Updates on the risk factors for latent tuberculosis reactivation and their managements.
Updates on the risk factors for latent tuberculosis reactivation and their managements.
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DOI：
10.1038/emi.2016.10
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发表时间：
2016-02-03
影响因子：
13.2
通讯作者：
Zhang WH
中科院分区：
文献类型：
--
作者：
Ai JW;Ruan QL;Liu QH;Zhang WH
结核病潜伏感染（LTBI）的预防性治疗对全球结核病的消除和控制具有重要意义，但现有的LTBI筛查方法在预测结核病发病方面仍存在局限性。先前的研究发现，一些高危因素（包括人类免疫缺陷病毒（HIV）、器官移植、矽肺、肿瘤坏死因子-α阻断剂、密切接触者和肾透析）导致结核病复发率显著增加。本文综述了每种危险因素与结核病的关系以及解决这些因素的方法。世界卫生组织目前推荐了五种方案，没有一种方案显示出优于其他方案。近年来，研究逐渐缩小到LTBI的预防性治疗的高危目标群体，如矽肺患者，器官移植受者和HIV感染者。本综述讨论了每个目标组的治疗方案，并比较了不同方案的疗效。对于HIV患者和移植受者，异烟肼单药治疗LTBI是有效的，但对于其他人，目前几乎没有证据。
The preventive treatment of latent tuberculosis infection (LTBI) is of great importance for the elimination and control of tuberculosis (TB) worldwide, but existing screening methods for LTBI are still limited in predicting the onset of TB. Previous studies have found that some high-risk factors (including human immunodeficiency virus (HIV), organ transplantation, silicosis, tumor necrosis factor-alpha blockers, close contacts and kidney dialysis) contribute to a significantly increased TB reactivation rate. This article reviews each risk factor's association with TB and approaches to address those factors. Five regimens are currently recommended by the World Health Organization, and no regimen has shown superiority over others. In recent years, studies have gradually narrowed down to the preventive treatment of LTBI for high-risk target groups, such as silicosis patients, organ-transplantation recipients and HIV-infected patients. This review discusses regimens for each target group and compares the efficacy of different regimens. For HIV patients and transplant recipients, isoniazid monotherapy is effective in treating LTBI, but for others, little evidence is available at present.