结核分枝杆菌感染人群诊断及预防治疗研究进展

Research progress of diagnosis, prevention and treatment of the crowd of Mycobacterium tuberculosis infection

结核潜伏感染（LTBI）者是结核病患者的重要来源，可通过免疫学方面检测（结核菌素试验和γ-干扰素释放试验）诊断，对LTBI的预防性治疗可以减低将来结核分枝杆菌再活化及发展成结核病的风险。LTBI 的检测属于针对性检测，只有对于有高风险发展成结核病或者能从 LTBI的预防性治疗中获益的人群才进行LTBI的检测。常用的标准预防性治疗方案是6～9个月的异烟肼治疗方案，可以降低LTBI 90%的发病风险，由于疗程长、肝损害常见，完成率仅仅在50%左右。针对上述问题衍生出了一些其他的单药或者联合用药的方案，包括4RIF、3INH-RPT、3-4INH-RIF及2RIF-PZA，其中有效性、安全性和完成率均较好的是3INH-RPT。预防性治疗既往并未得到有效利用，对LTBI的规范诊疗将有助于实现国家结核病防治规划。

Latent tuberculosis infection （LTBI） is an important source of tuberculosis （TB） patients, it can be detected with immune based tests, such as tuberculin skin test （TST） or interferon gamma release assays （IGRA）. Preventive therapy for LTBI can reduce the prospective risk ofMycobacterium tuberculosis re-activation and development of active TB. Targeted testing is recommended only in population who are at high risk of developing TB or can benefit from therapy. Common standard therapy is 6-9 months INH, which can reduce 90% risk of active TB, but the completion is only about 50% due to the long duration and common hepatotoxicity. To solve the above problems, some other regimens of single drug or combination of solutions have been derived, including 4RIF, 3INH-RPT, 3-4INH-RIF and 2RIF-PZA. Of these, 3INH-RPT has outstanding performance in effectiveness, safety and completion. LTBI therapy has not been underutilized previously, standardizing clinical diagnosis and therapy will contribute to National TB control program.