UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

无HIV感染成人中潜伏结核感染的诊断(结核病筛查)

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

引言

治疗活动性结核病(tuberculosis, TB)个体是控制结核病的首要任务，但识别和治疗潜伏结核感染(latent tuberculosis infection, LTBI)个体是一项重要的第二优先任务[1-3]。

对于大多数个体，结核分枝杆菌(Mycobacterium tuberculosis)感染最初会被宿主免疫防御所遏制，然后感染维持为潜伏性[4]。然而，潜伏性感染有随时发展为活动性结核病的可能。识别和治疗LTBI可使活动性结核病发生的风险降低多达90%[5]，因此有可能通过减少潜在传染源的数量来保护个体和公众的健康[6,7]。

识别LTBI有两种主要的检测方法：结核菌素皮肤试验(tuberculin skin test, TST)和γ-干扰素释放试验(interferon gamma release assay, IGRA)[8,9]。两种检测都评估的是细胞介导免疫。

本文将总结TST在无HIV感染者中用于诊断LTBI。HIV感染者或接受TNF-α抑制剂患者的LTBI治疗将会单独详细讨论；与儿童结核病筛查相关的问题及非HIV感染者LTBI治疗的相关问题，也将会单独详细讨论。 (参见“HIV感染者潜伏结核感染的治疗”和“儿童潜伏结核感染”和“Tumor necrosis factor-alpha inhibitors and mycobacterial infections”和“Interferon-gamma release assays for diagnosis of latent tuberculosis infection”)

检测的指征

检测LTBI的目的是识别结核病发生风险增加的个体，从而使这些个体获益于LTBI的治疗(表 1和表 2)；这些个体包括[10-13]：

                           

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-02-27.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. World Health Organization. Guidelines on the management of latent tuberculosis infection. WHO, Geneva 2015. http://www.who.int/tb/publications/ltbi_document_page/en/ (Accessed on March 02, 2016).
  2. Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017; 64:e1.
  3. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161:S221.
  4. Pai M, Behr MA, Dowdy D, et al. Tuberculosis. Nat Rev Dis Primers 2016; 2:16076.
  5. Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999; 3:847.
  6. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004; 350:2060.
  7. Rieder HL. Interventions for Tuberculosis Control and Elimination. International Union Against Tuberculosis and Lung Disease, 2002.
  8. Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med 2015; 372:2127.
  9. Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015; 46:1563.
  10. Horsburgh CR Jr, Rubin EJ. Clinical practice. Latent tuberculosis infection in the United States. N Engl J Med 2011; 364:1441.
  11. Mancuso JD, Tribble D, Mazurek GH, et al. Impact of targeted testing for latent tuberculosis infection using commercially available diagnostics. Clin Infect Dis 2011; 53:234.
  12. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:962.
  13. Kahwati LC, Feltner C, Halpern M, et al. Primary Care Screening and Treatment for Latent Tuberculosis Infection in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 316:970.
  14. Marais BJ, Gie RP, Schaaf HS, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004; 8:392.
  15. Linas BP, Wong AY, Freedberg KA, Horsburgh CR Jr. Priorities for screening and treatment of latent tuberculosis infection in the United States. Am J Respir Crit Care Med 2011; 184:590.
  16. Canadian Tuberculosis Standards, 7th Edition 2013. http://www.respiratoryguidelines.ca/tb-standards-2013 (Accessed on November 16, 2016).
  17. Comstock GW, Edwards LB, Livesay VT. Tuberculosis morbidity in the U.S. Navy: its distribution and decline. Am Rev Respir Dis 1974; 110:572.
  18. Cheng MP, Abou Chakra CN, Yansouni CP, et al. Risk of Active Tuberculosis in Patients with Cancer: A Systematic Review and Meta-Analysis. Clin Infect Dis 2016.
  19. Stead WW, To T, Harrison RW, Abraham JH 3rd. Benefit-risk considerations in preventive treatment for tuberculosis in elderly persons. Ann Intern Med 1987; 107:843.
  20. Kopanoff DE, Snider DE Jr, Caras GJ. Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study. Am Rev Respir Dis 1978; 117:991.
  21. The Online TST/QFT Interpreter. Version 2.0. http://www.tstin3d.com/index.html (Accessed on September 24, 2010).
  22. Pai M, Kunimoto D, Jamieson F, Menzies D. Diagnosis of Latent TB Infection. In: Canadian Tuberculosis Standards, 7th ed, Menzies D. (Ed), Canadian Lung Association and Public Health Agency of Canada, Ottawa 2013.
  23. Hoppe LE, Kettle R, Eisenhut M, et al. Tuberculosis--diagnosis, management, prevention, and control: summary of updated NICE guidance. BMJ 2016; 352:h6747.
  24. COMSTOCK GW, EDWARDS LB, PHILIP RN, WINN WA. A COMPARISON IN THE UNITED STATES OF AMERICA OF TWO TUBERCULINS, PPD-S AND RT 23. Bull World Health Organ 1964; 31:161.
  25. Menzies D, Doherty TM. Diagnosis of latent tuberculosis infection. In: Reichman and Hershfield's Tuberculosis, a comprehensive international approach, Raviglione MC (Ed), Informa Healthcare USA, New York 2006. p.215.
  26. DUBOCZY BO, BROWN BT. Multiple readings and determination of maximal intensity of tuberculin reaction. Am Rev Respir Dis 1961; 84:60.
  27. FURTHER studies of geographic variation in naturally acquired tuberculin sensitivity. Bull World Health Organ 1955; 12:63.
  28. Centers for Disease Control and Prevention. Guide to Vaccine Contraindications and Precautions. Department of Health and Human Services. Available at: http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindications-guide-508.pdf
  29. Menzies D. Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion. Am J Respir Crit Care Med 1999; 159:15.
  30. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006; 10:1192.
  31. von Reyn CF, Horsburgh CR, Olivier KN, et al. Skin test reactions to Mycobacterium tuberculosis purified protein derivative and Mycobacterium avium sensitin among health care workers and medical students in the United States. Int J Tuberc Lung Dis 2001; 5:1122.
  32. A World Atlas of BCG Vaccination Policies and Practices http://www.bcgatlas.org/ (Accessed on April 01, 2009).
  33. Vinkeles Melchers NV, van Elsland SL, Lange JM, et al. State of affairs of tuberculosis in prison facilities: a systematic review of screening practices and recommendations for best TB control. PLoS One 2013; 8:e53644.
  34. Arshad S, Bavan L, Gajari K, et al. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J 2010; 35:1336.
  35. Rieder H. What is the role of case detection by periodic mass radiographic examination in tuberculosis control?. In: Toman’s Tuberculosis: Case detection, treatment, and monitoring – questions and answers, 2nd ed, Frieden, T. (Eds), World Health Organization, Geneva 2004. p.72.
  36. Tarlo SM, Day JH, Mann P, Day MP. Immediate hypersensitivity to tuberculin. In vivo and in vitro studies. Chest 1977; 71:33.
  37. Youssef E, Wooltorton E. Serious allergic reactions following tuberculin skin tests. CMAJ 2005; 173:34.
  38. Froeschle JE, Ruben FL, Bloh AM. Immediate hypersensitivity reactions after use of tuberculin skin testing. Clin Infect Dis 2002; 34:E12.
  39. Richard Menzies, MD, MSc, personal communication.
  40. Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005; 54:1.
  41. World Health Organization. Guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings. WHO/CDS/TB/99.269. IJTLD 1999.
  42. Menzies R, Vissandjee B, Rocher I, St Germain Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med 1994; 120:190.
  43. Richards NM, Nelson KE, Batt MD, et al. Tuberculin test conversion during repeated skin testing, associated with sensitivity to nontuberculous mycobacteria. Am Rev Respir Dis 1979; 120:59.
  44. Gordin FM, Perez-Stable EJ, Flaherty D, et al. Evaluation of a third sequential tuberculin skin test in a chronic care population. Am Rev Respir Dis 1988; 137:153.
  45. Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis. Adv Tuberc Res 1969; 17:28.