Sotgiu Giovanni
Istituto di Igiene e Medicina Preventiva, Università di Sassari, Sassari, Italy.
G Ital Med Lav Ergon. 2010 Jul-Sep;32(3):264-8.
Despite dramatic advances in diagnosis and treatment, tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide. World Health Organization (WHO) reports that one-third of the global population is infected by M. tuberculosis. Direct identification of individuals who are latently infected with live M. tuberculosis without active disease is currently not possible (Latent TB Infection, LTBI). Available immunodiagnostic tests, i.e. Tuberculin Skin Testing and Interferon-gamma Release Assay, ascertain a state of M. tuberculosis specific immune response; they have several limitations in their ability to predict the risk of developing TB disease. Protective efficacy of isoniazid preventive treatment for 6 to 12 months was proved among non-HIV-infected and HIV-infected individuals. The frequency of symptomatic hepatitis due to isoniazid has been estimated to be 1 to 3 per 1,000 persons. The protection of isoniazid treatment in HIV-infected persons appears to be short-lasting (1-2.5 years), in areas with a high incidence of TB. Isoniazid plus rifampicin for 3 months has proven efficacy. There are not sufficient data on preventive treatment for contacts of patients with drug-resistant TB; existing recommendations are based on expert opinions. Rifampicin for 4 months is a choice for the treatment of individuals exposed to an index case with isoniazid-resistant TB. WHO does not recommend anti-TB second-line drugs for preventive therapy.
尽管在诊断和治疗方面取得了显著进展，但结核病仍然是全球发病和死亡的主要原因之一。世界卫生组织（WHO）报告称，全球三分之一的人口感染了结核分枝杆菌。目前无法直接识别潜伏感染活结核分枝杆菌但无活动性疾病的个体（潜伏性结核感染，LTBI）。现有的免疫诊断测试，即结核菌素皮肤试验和干扰素-γ释放试验，可确定结核分枝杆菌特异性免疫反应的状态；它们在预测患结核病风险的能力方面有若干局限性。在未感染艾滋病毒和感染艾滋病毒的个体中，已证实异烟肼预防性治疗6至12个月具有保护作用。据估计，异烟肼引起的症状性肝炎发生率为每1000人中有1至3例。在结核病高发地区，异烟肼治疗对感染艾滋病毒者的保护作用似乎是短暂的（1至2.5年）。异烟肼加利福平治疗3个月已证实有效。关于耐多药结核病患者接触者预防性治疗的数据不足；现有建议基于专家意见。利福平治疗4个月是治疗接触异烟肼耐药结核指数病例个体的一种选择。WHO不推荐使用抗结核二线药物进行预防性治疗。
