Management of latent tuberculosis infection in China: Exploring solutions suitable for high-burden countries
Management of latent tuberculosis infection in China: Exploring solutions suitable for high-burden countries
复制标题
中国潜伏性结核感染的管理：探索适合高负担国家的解决方案
DOI：
10.1016/j.ijid.2020.02.034
复制
发表时间：
2020-03-01
影响因子：
8.4
通讯作者：
Cao, Bin
中科院分区：
文献类型：
--
作者：
Cui, Xiaojing;Gao, Lei;Cao, Bin
我国是结核病和结核潜伏感染高负担国家之一。据最近估计，中国是世界上LTBI负担最高的国家，约有3.5亿人感染。结核菌素皮试（TST）比γ-干扰素释放试验（IGRA）高估了中国LTBI的患病率。一项基于人群的研究发现，IGRA阳性率在13.5%至19.8%之间。根据转换者IGRA持续阳性结果，农村人口的年结核感染率为1.5%。在一般农村人口中，在新转为IGRA阳性的个体中，前2年LTBI活动性结核的发展为0.87/100人年。学生结核病控制工作受到政府的高度重视，加强了对与活动性肺结核患者密切接触的学生LTBI的管理。利福喷丁加异烟肼（3 H（2）P（2），最大剂量均为600 mg）每周两次，3个月方案已在中国用于LTBI治疗多年。关于使用免疫抑制剂人群的LTBI管理，2013年中国发表了关于肿瘤坏死因子拮抗剂应用中结核病预防和管理的专家共识。为实现“终结结核病战略”的全球目标，中国需要创新理念和技术，通过管理LTBI降低结核病发病率，如确定LTBI检测和治疗的人群，选择和开发可靠的LTBI检测方法，探索安全有效的预防性治疗工具，建立一套优化的LTBI管理体系。(C)2020年，任作家。由爱思唯尔有限公司代表国际传染病学会出版。
China is one of the countries with a high burden of tuberculosis (TB) and latent tuberculosis infection (LTBI). It was recently estimated that China had the highest LTBI burden in the world, with approximately 350 million persons living with the infection. The prevalence of LTBI in China is overestimated by tuberculin skin test (TST) as compared to interferon-gamma release assay (IGRA). A population-based study found that IGRA positivity rates ranged between 13.5% and 19.8%. The annual TB infection rate in the rural population was 1.5% based on persistent positive IGRA results in converters. The development of active TB from LTBI in the general rural population was 0.87 per 100 person-years in the first 2 years among individuals who newly converted to IGRA-positive. TB control in students has been paid more attention by the government, which also improved LTBI management among students in close contact with active TB patients. A 3-month regimen of twice-weekly rifapentine plus isoniazid (3H(2)P(2), both with a maximum dose of 600 mg) has been practiced for LTBI treatment in China for years. With respect to LTBI management in populations using immune inhibitors, an expert consensus on TB prevention and management in tumor necrosis factor antagonist application was published in 2013 in China. In order to achieve the global goals of the End TB Strategy, China needs innovative ideas and technologies to reduce the TB incidence by management of LTBI, such as the identification of populations for LTBI testing and treatment, selecting and developing reliable LTBI tests, exploring safe and effective preventive treatment tools, and establishing a set of optimized LTBI management systems. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.