Yamagishi Fumio
Department of Respiratory Diseases, National Hospital Organization Chiba-East National Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712, Japan.
Kekkaku. 2005 Oct;80(10):647-53.
In Japan, a person who is 29 or younger, contacted a tuberculosis patient recently and judged to have received infection is the object of the chemoprophylaxis by the public expenditure. On the other hand, in ATS/CDC, they call chemoprophylaxis as the treatment of latent tuberculosis infection, and if there is a strong possibility that a person may appear tuberculosis, they start chemoprophylaxis, regardless of age. We usually prescribe isoniazid for latent tubercular infection. The period of prescription is at least 6 months, which is effective, but 9 months is more desirable. Recently, in the West, tuberculosis are frequent among patients who are administered Infliximab, anti-tumor necrosis factor-alpha. In Japan, after 6 months' evaluation period for Infliximab medication to rheumatoid arthritis, 11 out of 2,000 became tuberculosis (100,000 to 550). As for the tuberculin reaction before Infliximab medication, 2 were un-carrying out and 4 were negative. Moreover, even in positive examples, many of them were small redness. From this result, the Japanese Society for Tuberculosis and the Japan College of Rheumatology advised jointly. Those who are using immunosuppressant drugs and a doctor judged that they need chemoprophylaxis are supposed to the start medication if they are positive in tuberculin reaction, or there are some proof of tubercular infection on chest X-ray film, or there are high possibility of having received tubercular infection. By carrying out active chemoprophylaxis regardless of age, tuberculosis from high risk group is expected to decrease.
在日本，29岁及以下、近期接触过肺结核患者且被判定已受感染的人是公费化学预防的对象。另一方面，美国胸科学会/美国疾病控制与预防中心（ATS/CDC）将化学预防称为潜伏性结核感染的治疗，并且如果一个人很有可能出现结核病，无论年龄大小都会开始进行化学预防。我们通常为潜伏性结核感染开异烟肼。处方期至少为6个月，这是有效的，但9个月更佳。最近，在西方，接受英夫利昔单抗（一种抗肿瘤坏死因子-α药物）治疗的患者中结核病频发。在日本，对类风湿关节炎患者使用英夫利昔单抗进行6个月的评估期后，2000人中有11人患结核病（发病率为10万分之550）。关于英夫利昔单抗用药前的结核菌素反应，2人未进行检测，4人呈阴性。此外，即使在呈阳性的病例中，许多也只是小红斑。基于此结果，日本结核病学会和日本风湿病学会联合给出建议。正在使用免疫抑制药物且医生判定需要进行化学预防的人，如果结核菌素反应呈阳性，或者胸部X光片有结核菌感染的某些证据，或者有很高的结核菌感染可能性，就应该开始用药。通过不分年龄地进行积极的化学预防，有望降低高危人群中的结核病发病率。
