制定我国潜伏性结核感染全人群防控策略

doi:10.3969/j.issn.1000-6621.2020.08.004

摘要/Abstract

摘要：

加强潜伏性结核感染(latent tuberculosis infection,LTBI)人群的有效管理,是实现结核病防控目标的重要路径之一。目前,我国LTBI管理存在高危人群对结核病发病率贡献率偏低、发病风险特征尚未明确、现有筛查手段普遍存在局限性、预防性服药推广困难等问题。为改善上述现状,笔者提出LTBI全人群防控策略,通过加强全社会健康教育,尤其是国家政策引导及采用适宜在全人群中普及的公共卫生手段,降低疾病对全社会的危害。作为患者管理策略及高危人群策略的重要补充,科学可行的LTBI全人群管理策略,包括充分借助现阶段创新技术手段开展主动筛查、人群监测等措施,对于制定新时代我国结核感染控制规划和政策,逐步实现“终止结核病”战略目标将具有重要意义。

关键词: 潜伏性结核病, 感染控制, 人群监测

Abstract:

To strengthen the management of latent tuberculosis infection (LTBI) populations is one of the important ways to achieve the goal of tuberculosis (TB) prevention and control. Lower contribution rate of high-risk population in the incidence of TB, unclear risk characteristics, limited screening methods, and difficulty in preventive drug promotion, etc., are the problems of China’s LTBI management. A prevention and control strategy for LTBI population is proposed to improve the situation. We wonder to reduce the harm of TB to the whole society by health education, especially guiding and the adopting suitable public health measures for the whole population by national policy. As an important supplement to the management strategy of patients and high-risk population, scientific and feasible population management strategy of LTBI, including making full use of current innovative technologies to carry out active screening, population monitoring and other measures, in order to formulate TB infection control plans and policies in China, and it is important to gradually achieve the goal of “End TB”.

Key words: Latent tuberculosis, Infection control, Population surveillance

竺丽梅, 陈灿灿, 陈伟, 胡晓光, 张亚男, 马俊扬. 制定我国潜伏性结核感染全人群防控策略[J]. 中国防痨杂志, 2020, 42(8): 794-798. doi: 10.3969/j.issn.1000-6621.2020.08.004

ZHU Li-mei, CHEN Can-can, CHEN Wei, HU Xiao-guang, ZHANG Ya-nan, MA Jun-yang. To formulate prevention and control strategy for latent tuberculosis infection population in China[J]. Chinese Journal of Antituberculosis, 2020, 42(8): 794-798. doi: 10.3969/j.issn.1000-6621.2020.08.004

参考文献 26

[1]	Cui X, Gao L, Cao B. Management of latent tuberculosis infection in China: Exploring solutions suitable for high-burden countries. Int J Infect Dis, 2020,92S:S37-S40. doi: 10.1016/j.ijid.2020.02.034. doi: 10.1016/j.ijid.2020.02.034 URL pmid: 32114201
[2]	World Health Organization. Global strategy and target for tuberculosis prevention, care and control after 2015: Report by the Secretariat. Geneva: World Health Organization, 2014.
[3]	World Health Organization. WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment. Geneva: World Health Organization, 2020.
[4]	Getahun H, Matteelli A, Chaisson RE, et al. Latent Mycobacterium tuberculosis infection. N Engl J Med, 2015,372(22):2127-2135. doi: 10.1056/NEJMra1405427. URL pmid: 26017823
[5]	Mancuso JD, Diffenderfer JM, Ghassemieh BJ, et al. The prevalence of latent tuberculosis infection in the United States. Am J Respir Crit Care Med, 2016,194(4):501-509. doi: 10.1164/rccm.201508-1683OC. doi: 10.1164/rccm.201508-1683OC URL pmid: 26866439
[6]	Shea KM, Kammerer JS, Winston CA, et al. Estimated rate of reactivation of latent tuberculosis infection in the United States, overall and by population subgroup. Am J Epidemiol, 2014,179(2):216-225. doi: 10.1093/aje/kwt246. doi: 10.1093/aje/kwt246 URL pmid: 24142915
[7]	Essential components of a tuberculosis prevention and control program. Recommendations of the advisory council for the elimination of tuberculosis. MMWR Recomm Rep, 1995,44(RR-11):1-16. URL pmid: 7565539
[8]	中华人民共和国国务院办公厅. “十三五”全国结核病防治规划. 国办发〔2017〕16号. 2017-02-01.
[9]	中华人民共和国国家卫生健康委员会疾病预防控制局. 遏制结核病行动计划(2019—2022年). 国卫疾控发〔2019〕41号.2019-06-13.
[10]	中华人民共和国国家卫生和计划生育委员会. WS 196—2017 结核病分类. 2017-11-09.
[11]	中华人民共和国国家卫生健康委员会办公厅. 中国结核病预防控制工作技术规范(2020年版). 国卫办疾控函〔2020〕279号. 2020-04-02.
[12]	中华人民共和国国家卫生和计划生育委员会办公厅, 中华人民共和国教育部办公厅. 学校结核病防控工作规范(2017版). 国卫办疾控发〔2017〕22号.2017-06-29.
[13]	上海市防痨协会, 中国防痨协会青年理事会, 《中国防痨杂志》编辑委员会. 学校结核病疫情流行病学调查和现场处置专家共识. 中国防痨杂志, 2019,41(1):9-13.doi: 10.3969/j.issn.1000-6621.2019.01.004.
[14]	肿瘤坏死因子拮抗剂应用中结核病预防与管理专家建议组. 肿瘤坏死因子拮抗剂应用中结核病预防与管理专家共识. 中华风湿病学杂志, 2013,17(8):508-512. doi: 10.3760/cma.j.issn.1007-7480.2013.08.002.
[15]	中华医学会感染病学分会艾滋病学组, 中华医学会热带病与寄生虫学分会艾滋病学组. HIV合并结核分枝杆菌感染诊治专家共识. 中华临床感染病杂志, 2017,10(2):81-90.doi: 10.3760/cma.j.issn.1674-2397.2017.02.001.
[16]	World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization, 2019.
[17]	钟球, 成诗明, 周林. 学校结核病筛查技术手册. 北京: 人民卫生出版社, 2018.
[18]	Jiang Q, Lu L, Wu J, et al. Assessment of tuberculosis contact investigation in Shanghai, China: An 8-year cohort study. Tuberculosis (Edinb), 2018,108:10-15. doi: 10.1016/j.tube.2017.10.001. doi: 10.1016/j.tube.2017.10.001 URL
[19]	高磊, 权竹声, 成君, 等. 结核分枝杆菌感染检测两步法在学校结核病控制工作中的应用探讨. 中华预防医学杂志, 2020,54(4):385-391. doi: 10.3760/cma.j.cn112150-20191204-00909.
[20]	卢鹏, 成君, 路希维, 等. 科学开展预防性治疗加速遏制结核病进程. 中国防痨杂志, 2020,42(4):316-321.doi: 10.3969/j.issn.1000-6621.2020.04.004.
[21]	吕筠, 李立明. 高危人群策略与全人群策略解读. 中华流行病学杂志, 2010,31(2):231-232,178.doi: 10.3760/cma.j.issn.0254-6450.2010.02.026.
[22]	陶立峰, 蒲江. 结核病疫苗研究进展. 中国新药杂志, 2019,28(21):2624-2629.
[23]	Eastment MC, McClintock AH, McKinney CM, et al. Factors that influence treatment completion for latent tuberculosis infection. J Am Board Fam Med, 2017,30(4):520-527. doi: 10.3122/jabfm.2017.04.170070. doi: 10.3122/jabfm.2017.04.170070 URL pmid: 28720633
[24]	Rose G, Khaw KT, Marmot M. Rose’s strategy of preventive medicine. Oxford: Oxford University Press, 2008.
[25]	高谦, 梅建, 谭卫国. 实事求是抓住核心脚踏实地精准防控. 中国防痨杂志, 2019,41(10):1074-1079.doi: 10.3969/j.issn.1000-6621.2019.10.002.
[26]	World Health Organization. New WHO recommendations to prevent tuberculosis aim to save millions of lives. Geneva: World Health Organization, 2020.