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潜伏性结核感染的诊断与治疗进展

Advances in diagnosis and treatment of latent tuberculosis infection.

作者信息

Chapman Helena J, Lauzardo Michael

机构信息

From the Southeastern National Tuberculosis Center, Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville (HJC, ML); and the Department of Environmental and Global Health, University of Florida, Gainesville (HJC).

出版信息

J Am Board Fam Med. 2014 Sep-Oct;27(5):704-12. doi: 10.3122/jabfm.2014.05.140062.

Abstract

In the United States, latent tuberculosis infection (LTBI) affects between 10 and 15 million people, of whom 10% may develop active tuberculosis disease. People at increased risk for tuberculosis reactivation include recent immigrants from countries with a high incidence of tuberculosis, children younger than age 5, people who have been infected with Mycobacterium tuberculosis within the past 2 years, or people with immunosuppression for a variety of reasons. Appropriate diagnosis and treatment of LTBI are critical for controlling and eventually eliminating tuberculosis as a public health problem. Although the tuberculin skin test is the traditional diagnostic measure for LTBI, reduced specificity has promoted the development and utilization of the interferon-γ release assays as an in vitro blood test with specific antigens to M. tuberculosis (QuantiFERON-TB Gold In-Tube test and the T.SPOT-TB test are commercially available). Despite the rise of the new diagnostic tests, however, there is still no gold standard for diagnosing LTBI, and epidemiologic risks and comorbidities need to be taken into account before initiating therapy. Current diagnostic tests combined with recommended treatment regimens are valuable tools that, when used correctly, promise to hurry the elimination of tuberculosis.

摘要

在美国,潜伏性结核感染(LTBI)影响着1000万至1500万人,其中10%可能会发展为活动性结核病。结核病复发风险增加的人群包括来自结核病高发国家的新移民、5岁以下儿童、过去2年内感染结核分枝杆菌的人,或因各种原因免疫抑制的人。对LTBI进行适当的诊断和治疗对于控制并最终消除结核病这一公共卫生问题至关重要。尽管结核菌素皮肤试验是LTBI的传统诊断方法,但特异性降低促使了γ-干扰素释放试验的开发和应用,这是一种针对结核分枝杆菌特定抗原的体外血液检测(全血γ-干扰素释放试验和T.SPOT-TB试验均可商业化获得)。然而,尽管新诊断试验不断涌现,但LTBI的诊断仍没有金标准,在开始治疗前需要考虑流行病学风险和合并症。目前的诊断试验与推荐的治疗方案相结合是很有价值的工具,如果使用得当,有望加速结核病的消除。

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