结核分枝杆菌潜伏感染防控策略的研究进展

doi:10.19983/j.issn.2096-8493.20260125

摘要/Abstract

摘要：

全球约有1/4人口(约20亿)感染了结核分枝杆菌,其中结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)构成了一个重要部分。目前,尚没有诊断的金标准,结核菌素皮肤试验(TST)和γ-干扰素释放试验(IGRA)等主要检测手段亦存在一定的缺陷。结核分枝杆菌潜伏感染人群的筛查、治疗指征把控以及治疗依从性差,是当前结核病防控面临的三大难题,严重制约防控成效。因此,开发更多检测手段以准确评估感染状态、预测发病风险,同时不断优化治疗方案以提升依从性是突破结核病防控瓶颈的关键所在。作者依托最新循证医学证据与国际权威指南,围绕“消除结核”全球战略目标,系统梳理结核分枝杆菌潜伏感染在诊断与治疗领域的研究进展,探讨其防控策略的临床实践和优化路径,旨在为实现终结结核病流行提供理论依据与实践参考。

关键词: 分枝杆菌,结核, 感染, 预防和防护用药, 综述文献(主题)

Abstract:

Approximately one quarter of global population, nearly two billion individuals, are infected with Mycobacterium tuberculosis, with latent tuberculosis infection (LTBI) accounting for the majority of cases. However, there are no direct diagnostic methods for LTBI, and the major diagnostic assays like tuberculin skin test (TST) and interferon-gamma release assay (IGRA) have notable limitations. Deficiencies in LTBI screening, strict treatment indications, and poor treatment adherence constitute three major challenges confronting current tuberculosis prevention and control, which severely hamper the effectiveness of disease prevention and management. Therefore, developing additional detection modalities to accurately evaluate infection status and predict disease onset risk, coupled with continuous optimization of therapeutic regimens to improve treatment adherence, represent the key to breaking through bottlenecks in tuberculosis prevention and control. Based on latest evidence-based medical data and internationally authoritative guidelines, the authors systematically reviewed advances in LTBI diagnosis and management in alignment with the global End TB Strategy, and further discussed clinical implementation and optimized approaches of LTBI prevention and control, intending to provide theoretical foundation and practical reference for ending global tuberculosis epidemic.

Key words: Mycobacterium tuberculosis, Infections, Protective agents, Review literature as topic

中图分类号:

R52
R183.3

江萍, 李天驹, 康光鸿, 向明确. 结核分枝杆菌潜伏感染防控策略的研究进展[J]. 结核与肺部疾病杂志,2026, 7(5): 679-686. doi: 10.19983/j.issn.2096-8493.20260125

Jiang Ping, Li Tianju, Kang Guanghong, Xiang Mingque. Research progress on prevention and control strategies for latent Mycobacterium tuberculosis infection[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 679-686. doi: 10.19983/j.issn.2096-8493.20260125

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项目	TST	TBST	IGRA
操作方法	前臂皮内注射5U结核菌素纯蛋白衍生物(PPD)—72h后观察皮肤反应	前臂皮内注射重组结核杆菌融合蛋白0.1ml(5U)—48h后观察皮肤反应	静脉血检测
试验设备	不需要仪器设备	不需要仪器设备	设备昂贵
操作特点	简便	简便	复杂
对人员要求	皮肤试验检测	皮肤试验检测	技术要求较高
受BCG干扰;能否区分MTB/NTM	受BCG干扰;不能区分	不受BCG干扰;能区分	不受BCG干扰;能区分
优势	费用低,可大面积筛查	检测准确性提升	特异度提高
劣势	存在主观性;可能为假阴性;受BCG接种的影响,高估实际的感染人数	存在主观性	费用高,不适合大面积筛查;可能为假阴性
预测进展为活动性结核病的能力	低	低	低

与利福平合用的药物	受影响结果
咪达唑仑、三唑仑、辛伐他汀	浓度下降
维拉帕米和大多数二氢吡啶类钙通道拮抗剂	治疗无效
地高辛(通过转运安保P-糖蛋白)	治疗无效
伊曲康唑和酮康唑、伏立康唑	疗效下降
HIV蛋白酶、整合酶抑制剂	疗效下降或无效
美沙酮	出现阿片类药物戒断症状
引起接受免疫抑制药物如接受环孢素治疗	浓度下降,出现急性移植排斥反应
华法林和磺酰脲类(减低CYP 2C底物血药浓度)	疗效下降