THE HISTORY OF TUBERCULOSIS AS A GLOBAL EPIDEMIC
THE HISTORY OF TUBERCULOSIS AS A GLOBAL EPIDEMIC
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DOI：
10.1016/s0025-7125(16)30188-2
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发表时间：
1993-11-01
影响因子：
5.9
通讯作者：
STEAD, WW
中科院分区：
文献类型：
--
作者：
BATES, JH;STEAD, WW
结核病应被视为一种缓慢进展的全球流行病。最初，它是一种低等哺乳动物的疾病，其病因可能早于地球上人类的出现。当人类开始定居乡村并发展农业时，它就成为一种罕见的人类地方病。欧洲城市的拥挤，以及后来欧洲的工业革命，为这种地方病的流行提供了必要的环境条件。在接下来的 400 年里，这种疾病通过欧洲帝国的建立和殖民而传播。它到达撒哈拉以南非洲和太平洋岛屿的时间较晚，到达新几内亚高地的时间更晚。随着耐药个体的生存和繁殖，这种流行病在一个大的人群中逐渐减弱。这种天然抵抗力反映在巨噬细胞控制生物体细胞内生长的能力上。耐药宿主表现出主要影响肺部的慢性感染，而高度易感宿主则表现出迅速致命的疾病，疾病广泛传播到许多器官。初次感染的幸存者会表现出另一种基于致敏 T 细胞的对再感染的抵抗力。当该系统仅部分成功时，宿主就会具有传染性并能够广泛传播感染。结核病流行病学研究以及预防或控制该疾病的各种公共卫生措施的评估要求研究者了解所研究的特定人群中结核病流行的性质和持续时间。这个因素对流行病进程的决定因素比人类可以采取的任何公共卫生措施都要大得多，就像河中的水流对独木舟的航向的影响比最有力的桨手的影响更大一样。
TB should be thought of as a slowly progressing worldwide epidemic. Initially it was a disease of lower mammals, and the etiologic agent probably preceded the development of man on earth. It became an uncommon endemic disease in man about the time man began to settle in villages and develop agriculture. Crowding in European cities, and later the industrial revolution in Europe, provided the necessary environmental conditions for the endemic disease to become epidemic. For the next 400 years, the disease was spread by European empire-building and colonization. It came late to sub-Saharan Africa and to the Pacific Islands, and still later to the highlands of New Guinea. The epidemic gradually wanes within a large population group as resistant individuals survive and reproduce. This natural resistance is reflected in the ability of the macrophage to control intracellular growth of the organism. The resistant host shows a chronic infection primarily affecting the lungs, whereas the highly susceptible host shows a rapidly fatal illness with generalized spread of disease to many organs. Survivors of the initial infection then show another type of resistance to reinfection that is based on sensitized T cells. When this system is only partially successful, the host becomes infectious and capable of spreading the infection widely. The study of the epidemiology of TB and the evaluation of various public health measures to prevent or contain the disease requires that the investigator have an understanding of the nature and duration of the TB epidemic in the particular population under study. This factor is a much greater determinant of the course of an epidemic than any public health measure that man can institute, just as the currents in a river can have a more powerful effect on the course of a canoe than the most vigorous paddler.