秒速赛车控制器

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2015 年 WHO「潛伏結核感染管理指南」解讀
發布時間: 2015-11-20     來源: 丁香園

 2014 年 5 月,第 67 屆世界衛生組織大會制定并通過了 2015 年后的全球結核病戰略—消除結核(TB)。戰略的愿景是讓世界不再受肺結核之苦,即零死亡、零發病和零痛苦。其中潛伏性結核感染的管理是該戰略中至關重要的一部分。

JINQIQIANFUXINGJIEHEGANRANGUANLIZHINANYIJINGTUICHU,GAIZHINANZHUYAOYOU 4 GEBUFENZUCHENG,JIZHINANXINGCHENGDEBEIJINGYUGUOCHENG、TUIJIANFANGAN、SHISHIZHONGJIANGYUDAODEWENTI、YANJIUKONGBAI,BINGZAIFULUZHONGLIECHULEZHINANDEZHUYAOMUBIAOGUOJIA、JIXITONGXINGPINGJIA、GEIYAOJILIANGDENG。XIAMIANJIUZHINANZHONGYULINCHUANGGUANXIMIQIEDEBUFENZUOJIANYAOZONGJIE。

LTBI 定義

JIEHEFENZHIGANJUNGANRANFENWEIQIANFUXINGYUHUODONGXINGLIANGZHONGZHUANGTAI。QIANFUXINGJIEHEGANRAN(YIXIAJIANCHENG LTBI)BEIDINGYIWEIJITIDUIJIEHEFENZHIGANJUNKANGYUANYOUCHIXUDEMIANYIYINGDA,DANWUHUODONGXINGJIEHELINCHUANGZHENGJUDEYIZHONGZHUANGTAI。

MUQIANSHANGWUGONGJUKEZHIJIEJIANCE TB GANRANZHE。JUEDADUOSHUGANRANZHEWUJIEHEJIBINGDEJIXIANGHUOZHENGZHUANGQIEWUCHUANRANXING,DANRENGYOUFAZHANWEIHUODONGXING TB DEFENGXIANBINGJUCHUANRANXING。QIZHONG,RENTIDEMIANYIZHUANGTAISHIFAZHANWEI TB ZUIGUANJIANDEJUEDINGYINSU。

識別和檢測高危群體

YINGJINXING LTBI JIANCEHEZHILIAODEGAOWEIQUNTISHICONG 3 FENXITONGPINGJIAZHONGQUANHENGLIBIHOUQUEDINGDE。ZHINANGENJUKEFENPEIZIYUANQINGKUANGTIGONGFENJIBIEDEJIANYI:

秒速赛车控制器1. GUJI TB FABINGLVXIAOYU 100/10 WANRENNIANDEGAOSHOURU / ZHONGGAOSHOURUGUOJIA

(1)QIANGLIEJIANYIDUI HIV GANRANZHE、YOUFEIJIEHEJIECHUSHIDECHENGRENHEERTONG、KAISHIKANGZHONGLIUHUAISIYINZI(TNF)ZHILIAODEHUANZHE、TOUXIZHILIAOHUANZHE、ZHUNBEIQIGUANHUOXUEYEYIZHIDEHUANZHEYIJIGUIFEIHUANZHE,JUNYINGJINXINGXITONGDE LTBI JIANCEHEZHILIAO。JIANYISHIYONGGANRAOSU - γ SHIFANGSHIYAN(IGRA)HEJIEHEJUNSUPIFUSHIYAN(TST)YONGYU LTBI JIANCE。

(2)TIAOJIANXINGJIANYIDUIQIUFAN、YIWURENYUAN、LAIZI TB GAOFUDANGUOJIADEYIMIN、WUJIAKEGUIZHEHEWEIFAYAOWUSHIYONGZHEJINXINGXITONGDE LTBI DEJIANCEHEZHILIAO。

秒速赛车控制器(3)CHUFEISHUYUSHANGSHUTUIJIANRENQUN,FOUZEBUJIANYIDUITANGNIAOBINGHUANZHE、XUJIUZHE、XIYANZHEHEDITIZHONGZHEJINXINGXITONGDE LTBI JIANCE。

2. CHUSHANGSHUGUOJIAWAIDEQITAZIYUANYOUXIANDEGUOJIAJIZHONGDENGSHOURUGUOJIA

秒速赛车控制器HIV GANRANZHE、HUOYUJIEHE /LTBI GANRANZHEYOUMIQIEJIECHUSHI、HUOJIATINGCHENGYUANZHONGYOUGANRANZHEDE 5 SUIYIXIAERTONGYINGJINXINGZHILIAO。

檢測和治療流程


圖 1. 高風險群體的個體目標診斷和治療流程

秒速赛车控制器YOUYUPAICHUHUODONGXING TB HEQUEZHEN LTBI DUIHUANZHEDEYUHOUZHIGUANZHONGYAO,GUZHINANQIANGLIETUIJIANZHENGZHUANGSHAICHAHEZHILIAOQIANYUXIANXIONGPIANJIANCHA。

ZAIKAISHI LTBI JIANCHAHEZHILIAOQIAN,XUNWENHUANZHE TB XIANGGUANZHENGZHUANG。XIONGPIANJIANCHAYONGYUFAXIANHUODONGXINGJIEHE。YOU TB ZHENGZHUANGHUOXIONGPIANYICHANGZHEYINGGAIJINXINGJINYIBUJIANCHAZHENGSHIHUODONGXING TB HUOQITAQINGKUANG。ZAIJIEHEFABINGLVGUZHI<100/10 WANRENDEGAOHUOZHONGGAOSHOURUGUOJIA,WULUN IGRA HUANSHI TST JIEKEYONGYU LTBI DEJIANCE。ZAIDISHOURUHEQITAZHONGDENGSHOURUGUOJIA,IGRA BUYINGTIDAI TST。

LTBI 的治療方案

一項  包含 53 組隨機對照試驗的研究系統評估了 LTBI 治療的有效性和安全性。經分析,LTBI 的治療推薦有如下 5 項可選:

秒速赛车控制器1. YIYANJINGZHILIAO 6 GEYUE;

秒速赛车控制器2. YIYANJINGZHILIAO 9 GEYUE;

3. LIFUPENDING + YIYANJINGZHILIAOMEIZHOUYICI,LIAOCHENG 3 GEYUE;

4. YIYANJING + LIFUPINGZHILIAO 3-4 GEYUE;

秒速赛车控制器5. DANYONGLIFUPINGZHILIAO 3-4 GEYUE。

表 1. 推薦藥物劑量 

其中,對前三項等效的觀點,委員會已達成共識。需要注意的是,由于藥物的相互作用,包含利福平和利福噴丁的治療方案慎用于正在進行抗逆轉錄病毒治療的 HIV 感染者。

由于證據質量的限制,指南未推薦將多重耐藥 TB 的預防性治療作為公共衛生措施。對 活動性 TB 的患者要進行  至少兩年的嚴格臨床觀察和密切監測。有多重耐藥 TB 接觸史者的管理需綜合個人風險評估,權衡利弊。利大于弊時,臨床醫生可考慮個體化治療方案。

不良事件監測

YAOWUDEBULIANGFANYING,YIYANJINGYOUWUZHENGZHUANGDEXUEJIANGGANMEINONGDUSHENGGAO、WAIZHOUSHENJINGBINGBIANHEGANDUXING,LIFUPINGHELIFUPENDINGYOUPIFUFANYING、GUOMINXINGFANYING、WEICHANGDAOFANYINGHEGANDUXING。QIZHONG,ZUIYINGZHUYIYUFANGYAOWUXIANGGUANDEGANDUXING。

ZHINANQIANGDIAOCHANGGUILINCHUANGJIANCEDEZHONGYAOXING。LTBI ZHILIAOQIJIANYINGMEIYUEFUZHEN。YIWURENYUANYINGXIANG LTBI GANRANZHEJIESHIJIBINGJINCHENG、ZHILIAOYUANLI,BINGQIANGDIAOWANCHENGZHILIAODEZHONGYAOXING。RUOCHUXIANWUFAJIESHIDEYANSHI、EXIN、OUTU、FUBUBUSHI、CHIXUFALIHUOXURUO、NIAOSESHEN、TAOTUYANGBIANHUOHUANGDANSHI,ZHILIAOYINGLIJITINGZHI。

ZHINANQIANGLIEJIANYIBAOHANXIALIEFENGXIANYINSUZHEJINXINGJIZHUNSHIYANSHIJIANCHA:YOUGANZANGBINGSHI、SHIJIU、MANXINGGANBING、HIV GANRAN、DAYU 35 SUI、HUAIYUNHUOCHANHOUSANYUENEI。YIJINGFAXIANJIBENJIANCHAJIEGUOYICHANG,YINGCHANGGUIDINGQIJINXINGSHIYANSHIJIANCHA。

LTBI 治療的耐藥風險

MUQIANYOUZHENGJUXIANSHIKANGJIEHEYAOWUNAIYAOHESHIYONGYIYANJINGHELIFUPINGZHILIAO LTBI ZHIJIANWUMINGXIANXIANGGUAN,DANZHENGJUZHILIANGJIDI,GUYINGJIANLIGUOJIAJINAIYAOJIANCEXITONGJISHISHI LTBI GUANLIXIANGMU。

BENZHINANWEIRAO LTBI GUANLIZHEYIDAQIANTI,TONGGUOFENXIYUANSHIZHENGJU,QUANHENGLIBI,ZAISHAICHAGAOWEIQUNTI、JIANCEFANGFA、ZHILIAOJISUIFANGDENGFANGMIANTICHUBUTONGJIBIEDETUIJIAN。CHUCIZHIWAI,HUANLIECHULETUIJIANYUANYINJITUIJIANDEGUOCHENG。WULUNSHIDUIJINHOUGUOJIACENGMIANSHANGDEZONGHEFANGZHIHUANSHILINCHUANGZHONGGETIHUAJIANCEHEZHILIAO,DOUJUYOUHENQIANGDEZHIDAOYIYI。