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Testing and Prophylaxis of Latent Tuberculosis Infection in Patients Receiving Tumor Necrosis Factor-α Antagonists
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摘要: 肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)拮抗剂的使用是发生活动性结核的高危因素，尤其对于潜伏结核感染(latent tuberculosis infection，LTBI)患者，结核再活动的风险更高。2015年世界卫生组织发布的LTBI管理指南强烈推荐在应用TNF-α拮抗剂前应进行LTBI筛查，并推荐了5种治疗方案，然而，该指南中关于5种方案在此类人群中的有效性和安全性尚无数据。接受TNF-α拮抗剂治疗人群LTBI的筛查和治疗方案选择应受到重视。本文主要综述应用TNF-α拮抗剂LTBI的筛查和治疗，以期为该类人群LTBI的管理提供依据。
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关键词:
- 肿瘤坏死因子-α拮抗剂 /
- 潜伏结核感染 /
- 管理
Abstract: Treatment with tumor necrosis factor-α(TNF-α) antagonists is a risk factor for active tuberculosis. Especially for patients with latent tuberculosis infection (LTBI), the risk of tuberculosis reactivation is greater, which lays weight on the importance of the screening of LTBI and the choice of treatment regimens in this population. 2015 World Health Organization (WHO) guidelines on the management of LTBI strongly recommended that patients should receive LTBI screening before using TNF-α antagonists. Furthermore, there were five regimens recommended. However, no data are available on the efficacy and safety of the five regimens in this population in WHO guidelines. This review focuses on the screening and treatment of LTBI in patients receiving TNF-α antagonists, in order to provide a basis for the management of LTBI in clinical practice.利益冲突 无 -
表 1 应用TNF-α拮抗剂LTBI治疗方案指南或共识
国家/地区(年份) LTBI治疗方案 抗结核治疗后开始TNF-α拮抗剂治疗时间 中国(2013)[13] INH+RIF 6个月 ≥4周 INH+RFT 6个月 法国(2003)[19] INH+RIF 3个月 ≥3周 INH 9个月 英国(2005)[20] INH 6个月 ≥2个月; 若有异常胸片表现或结核 INH+RIF 3个月 病史，完成预防治疗后开始 西班牙(2005)[21] INH 9个月 1个月 日本(2007)[22] INH 9个月 无明确推荐 瑞士(2007)[23] INH 9个月 1个月 RIF 4个月 欧洲(2010)[24] INH 9~12个月 4周 INH+RIF 3个月 美国(2012)[25] 无明确推荐 1个月 美国(2013)[26] INH 9个月 无明确推荐，倾向于完成预防治疗后开始 INH 6个月 INH+RIF 3个月 RIF 4个月 意大利(2011)[27] INH 9个月 1个月 加拿大(2012)[28] INH 9个月 1~2个月 TNF-α：肿瘤坏死因子-α; LTBI：潜伏结核感染; INH：异烟肼; RIF：利福平; RFT：利福喷丁 
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