非活动性肺结核人群的流行病学特征和预防干预

Epidemiology and preventive intervention of inactive tuberculosis

Houben博士等利用高斯过程回归模型估算我国约有3.5亿人感染结核分枝杆菌(MTB),是世界上MTB感染负担最重的国家之一。2020年,世界卫生组织发布的《结核病综合指南:预防性治疗》中提出“有既往结核病史或者非活动性肺结核病灶者因有更高的发病风险也应该成为暴露后干预的目标人群”。美国和加拿大等国家均将提示有既往肺结核病史的肺部纤维化病灶人群作为潜伏性结核感染检测和治疗的目标人群。目前,我国暂未对有非活动性肺结核人群进行系统干预。考虑到结核病高负担国家和地区可能同样存在较重的非活动性肺结核负担,针对这一高危人群开展活动性结核病的常规监测和早诊早治,并对潜伏性结核感染者开展预防性干预将可能对降低社区发病率做出重要贡献。

China is one of the countries with the highest burden of Mycobacterium tuberculosis(MTB)infection in worldwide with 350 million people were infected as estimated by Dr.Houben and colleagues using Gaussian process regression model.The guidelines on tuberculosis(TB)preventive treatment updated by the World Health Organization in 2020 recommended that“A history of prior TB or TB preventive treatment should not be a contraindication for preventive treatment in case of exposure,following the exclusion of reactivated disease.These individuals,including those with fibrotic radiological lesions,may be at increased risk of progression.”Individuals with chest radiography abnormalities suggestive of prior healed TB has been recommended as targets for latent tuberculosis infection(LTBI)testing and treatment in American and Canada.In countries and areas with high burden of TB,considering the potential high burden of inactive TB,enhancing active case finding and LTBI preventive treatment in this high-risk group might benefit TB incidence decline in a community level.