Miossec Pierre
Département d'immunologie et de rhumatologie, et Laboratoire immunogénomique et inflammation EA 4130, université de Lyon, Lyon, France.
Rev Prat. 2018 May;68(5):537-540.
Reactivation of tuberculosis during treatment with inhibitors of TNF. The inhibition of the tumor necrosis factor (TNF) has been a major progress in the treatment of chronic inflammatory diseases by acting on their local and systemic manifestations. However, this treatment can be responsible for severe infections, specifically reactivation of tuberculosis. The underlying mechanisms of these infections in this context are now better understood. First, chronic inflammatory diseases are associated with a cellular mediated immune defect, specifically affecting the Th1 pathway. On the other hand, TNF has a central role in granuloma formation. TNF inhibition allows the escape of tuberculosis bacillus from residual sites and its rapid diffusion. This understanding has allowed the implementation of prevention measures with screening and treatment of latent tuberculosis.
在使用肿瘤坏死因子（TNF）抑制剂治疗期间结核病的再激活。肿瘤坏死因子（TNF）的抑制作用通过作用于慢性炎症性疾病的局部和全身表现，在这些疾病的治疗中取得了重大进展。然而，这种治疗可能导致严重感染，特别是结核病的再激活。在这种情况下，这些感染的潜在机制现在已得到更好的理解。首先，慢性炎症性疾病与细胞介导的免疫缺陷有关，特别是影响Th1途径。另一方面，TNF在肉芽肿形成中起核心作用。TNF抑制使结核杆菌从残留部位逃逸并迅速扩散。这种认识使得通过筛查和治疗潜伏性结核病来实施预防措施成为可能。
