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HIV感染患者中潜伏结核感染的诊断

Authors
Madhukar Pai, MD, PhD
Dick Menzies, MD, MSc
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
贺建清, 主任医师，教授

引言

据估计，约1/3的世界人口潜伏感染结核分枝杆菌(Mycobacterium tuberculosis, MTB)，是潜在活动性结核的主要储存库[1]。人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染疫情和结核病(tuberculosis, TB)疫情的交叉导致TB病例大量涌现，尤其是在TB流行的资源有限的地区[2,3]。然而，HIV感染患者中发生活动性TB病的风险可通过预防性治疗降低，由此强调了对潜伏结核感染(latent tuberculosis infection, LTBI)进行适当诊断性和治疗性干预的重要性[4-6]。

本专题将讨论HIV感染患者中LTBI的诊断。HIV感染宿主中LTBI的治疗将在别处详细讨论。 (参见“HIV感染者潜伏结核感染的治疗”)

HIV血清阴性宿主中LTBI的诊断性试验将在别处讨论。 (参见“无HIV感染成人中潜伏结核感染的诊断(结核病筛查)”)

一般概念

什么是潜伏结核？ — TB感染由吸入活杆菌导致，通常持续处于非活动状态，称为LTBI，有时迅速进展为活动性TB病。LTBI个体没有症状、不具有传染性。然而，这些潜伏TB杆菌仍保持活力，并可能在数年后“再激活”，导致活动性的、有症状的且通常具有传染性的TB病[7]。

HIV是活动性结核病的一个危险因素 — 伴发HIV感染是LTBI进展至活动性结核的一个主要危险因素[8,9]。在非地方性流行区域，在合并LTBI的HIV感染患者中，进展为活动性TB病的发生率为每年5%-8%，而在一般人群中终生风险为10%[10]。在资源有限的地区，TB是死亡的主要原因，再激活的风险在每年10%的范围内[11,12]。因此，在HIV治疗中要高度优先考虑预防活动性TB病[5]。 (参见“HIV感染者潜伏结核感染的治疗”，关于‘发生进展的危险因素’一节)

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-05.
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