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结核病和炎症性肠道疾病
Lucía Madero1, Iria Bastón2, Eduard Brunet-Mas3
1Hospital General Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
接受免疫抑制剂的炎症性肠病 (IBD) 患者面临更高的结核病 (TB) 风险. 在治疗前对潜伏结核病感染 (LTBI) 的查至关重要,以防止重新激活并安全指导治疗.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 炎症性肠病 (IBD) 包括性结肠炎和克罗恩病.
- 肠胃炎症患者,特别是那些接受抗TNF药物等免疫抑制疗法的患者,患结核病 (TB) 的风险较高.
- 结核病再激活的风险受免疫抑制药物的类型的影响,药物的组合可能会增加这种风险.
研究的目的:
- 要突出患有炎症性肠道疾病的患者肺结核风险增加.
- 强调在开始IBD患者免疫抑制疗法之前对潜伏结核感染 (LTBI) 进行查的必要性.
- 在该患者群体中提供关于LTBI和活跃结核病的诊断方法和管理策略的指导.
主要方法:
- 审查有关IBD患者结核病风险的当前指南和文献.
- 讨论LTBI的诊断方式,包括结核素皮肤测试 (TST) 和干扰素释测试 (IGRA).
- 考虑像胸部X射线等成像技术以及LTBI和活跃结核病的管理协议.
主要成果:
- 针对IBD的免疫抑制疗法,包括抗TNF药物,免疫调节剂,抗整体素,IL-12/23抑制剂和JAK抑制剂,与结核病复激活的变化风险有关.
- 建议在IBD诊断或先进治疗之前对LTBI进行查,对于免疫受损的个人建议进行双重测试.
- 在免疫抑制之前建议对LTBI进行化疗预防;活性结核病需要停止治疗和抗结核疗法.
结论:
- 潜伏结核病感染的积极查和管理对于炎症性肠病患者的安全治疗至关重要.
- 应仔细考虑免疫抑制疗法,根据个体患者的因素进行风险分层和潜在的重新引入.
- 活疫苗,如BCG,在接受免疫抑制治疗的IBD患者中是禁忌的.
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