关口前移:结核潜伏感染及其控制

全球有近1/4的人群感染结核分枝杆菌,其中5%~10%可能在一生中发生活动性结核病,潜伏感染人群成为一个庞大的潜在患者库。世界卫生组织相继于2015年和2018年发布和更新《结核潜伏感染管理指南》,指导包括中国在内的中高收入、结核病发病率低于100/10万的国家和地区推广高危人群结核潜伏感染检测和预防性治疗。我国结核潜伏感染控制策略的开发应该紧密结合国情和结核病疫情特点,可以借鉴但不能照搬国外方案。准确界定干预目标人群、探索适宜的干预手段、建立科学的管理和评价体系等,都需要系统性的基础研究和临床研究提供技术支撑。以结核潜伏感染干预为手段探索结核病防控的关口前移将是落实“预防为主”综合防治策略的重要举措。

Management of latent tuberculosis infection: moving forward to prevention first

It was estimated that about a quarter of the global population were latently infected with Mycobacterium tuberculosis, and millions of active tuberculosis (TB) diseases will occur from this reservoir. World Health Organization released guidelines in 2015 and in 2018 respectively, to provide updated consolidated guidance for expanding latent tuberculosis infection (LTBI) management in high-income or upper middle-income countries with an estimated TB incidence rate of less than 100 per 100000 population (including China). The development of the national guidelines should adapt to local epidemiology of TB, the availability of resources, and other determinants. Identifying at-risk populations, exploring appropriate intervention tools, and establishing systematic management system all require technical supports by means of strengthening basic research and clinical research. LTBI management is one of the important tools for moving TB control forward to prevention first.