González-Sixto B, Rodríguez-Prieto M A
Servicio de Dermatología, Complejo Asistencial de León, León, España.
Actas Dermosifiliogr. 2010 May;101 Suppl 1:62-9. doi: 10.1016/s0001-7310(10)70011-9.
Drugs that block the tumor necrosis factor alpha (TNFalpha) increase the risk of reactivation of latent tuberculosis infection (LTI). The risk is greater with monoclonal antibodies than with etanercept. In order to reduce this risk, screening of latent tuberculosis infection should be performed prior to the initiation of the treatment. Screening includes a complete clinical history, physical examination, tuberculin test, in vitro detection of interferon-gamma (INF-gamma) production and a chest x-ray. The limitations of the different tests should be taken into consideration by the physician. After the diagnosis of latent tuberculosis infection, the patient must receive treatment with isoniacide for 9 months. In spite of screening and adequate treatment of latent tuberculosis treatment, the patients receiving treatment with anti-TNFalpha drugs may develop active tuberculosis. Thus, the patient should undergo clinical follow-up to detect signs of active tuberculosis with atypical and disseminated pictures.
阻断肿瘤坏死因子α（TNFα）的药物会增加潜伏性结核感染（LTI）再激活的风险。单克隆抗体引发这种风险的可能性比依那西普更大。为降低此风险，应在开始治疗前对潜伏性结核感染进行筛查。筛查包括完整的临床病史、体格检查、结核菌素试验、体外检测干扰素γ（INF - γ）产生情况以及胸部X光检查。医生应考虑不同检测方法的局限性。诊断出潜伏性结核感染后，患者必须接受异烟肼治疗9个月。尽管对潜伏性结核进行了筛查和充分治疗，但接受抗TNFα药物治疗的患者仍可能发生活动性结核病。因此，患者应接受临床随访，以发现具有非典型和播散性表现的活动性结核病迹象。
