Schaberg T, Hauer B, Haas W H, Hohlfeld J, Kropp R, Loddenkemper R, Loytved G, Magdorf K, Rieder H L, Sagebiel D
Pneumologie. 2004 Apr;58(4):255-70. doi: 10.1055/s-2003-812534.
The immunologic mechanisms of latent tuberculosis (TB) infection are complex and hitherto not completely understood. The lifelong risk of an immunocompetent individual of developing active TB after infection with M. tuberculosis is 5-10 % and highest during the first two years after infection. Various factors may considerably increase the risk of developing active TB, e. g., immunosuppressive disease or immunosuppressive medication. However, the development of active TB may be avoided by preventive chemotherapy, the therapy of choice being isoniazid over a 9-month period. Alternative treatment regimens may be indicated in special cases, but it must be borne in mind that the efficacy of these regimens has not been studied sufficiently while they seem to be less well tolerated than isoniazid monotherapy. The tuberculin skin test is still the only sufficiently documented method to detect latent infection with M. tuberculosis which is also suitable for routine application. This test today should be performed exclusively as described by Mendel and Mantoux. Its sensitivity and specificity depend on the prevalence of tuberculosis infection. It should therefore be restricted to individuals at increased risk of latent TB infection. When interpreting the tuberculin skin test, it is necessary to know whether an individual belongs to one of the defined risk groups or has an elevated risk of developing active TB. Among the risk groups are individuals who may have been infected recently with M. tuberculosis (contacts of contagious TB patients) or in whom other factors increase their risk of developing active TB. The indication for chemotherapy for latent TB infection must be based on a careful individual risk-benefit analysis and, besides patient compliance, requires full information of the patient and careful monitoring during therapy. Before initiating treatment, active TB must always be excluded by the proven methods.
潜伏性结核感染的免疫机制复杂，迄今为止尚未完全明确。免疫功能正常的个体在感染结核分枝杆菌后发生活动性结核病的终生风险为5%-10%，且在感染后的头两年风险最高。多种因素可能会显著增加发生活动性结核病的风险，例如免疫抑制性疾病或免疫抑制性药物。然而，预防性化疗可避免活动性结核病的发生，首选治疗药物为异烟肼，疗程9个月。特殊情况下可能需要采用替代治疗方案，但必须牢记，这些方案的疗效尚未得到充分研究，而且其耐受性似乎不如异烟肼单药治疗。结核菌素皮肤试验仍然是检测结核分枝杆菌潜伏感染的唯一有充分文献记载的方法，也适用于常规应用。如今，该试验应严格按照门德尔和曼托克斯的描述进行。其敏感性和特异性取决于结核病感染的流行率。因此，应仅限于潜伏性结核感染风险增加的个体。在解读结核菌素皮肤试验结果时，有必要了解个体是否属于已确定的风险组之一，或发生活动性结核病的风险是否升高。风险组包括可能近期感染结核分枝杆菌的个体（传染性结核病患者的接触者）或其他因素增加其发生活动性结核病风险的个体。潜伏性结核感染化疗的适应证必须基于仔细的个体风险效益分析，除患者依从性外，还需要患者充分知情并在治疗期间进行仔细监测。在开始治疗前，必须始终通过已证实的方法排除活动性结核病。
