Rheumatology and Department of Medicine, IDIS, Hospital Clinico Universitario, Universidad de Santiago de Compostela, 15701 Santiago, Spain.
Expert Rev Clin Immunol. 2011 May;7(3):329-40. doi: 10.1586/eci.11.6.
Over the last 12 years, TNF antagonists have been successfully used for the treatment of numerous patients afflicted by chronic inflammatory disorders. However, data from clinical trials and registries have shown that patients treated with these biologics have an increased risk of reactivating latent TB. The fact that TNF plays a role in the immune cell response and, more specifically, in maintenance of granuloma integrity is the accepted grounds for reactivation of TB following inhibition of TNF. Appropriate screening of latent TB and proper management of cases substantially reduces the incidence of active TB. Nevertheless, debate still remains regarding the value of the tuberculin skin test and IFN-γ-release assays as diagnostic tools, and treatment across guidelines and recommendations. This largely reflects differences in background population.
在过去的 12 年中，TNF 拮抗剂已成功用于治疗许多患有慢性炎症性疾病的患者。然而，临床试验和注册数据显示，接受这些生物制剂治疗的患者发生潜伏性结核病再激活的风险增加。TNF 在免疫细胞反应中发挥作用，更具体地说，在维持肉芽肿完整性方面发挥作用，这是 TNF 抑制后结核病再激活的公认基础。适当的潜伏性结核病筛查和适当的病例管理可显著降低活动性结核病的发病率。然而，关于结核菌素皮肤试验和 IFN-γ 释放试验作为诊断工具的价值以及治疗方法是否符合指南和建议，仍存在争议。这在很大程度上反映了背景人群的差异。
