2023年美国预防医学服务工作组《成人结核分枝杆菌潜伏感染筛查》解读

doi:10.19983/j.issn.2096-8493.2024105

摘要/Abstract

摘要：

结核分枝杆菌潜伏感染人群是一个庞大的潜在肺结核“患者库”,在群体层面导致结核病的持续传播,严重威胁人类健康和生命。2016年美国预防医学服务工作组提出结核分枝杆菌潜伏感染的筛查和治疗方案,但该指南尚未明确治疗方案的适用人群。基于不断更新的研究证据,2023年美国预防医学服务工作组更新了成年人结核分枝杆菌潜伏感染筛查的相关意见,以帮助明确成人结核分枝杆菌潜伏感染筛查路径,提供治疗方案的适用人群,为临床成人结核分枝杆菌潜伏感染的管理提供清晰的结构框架。作者旨在对该推荐更新情况进行解读,为中国成人结核分枝杆菌潜伏感染的筛查提供参考意见。

关键词: 分枝杆菌,结核, 成年人, 感染, 指南

Abstract:

Individuals with latent tuberculosis infection constitute a substantial reservoir of potential tuberculosis cases, contributing to ongoing transmission within populations and posing a significant threat to public health and human life. In 2016, the U.S. Preventive Services Task Force introduced guidelines for the screening and treatment of latent tuberculosis infection. However, these guidelines did not clearly define the specific populations that should be targeted by the recommended treatment protocols. Drawing on the latest research evidence, the 2023 U.S. Preventive Services Task Force revised its recommendations on the screening of latent tuberculosis infection in adults. This update seeks to elucidate the screening pathways for latent tuberculosis infection, identify the specific populations that would benefit from treatment regimens, and establish a clear framework for the clinical management of latent tuberculosis infection in adults. This article aims to interpret these updated recommendations and offer guidance for the screening of latent tuberculosis infection in adults within the context of China.

Key words: Mycobacterium tuberculosis, Adults, Infection, Guidelines

中图分类号:

吴绣岑, 陈贵华. 2023年美国预防医学服务工作组《成人结核分枝杆菌潜伏感染筛查》解读[J]. 结核与肺部疾病杂志, 2024, 5(5): 398-403. doi: 10.19983/j.issn.2096-8493.2024105

Wu Xiucen, Chen Guihua. Interpretation of the 2023 U.S. Preventive Clinical Services Guidelines Workgroup Statement of Recommendations for Screening Adults for Latent Tuberculosis Infection[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(5): 398-403. doi: 10.19983/j.issn.2096-8493.2024105

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目的	评估信息
早期发现、干预、治疗的益处	结核菌素皮肤试验和γ-干扰素释放试验是检测LTBI的准确筛查工具对于评估筛查LTBI的获益研究尚且不足使用疾病预防控制中心推荐的方案治疗LTBI会减少活动性结核病的发展筛查和治疗LTBI与预防活动性结核病的实质性健康益处有关
早期发现、干预、治疗的危害	对于筛查LTBI的危害研究尚且不足采用疾病预防控制中心推荐的方案治疗LTBI的危害程度很小,主要危害是肝毒性 LTBI的筛查和治疗存在轻微危害(主要是肝毒性) 在预防发展为癌症方面具有中等净效益。通过对肺结核感染风险较高的人群进行长期结核感染筛查,预防活动性肺结核

测试	汇总敏感度(%)	汇总特异度(%)
T-SPOT.TB	90	95~97
QFT-GIT	81	99
QFT-Gold Plus	89	98