载体。酶切图谱分析和DNA序列测定证实为目的片段。该片段经DIG标记,分别与11种分枝杆菌DNA进行Southern杂交,结果证明只与人型复合分枝杆菌发生杂交反应。利用该对引物建立的PcR检测拄术对74份结核病痰液标本进行检测,并与临床细菌快速培养结果相比较,发现48份临床阳性均为PcR阳性,在26份临床阴性标本中亦发现11份PCR检测阳性。将标本PCR产物与克隆探针进行杂交,显示两者结果完全一致。说明PCR检测体系结果可靠,其灵敏度明显高于目前临床所采用的方法,可作为一种常规技术用于结核病的临床检测。     

荧光定量PCR检测结核分枝杆菌Meta分析

目的系统评价荧光定量PCR(FQ-PCR)方法检测结核分枝杆菌的效果。方法按照系统评价的要求检索CBM、VIP、CNKI以及万方数据库等,获得20篇符合纳入标准的文献,对其进行Meta分析,并评价Meta分析结果的稳定性和发表偏倚。结果 FQ-PCR对照涂片染色、培养鉴定以及总数据的异质性检验P0.00001,采用随机效应模型进行Meta分析,其余的采用固定效应模型分析。FQ-PCR与涂片染色、培养鉴定、抗体检测等的总体效应Z值分别为7.76、5.00和7.34,P值均小于0.00001,差异具有统计学意义。总数据分析结果的合并OR=2.78,95%CI为1.93-4.01,总体效应检验,Z=5.49,P0.00001,差异具有统计学意义,固定效应模型OR值和95%CI(2.52[2.35-2.70])与随机效应模型比较接近,剔除小样本报道后的合并OR=2.93,95%CI为1.98-4.31,与剔除前的结果也比较接近。结论从现有的临床证据来看,FQ-PCR是检测结核分枝杆菌的有效方法,可推广应用与临床结核病辅助检测。     

应用多重PCR方法检测石蜡包埋组织标本中的分枝杆菌DNA

应用多重PCR方法检测并鉴别石蜡包埋组织中的结核分枝杆菌复合体与非结核分枝杆菌DNA扩增片段类型 ,为结核分枝杆菌复合体感染与非结核分枝杆菌感染的病理学诊断提供一种补充的鉴别诊断方法。应用三对具有特异性的寡核苷酸引物 ,进行多重PCR扩增。这三对引物分别对应于分枝杆菌 6 5kD表面抗原、结核分枝杆菌插入序列IS6 1 1 0及人类β 珠蛋白基因的部分序列 ,其扩增产物分别为 3 83bp、1 2 3bp和 2 6 8bp。此种多重PCR方法检测的灵敏度为 0 6pg。经多重PCR扩增后进行凝胶电泳 ,结核分枝杆菌复合体 (结核分枝杆菌、牛型结核分枝杆菌、BCG)均可见 3 83bp、1 2 3bp片段 ,而非结核分枝杆菌 (鸟、龟、瘰疬、蟾蜍、堪萨斯、胞内、耻垢分枝杆菌 )仅见 3 83bp片段 (猿猴分枝杆菌与结核分枝杆菌复合体相同 )。与上述相比 ,分枝杆菌感染的临床标本分别增加了一条 2 6 8bp片段。对 2 0 9例临床初步诊断为淋巴结结核病人的石蜡包埋组织标本进行了多重PCR检测 ,1 93例病理诊断为淋巴结结核、结核性肉芽组织、结核性肉芽肿性炎症病人的标本 ,检测结果符合结核分枝杆菌复合体感…     

结核分枝杆菌快速检测中的新技术

结核分枝杆菌体外培养生长缓慢的特性和耐多药性给传统的实验室检测和药物敏感试验带来很多麻烦,从而给结核病的诊断和治疗增加困难,随着现代实验技术的发展,分子生物学技术,色谱技术以及计算机等技术在该菌中的研究和应用已显示出极大的优势,不仅能够快速鉴定到其种和株的水平,还能够提供快速的药敏试验的结果和考核抗结核治疗的效果,并可进行耐药基因的分析及分子流行病学调查,为人类最终控制并战胜结核病提供了有效的手段。     

新型Taq Man-MGB探针在结核分枝杆菌实时PCR检测中的应用

为建立一种比现有方法敏感、准确性高、重复性好的结核分枝杆菌DNA定性定量检测方法 ,以TaqMan探针技术为基础 ,运用TaqMan MGB探针 ,实时检测临床标本中的结核分枝杆菌DNA .用来自临床标本的DNA及克隆于载体的IS6 1 1 0序列检测所建立方法的有效性 .结果显示 ,所建立方法的最低检测限度为 1个基因拷贝 反应 ,在每反应 1 0 0 ～ 1 0 8拷贝范围内 ,Ct 值同DNA量的对数呈线性关系 .同一模板不同时间或同一时间不同管内扩增 ,所得Ct 值恒定 .用该方法检测 37例结核分枝杆菌培养阳性的痰液标本 ,敏感度为 1 0 0 % ;用该方法检测 1 6例TB系列阴性参考品 ,特异性为1 0 0 % .结果表明 ,所建立的方法是用于结核分枝杆菌定性定量检测较理想的方法     

人结核分枝杆菌特异性核酸探针制备及结核病PCR检测技术的初步临…

采用人结核分枝杆菌染色体ＤＮＡ为模板,选择位于插入片段ＩＳ６１１０中８８４￣８６５和５６８￣５８８碱基对处的两个片段为引物,扩增出３１７ｂｐ的特异性片段,将共克隆进ｐＵＣ１９载体,酶切酶谱分析和ＤＮＡ序列测定证实为目的片段。     

结核分枝杆菌临床株4种耐药基因的检测与分析

结核分枝杆菌Mycobacterium tuberculsis(M.t)4种耐药基因的研究,了解耐药基因突变情况和耐药水平的关系。108例临床痰标本临床分离株均做传统梯度药敏试验和聚合酶链反应多态-单链构象多态性（PCR-SSCP）试验。结果表明耐SM（rpsL）REP(rpoB）INH(katG）EMB（embB）基因突变率分别为78.5%,68.2%,70.5%,48.6%。其中,上海高耐药株基因突变率分别为86.5%,89.3%,84.3%,35.3%。低耐药株分别为28.5%,16.5%,7.1%。EMB在低耐药区无基因突变。M.t的4种耐药基因联合检测的分析,在国内外很少报道。部分M.t的耐药由耐药基因突变所致,M.t耐药基因突变与耐药水平密切相关,且M.t基因突变绝大多数发生在高耐药区中,也有少部分在低耐区株中发生。     

结核分枝杆菌感染动物模型的研究进展

人类结核病位居单一病原引起死亡的严重传染病之首,结核分枝杆菌是其主要病原.尽管结核分枝杆菌可引起许多种动物感染并患病,但人类是其主要宿主.动物模型作为研究人类疾病的标准化工具,虽然不能完全模拟人类结核病的整个过程,但可成为研究结核病的有用工具,有助于研究其发病机制、治疗过程及宿主对病原的免疫病理学反应.由于不同种类动物对结核分枝杆菌的敏感性不同,因此根据研究需要选择合适的动物模型非常必要.本文综述了结核病研究中最常用的动物模型,包括豚鼠、小鼠、兔、非人灵长类和鱼类等模型,归纳了结核病各种动物模型的特点和研究概况.     

恶性肿瘤组织中结核杆菌DNA的检测

目的　探讨结核杆菌感染与恶性肿瘤的关系。方法　采用多聚酶链反应（ＰＣＲ） 技术检测两种恶性肿瘤组织中结核杆菌ＤＮＡ（ＴＢ－ ＤＮＡ） 。结果４１ 例恶性肿瘤组织中检出ＴＢ－ ＤＮＡ 阳性患者８ 例,占１９．５ ％ ,且ＴＢ－ＤＮＡ 阳性患者肿瘤发病部位基本与结核病的好发部位一致。结论 结核杆菌感染可能与一些恶性肿瘤存在特殊相关性。     

一种随机引物联合多特异性DNA片段检测结核分支杆菌的新方法

目的:针对目前结核性疾病实验室诊断的局限性,探索一种更为敏感和特异的结核分枝杆菌DNA检测新方法。方法:选取10株江苏地区流行的结核分支杆菌(MTB)菌株,选取临床其他常见菌株及分枝杆菌菌株作为对照组,分别提取DNA作为随机引物的模板。参考国内、外文献设计12条随机引物,并分别对MTB及对照菌株进行单个引物随机扩增,2%的琼脂糖凝胶电泳对扩增产物进行分离并切胶纯化,通过TA克隆将纯化片段连接到质粒pEASYTM-T5 Zero并进行测序,通过BLAST-nr比对验证是否为MTB DNA片段。按照所确定的MTB片段序列,在其内部设计、合成一对特异性引物。用此特异性引物扩增对应的随机引物扩增产物,获得MTB特异性条带图谱。并将该方法检测的敏感性和特异性与临床上常用的real-time PCR进行比较。结果:经BLAST-nr比对,随机引物IS986F,S535及IS986R扩增的条带与MTB DNA有高度同源性(均为99%)。随机引物IS986F、S535和IS986R分别联合其特异性引物可以检测稀释105倍、105倍和103倍的MTB DNA,其特异性分别为100%、90%和80%。常规real-time PCR可检测出稀释104倍的MTB DNA。结论:随机引物IS986F联合其特异性引物检测结核分枝杆菌的灵敏度和特异性优于S535、IS986R两组,特异性为100%,且灵敏度优于常规real-time PCR法。     

Tuberculosis vaccine design: influence of the completed genome sequence

Tuberculosis continues to be a major health problem, with more adults dying from Mycobacterium tuberculosis than any other pathogen world-wide.With the onset of the HIV epidemic and an increase in drug-resistant M. tuberculosis strains, the need for an improved vaccine has become an international priority.The recent completion of the genome sequences for two M. tuberculosis strains provides a wealth of information that can be used to design new strategies for vaccine development. The challenge comes in making rational choices from among the 4,000 genes of the most probable candidate immunogens or virulence genes.Thus, a well-designed screen is needed to reduce the number of candidates that must be tested. Presently, the most valuable role that bioinformatics can play is to provide such a screen.     

Tuberculosis patients co-infected with Mycobacterium bovis and Mycobacterium tuberculosis in an urban area of Brazil

In this cross-sectional study, mycobacteria specimens from 189 tuberculosis (TB) patients living in an urban area in Brazil were characterised from 2008-2010 using phenotypic and molecular speciation methods (pncA gene and oxyR pseudogene analysis). Of these samples, 174 isolates simultaneously grew on Löwenstein-Jensen (LJ) and Stonebrink (SB)-containing media and presented phenotypic and molecular profiles of Mycobacterium tuberculosis, whereas 12 had molecular profiles of M. tuberculosis based on the DNA analysis of formalin-fixed paraffin wax-embedded tissue samples (paraffin blocks). One patient produced two sputum isolates, the first of which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, and the second of which only grew on SB media and presented phenotypic profiles of Mycobacterium bovis. One patient provided a bronchial lavage isolate, which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, but had molecular profiles of M. bovis from paraffin block DNA analysis, and one sample had molecular profiles of M. tuberculosis and M. bovis identified from two distinct paraffin blocks. Moreover, we found a low prevalence (1.6%) of M. bovis among these isolates, which suggests that local health service procedures likely underestimate its real frequency and that it deserves more attention from public health officials.     

Automatized PCR evaluation of Mycobacterium tuberculosis complex in respiratory and nonrespiratory specimens

In this study, Mycobacterium tuberculosis complex isolates recovered from respiratory and nonrespiratory specimens with culture were evaluated using an automatized PCR method. Specimens with suspected tuberculous disease were decontaminated and concentrated using the standard N-acetyl-L-cysteine NaOH method and were inoculated onto glycerol-supplemented L?wenstein-Jensen media and BACTEC B12 vials. Forty-one specimens with typical colonies on solid media and 127 specimens identified as M. tuberculosis complex in a BACTEC system were selected as the study group. As the control group, 46 specimens without growth on either culture media were selected. The PCR results were positive in 33 (80.5%) and 87 (68.5%) samples that were culture-positive on solid and liquid media, respectively. All (100%) culture-negative specimens within the control group were also negative in the COBAS AMPLICOR Mycobacterium tuberculosis (MTB) PCR method. In conclusion, although it is a fast method for identifying M. tuberculosis complex isolates from clinical specimens, the COBAS AMPLICOR MTB PCR method is found to be less sensitive than culture techniques, we propose therefore that it should only be used in combination with culture results in the clinical diagnosis of tuberculosis.     

Multiplex PCR assay for simultaneous detection and differentiation of Mycobacterium tuberculosis, Mycobacterium avium complexes and other Mycobacterial species directly from clinical specimens

Aims: Polymerase chain reaction (PCR) is the most rapid and sensitive method for diagnosing mycobacterial infections and identifying the aetiological Mycobacterial species in order to administer the appropriate therapy and for better patient management. Methods and Results: Two hundred and thirty‐five samples from 145 clinically suspected cases of tuberculosis were processed for the detection of Mycobacterial infections by ZN (Ziehl Neelsen) smear examination, L‐J & BACTEC^TM MGIT‐960 culture and multiplex PCR tests. The multiplex PCR comprised of genus‐specific primers targeting hsp65 gene, Mycobacterium tuberculosis complex‐specific primer targeting cfp10 (Rv3875, esxB) region and Mycobacterium avium complex‐specific primer pairs targeting 16S–23S Internal Transcribed Spacer sequences. The multiplex PCR developed had an analytical sensitivity of 10 fg (3–4 cells) of mycobacterial DNA. The multiplex PCR test showed the highest (77·24%) detection rate, while ZN smear examination had the lowest (20%) detection rate, which was bettered by L‐J culture (34·4%) and BACTEC^TM MGIT‐960 culture (50·34%) methods. The mean isolation time for M. tuberculosis was 19·03 days in L‐J culture and 8·7 days in BACTEC^TM MGIT‐960 culture. Using the multiplex PCR, we could establish M. tuberculosis + M. avium co‐infection in 1·3% HIV‐negative and 2·9% HIV‐positive patients. The multiplex PCR was also highly useful in diagnosing mycobacteraemia in 38·09% HIV‐positive and 15·38% HIV‐negative cases. Conclusions: The developed in‐house multiplex PCR could identify and differentiate the M. tuberculosis and M. avium complexes from other Mycobacterial species directly from clinical specimens. Significance and Impact of the Study: The triplex PCR developed by us could be used to detect and differentiate M. tuberculosis, M. avium and other mycobacteria in a single reaction tube.     

Development and evaluation of triplex PCR for direct detection of mycobacteria in respiratory specimens

AIMS: To develop a method for the simultaneous detection of Mycobacterium tuberculosis, Mycobacterium avium-intracellularecomplex (MAC), and other mycobacteria in clinical specimens using triplex PCR. METHODS AND RESULTS: The target of amplification was the internal transcribed spacer region between the l6S and 23S rDNA genes. Twenty-two mycobacterial type strains, 118 M. tuberculosis, 87 other mycobacteria, 75 nonmycobacterial pathogens, 115 respiratory specimens from confirmed cases of tuberculous or other mycobacterial diseases, and sputa from 50 patients with nonmycobacterial respiratory diseases were tested. In M. tuberculosis, 322 bp pan-mycobacterial and 133 bp species-specific bands were observed. In MAC, the respective bands were 322 and 84 bp. The other mycobacteria showed single pan-mycobacterial bands of approx. 300-350 bp. Nonspecific amplicons were not found in any of the nonmycobacterial pathogens. In the tuberculosis specimens, 96.4% of smear-positive specimens and 70.2% of smear-negative specimens showed positive reactions. Specimens from two patients with MAC infection were MAC positive. Only 1 of 50 specimens from nonmycobacterial diseases was positive (2.0%). CONCLUSION, SIGNIFICANCE AND IMPACT OF THE STUDY: Triplex PCR enables accurate and rapid diagnosis of tuberculosis and probably is useful for the detection of MAC and other mycobacteria in respiratory specimens.     

Extensively drug-resistant tuberculosis: current challenges and threats

Extensively drug-resistant tuberculosis (XDR-TB) is defined as tuberculosis caused by a Mycobacterium tuberculosis strain that is resistant to at least rifampicin and isoniazid among the first-line antitubercular drugs (multidrug-resistant tuberculosis; MDR-TB) in addition to resistance to any fluroquinolones and at least one of three injectable second-line drugs, namely amikacin, kanamycin and/or capreomycin. Recent studies have described XDR-TB strains from all continents. Worldwide prevalence of XDR-TB is estimated to be c. 6.6% in all the studied countries among multidrug-resistant M. tuberculosis strains. The emergence of XDR-TB strains is a reflection of poor tuberculosis management, and controlling its emergence constitutes an urgent global health reality and a challenge to tuberculosis control activities in all parts of the world, especially in developing countries and those lacking resources and as well as in countries with increasing prevalence of HIV/AIDS.