Pol Arch Intern Med. 2017 Aug 24;127(10):681-686. doi: 10.20452/pamw.4093.
In 2010, the British Thoracic Society published guidelines on the management of tuberculosis (TB) infection and disease in patients with chronic kidney disease (CKD), in response to physicians' concerns about the challenges encountered in treating this complex patient group. Later, in 2010, we summarized the main messages from these guidelines for readers of this journal. The purpose of this review is an update on the current management of latent and active Mycobacterium tuberculosis infection in patients with CKD. Patients with CKD have an increased risk of both infection and disease with Mycobacterium tuberculosis, and practice varies between renal units. Since 2010, the majority of published data have focused on screening for TB infection in immunosuppressed patients, including those with CKD and transplant recipients. While there is currently no perfect screening test, the evidence suggests that we should be using the available interferon‑γ release assays, with or without the tuberculin skin test, to try and reduce the undoubted risk of active TB in these patients. While we are not aware of any new evidence to change the recommended treatment regimens, we have reiterated some of the important recommendations outlined in the original guidelines.
2010 年，英国胸科学会（British Thoracic Society）针对治疗这一复杂患者群体所面临的挑战，发布了慢性肾脏病（chronic kidney disease，CKD）患者结核病（tuberculosis，TB）感染和疾病管理指南。后来，我们在 2010 年为本刊读者总结了这些指南的主要信息。本综述的目的是更新目前对 CKD 患者潜伏性和活动性结核分枝杆菌（Mycobacterium tuberculosis，MTB）感染的管理。CKD 患者感染和患 MTB 疾病的风险均增加，各肾脏科室的治疗方案也存在差异。自 2010 年以来，大多数已发表的数据都集中在对包括 CKD 患者和移植受者在内的免疫抑制患者的 TB 感染筛查上。虽然目前尚无完美的筛查试验，但有证据表明，我们应该使用现有的干扰素 -γ 释放试验，或联合结核菌素皮肤试验，以努力降低这些患者中确实存在的活动性 TB 风险。我们没有发现任何改变推荐治疗方案的新证据，但重申了原始指南中列出的一些重要建议。
