1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China.
2. Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250117, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Dec 25;51(6):691-696. doi: 10.3724/zdxbyxb-2022-0445.
One fourth of the global population has been infected with , and about 5%-10% of the infected individuals with latent tuberculosis infection (LTBI) will convert to active tuberculosis (ATB). Correct diagnosis and treatment of LTBI are important in ending the tuberculosis epidemic. Current methods for diagnosing LTBI, such as tuberculin skin test (TST) and interferon-γ release assay (IGRA), have limitations. Some novel biomarkers, such as transcriptome derived host genes in peripheral blood cells, will help to distinguish LTBI from ATB. More emphasis should be placed on surveillance in high-risk groups, including patients with HIV infection, those using biological agents, organ transplant recipients and those in close contact with ATB patients. For those with LTBI, treatment should be based on the risk of progression to ATB and the potential benefit. Prophylactic LTBI regimens include isoniazid monotherapy for 6 or 9 months, rifampicin monotherapy for 4 months, weekly rifapentine plus isoniazid for 3 months (3HP regimen) and daily rifampicin plus isoniazid for 3 months (3HR regimen). The success of the one month rifapentine plus isoniazid daily regimen (1HP regimen) suggests the feasibility of an ultra-short treatment strategy although its efficacy needs further assessment. Prophylactic treatment of LTBI in close contact with MDR-TB patients is another challenge, and the regimens include new anti-tuberculosis drugs such as bedaquiline, delamanid, fluoroquinolone and their combinations, which should be carefully evaluated. This article summarizes the current status of diagnosis and treatment of LTBI and its future development direction.
全球四分之一的人口已感染 ，约 5%-10%的潜伏性结核感染（LTBI）个体将转化为活动性结核病（ATB）。正确诊断和治疗 LTBI 对于终结结核病流行至关重要。目前用于诊断 LTBI 的方法，如结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA），均存在局限性。一些新的生物标志物，如外周血细胞中的转录组衍生宿主基因，将有助于区分 LTBI 和 ATB。应更加重视对高危人群的监测，包括 HIV 感染者、使用生物制剂者、器官移植受者和与 ATB 患者密切接触者。对于 LTBI 患者，治疗应基于进展为 ATB 的风险和潜在获益。LTBI 的预防性治疗方案包括异烟肼单药治疗 6 或 9 个月、利福平单药治疗 4 个月、每周利福喷丁加异烟肼治疗 3 个月（3HP 方案）和每日利福平加异烟肼治疗 3 个月（3HR 方案）。1 个月利福喷丁加异烟肼每日方案（1HP 方案）的成功表明超短疗程治疗策略的可行性，尽管其疗效仍需进一步评估。与耐多药结核病（MDR-TB）患者密切接触者的 LTBI 预防性治疗是另一个挑战，方案包括贝达喹啉、德拉马尼、氟喹诺酮及其组合等新型抗结核药物，应谨慎评估。本文总结了 LTBI 的当前诊断和治疗现状及其未来发展方向。
