低罹患国における結核専門診療所の20年間の経験
Sandra Pérez-Recio1, Maria D Grijota-Camino2, Jordi Guardiola3,4
1Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
まとめ
生物学的治療 (BioT) の前に結核 (TB) のスクリーニングが不可欠です. インターフェロンγ放出測定法 (IGRA) の単一の検査は有効であり,陰性検査の後の定期的な再スクリーニングは推奨されません.
科学分野:
- 免疫学
- 感染症
- 薬理学について
背景:
- 生物学的治療法 (BioT) は,結核 (TB) の再活性化のリスクを増加させる可能性があります.
- 効果的なスクリーニング戦略は,このリスクを軽減するために不可欠です.
- QuantiFERON- TB (QFT) Goldのようなインターフェロンγ放出アッセイ (IGRA) のスクリーニングにおける役割については,さらなる評価が必要である.
研究 の 目的:
- 生物治療を受ける患者の結核のリスクを評価する.
- 単独のスクリーニングテストとしてQFT Goldの有効性を評価する.
- 定期的な再検査が必要かどうかを判断する.
主な方法:
- 4つの異なる戦略を用いて,BioTを開始した1,368人の患者をスクリーニングした.
- 戦略には,様々な組み合わせで結核素皮膚検査 (TST) とQFTゴールド (インチューブまたはプラス) が含まれていた.
- 結核感染と診断された患者は予防療法を受けた.
主要な成果:
- 異なるスクリーニング戦略で結核感染の流行率が著しく低下した (40. 8% から 14. 8%).
- 追跡期間中に結核を発症したのは患者の0. 8%のみで,すべての症例は最初の1年以内に発症した.
- スクリーニング期間間には,結核無生存期における有意な差は認められなかった.
結論:
- BioTに関連した結核のリスクを減らすことはできますが,完全に予防することはできません.
- 単一のQFTゴールドテストは効果的なスクリーニング方法です.
- 定期的な結核再検査は,前バイオテストで陰性が出た場合では不要です.
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