免疫受损人群的潜伏性结核感染筛查和预防性治疗

Detection and preventive treatment of latent tuberculosis infection in immunocompromised patients

免疫受损人群的潜伏性结核感染（latent tuberculosis infection,LTBI）筛查和预防是控制结核病的重要挑战之一.免疫受损人群中,人类免疫缺陷病毒感染者、免疫介导的炎症性疾病患者、移植候选人及移植患者等是结核病易感人群,对高风险人群进行靶向LTBI筛查是进行预防性治疗的前提.γ干扰素释放试验和结核菌素皮肤试验在不同类型的免疫抑制人群中诊断潜伏性结核感染的能力存在异质性,因此选择合适的筛查策略尤其重要.对LTBI诊断试验阳性者进行预防性治疗可以降低发生活动性结核病的风险,而不同的免疫受损人群在LTBI预防性治疗的方案和时间点有所不同,需要更为深入地进行探索.

The latent tuberculosis infection （LTBI） detection and preventive treatment in the immunocompromised patients is one of the key challenges of tuberculosis （TB） control.Immunocompromised patients,including the patients with human immunodeficiency virus （HIV） infection,the patients with immune-mediated inflammatory diseases,the transplant candidates and recipients,are especially susceptible to TB.A targeted detection of LTBI in these high-risk groups is a precondition for providing the preventive treatment of TB.The performance of the two immunodiagnostic tests （interferon-gamma release assay and tuberculin skin test） is highly variable among different immunocompromised groups,so the selection of an appropriate screening strategy is very important.Preventive treatment of LTBI can reduce the risk of TB development,but the treatment regimens and the time of treatment can be different among different categories of compromised patients,and further researches are needed.