活动性结核病患者免疫功能状态评估和免疫治疗专家共识(2021年版)

Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition)

结核病不仅是一种细菌感染性疾病,也是一种免疫性疾病,它的发生、发展及转归与患者的抗结核免疫功能密切相关。结核病患者通常在固有免疫和适应性免疫功能方面存在异常,检测其免疫细胞数量和免疫功能可评价其免疫功能状态,为临床施行免疫干预提供依据。对活动性结核病患者应用免疫制剂进行免疫干预,可增强其免疫功能,从而提高治愈率、缩短疗程,同时,可清除持留菌而降低复发率。尽管目前结核病免疫辅助诊断在临床应用广泛,然而,对结核病的抗结核免疫和免疫异常机制及其在结核病中的作用尚认识不足、缺乏深入的研究;对活动性结核病患者免疫功能状态评估的指征、评估指标的应用及其临床意义尚未达成一致意见;而免疫制剂的应用受到政策的限制,对活动性结核病患者免疫干预与否、免疫治疗的指征、免疫制剂的选择也未达成一致意见,临床应用不规范。为此,中国人民解放军总医院第八医学中心、《中国防痨杂志》编辑委员会、中国医疗保健国际交流促进会结核病防治分会基础和临床学部联合组织专家拟定《活动性结核病患者免疫功能状态评估和免疫治疗专家共识(2021年版)》。本共识概述了抗结核免疫及结核病患者免疫异常机制,介绍了我国临床常用的结核病患者免疫相关检测方法,提出了活动性结核病患者免疫功能状态评估的指征、方法及策略;系统介绍了我国临床可用的免疫治疗制剂,确定了活动性结核病患者免疫治疗的适应证和禁忌证,以帮助临床医师对活动性结核病患者适时、合理地进行免疫治疗。

Tuberculosis is not only a bacterial infectious disease but also an immune disease.The occurrence,development,and prognosis of tuberculosis are closely related to the anti-tuberculosis immunity of the patients.Patients with active tuberculosis usually have abnormalities in the function of innate immune and adaptive immune.Detecting the number of immune cells and immune function can evaluate the immune status of active tuberculosis patients,to provide evidence for clinical immune intervention.The immune intervention using immune agents can enhance immunity function,improve the cure rate and shorten the course of treatment,eliminate the persistent Mycobacterium tuberculosis and reduce the recurrence rate.Although the immunodiagnosis of tuberculosis is widely used in the clinic,the mechanisms of anti-tuberculosis immunity and immune abnormality and their role in tuberculosis are not well understood and lack in-depth research.There is no consensus on the indication of immune function evaluation,the application of the evaluation index,and their clinical significance in active tuberculosis patients.In addition,the application of immune agents is limited by the policy,and there is also no consensus on immune intervention or not,the indication of immunotherapy and selection of immune agents for active tuberculosis patients.Therefore,the experts were organized to draw up“Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis(2021 Edition)”by the Eighth Medical Center of Chinese PLA General Hospital,Editorial Board of Chinese Journal of Antituberculosis,Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care.This expert consensus outlines the mechanism of anti-tuberculosis immunity and immune abnormality in tuberculosis patients;introduces the immunological detection methods commonly used in tuberculosis clinic practice;puts forward the indications,methods,and strategies for evaluating the immune status of active tuberculosis patients;systematically introduces the clinical immunotherapy preparations available in clinic practice,and puts forward the indications and contraindications of immunotherapy for active tuberculosis patients,to help clinicians timely and reasonably carry out the immunotherapy in the patients with active tuberculosis.