2017-01-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/701479摘要：結核病目前仍為國內重要法定傳染病，雖然「結核病十年減半全民動員計畫」成效卓著，但台灣的結核病防治仍然面臨嚴峻挑戰。在國內，目前的結核病潛伏感染檢查與投藥，主要集中在指標個案的近距離接觸者，對於世界衛生組織在指引中強烈建議的其他極高風險族群，例如HIV/AIDS患者以及洗腎與腎臟移植患者，尚無常規進行潛伏感染檢查與投藥，因此極需相關研究之評估。此外，除了HIV/AIDS患者以及洗腎與腎臟移植患者這類的高危險族群之外，在其他中等強度的危險族群，例如糖尿病、酗酒，吸菸、與營養不良族群等，是否該進行個案發現以及潛伏感染治療，其效益仍不明。這些中等強度之危險因子與結核病之間的相對風險大多在三倍以下，因此在非結核高盛行率的國家如台灣，若針對單一危險因子/族群篩檢，需要篩檢的人數可能都會很高。若能從這些危險因子當中找尋到風險最高的族群特徵 (例如:糖尿病控制不佳+吸菸+慢性腎衰竭)，不僅能增加篩檢效率，也可以大幅縮減需要篩檢的人數。本團隊針對國內特殊族群潛伏結核治療以及個案發現之防疫需求，提出一整合型計畫。對於極高風險的HIV/AIDS與洗腎及腎臟移植患者，我們將透過實證研究評估結核潛伏感染情形，以及感染陽性的預防性投藥之可能成效與副作用，同時建立起該族群進行潛伏感染檢查與投藥之醫療照護模式。此外，對於非極高風險的其他共病族群(糖尿病患者、吸菸、營養不良等)，我們將使用具有全國代表性的大型健康調查，建立一般民眾(非接觸者)之結核病發病風險預測評分系統，此系統將可拿來鎖定具有較高風險的特殊共病族群，在防疫資源有限之時，針對接觸者與極高風險以外的族群，以利進行個案發現以及潛伏結核檢查治療。<br> Abstract: Taiwan has made substantial progress in the reduction of tuberculosis burden in the past 10 years. Current control measures focus on passive case finding and directly observed therapy, active case finding in selected population (e.g., close contact of index cases and prisoners), and diagnosis and treatment of latent tuberculosis infection in close contact. To maintain or even accelerate the decline of tuberculosis incidence, it is necessary to consider expanding the targeted approach to include other high risk populations. Despite the strong recommendation by WHO, currently diagnosis and preventive treatment of latent tuberculosis infection is not routinely implemented in people living with HIV/AIDS, dialysis patients, and kidney transplantation patients. In addition, it is unclear whether other risk groups (such as diabetes, smoking, alcohol use, and malnutrition) should be included in active case finding and/or screening for latent tuberculosis infection. These risk factors often have a moderate association (relative risk < 3) with active tuberculosis. Therefore the efficiency and cost-effectiveness of targeting these populations remain unclear. A risk stratification system to help identify the population with the highest risk is urgently needed.We propose to conduct a one-year integrated project to address the research and policy need for latent tuberculosis infection treatment and active case finding. We will conduct empirical study on people living with HIV/AIDS, dialysis patients, and kidney transplantation patients to assess the prevalence of latent tuberculosis infection using interferon gamma release assay. For those who are test positive for latent infection, we will provide prophylactic treatment using directly observed therapy (DOPT). For the populations with moderately elevated tuberculosis risk, we will use a nationally representative health survey (National Health Interview Survey) to construct a cohort to comprehensively assess the risk of tuberculosis among specific populations. The cohort profile will be used to construct and validate a risk scoring system for active tuberculosis. The scoring system can be used to identify the groups with the highest risk of tuberculosis (e.g., diabetes with poor control plus smoking plus malnutrition) as the target of case finding and latent infection treatment. Our integrated project will add to the existing tuberculosis control interventions and help formulate the post-2015 tuberculosis control policy.潛伏結核感染預防投藥主動個案發現愛滋病洗腎腎臟移植風險評分系統latent tuberculosis infectionpreventive treatmentactive case findingHIV/AIDSdialysiskidney transplantationrisk scoring system