Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2, East Yinghua Road, Chaoyang District, Beijing 100029, China.
NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Int J Infect Dis. 2020 Mar;92S:S37-S40. doi: 10.1016/j.ijid.2020.02.034. Epub 2020 Feb 27.
China is one of the countries with a high burden of tuberculosis (TB) and latent tuberculosis infection (LTBI). It was recently estimated that China had the highest LTBI burden in the world, with approximately 350 million persons living with the infection. The prevalence of LTBI in China is overestimated by tuberculin skin test (TST) as compared to interferon-gamma release assay (IGRA). A population-based study found that IGRA positivity rates ranged between 13.5% and 19.8%. The annual TB infection rate in the rural population was 1.5% based on persistent positive IGRA results in converters. The development of active TB from LTBI in the general rural population was 0.87 per 100 person-years in the first 2 years among individuals who newly converted to IGRA-positive. TB control in students has been paid more attention by the government, which also improved LTBI management among students in close contact with active TB patients. A 3-month regimen of twice-weekly rifapentine plus isoniazid (3HP, both with a maximum dose of 600 mg) has been practiced for LTBI treatment in China for years. With respect to LTBI management in populations using immune inhibitors, an expert consensus on TB prevention and management in tumor necrosis factor antagonist application was published in 2013 in China. In order to achieve the global goals of the End TB Strategy, China needs innovative ideas and technologies to reduce the TB incidence by management of LTBI, such as the identification of populations for LTBI testing and treatment, selecting and developing reliable LTBI tests, exploring safe and effective preventive treatment tools, and establishing a set of optimized LTBI management systems.
中国是结核病（TB）和潜伏性结核感染（LTBI）负担较高的国家之一。最近估计，中国 LTBI 负担位居世界首位，约有 3.5 亿人感染。与干扰素 -γ释放试验（IGRA）相比，结核菌素皮肤试验（TST）高估了中国 LTBI 的流行率。一项基于人群的研究发现，IGRA 阳性率在 13.5%至 19.8%之间。根据持续 IGRA 阳性结果，农村人群的年 TB 感染率为 1.5%。在新转为 IGRA 阳性的个体中，在最初的 2 年内，普通农村人群中 LTBI 发展为活动性 TB 的年发生率为 0.87/100 人年。政府更加关注学生中的结核病控制，同时也改善了与活动性 TB 患者密切接触的学生中的 LTBI 管理。中国多年来一直采用每周两次利福平加异烟肼（3HP，最大剂量均为 600mg）的 3 个月方案治疗 LTBI。关于使用免疫抑制剂人群的 LTBI 管理，中国于 2013 年发布了关于肿瘤坏死因子拮抗剂应用中结核病预防和管理的专家共识。为了实现终结结核战略的全球目标，中国需要创新理念和技术，通过 LTBI 管理来降低结核病发病率，例如确定 LTBI 检测和治疗人群、选择和开发可靠的 LTBI 检测方法、探索安全有效的预防性治疗工具，以及建立一套优化的 LTBI 管理系统。
