Strategies against multidrug-resistant tuberculosis
Strategies against multidrug-resistant tuberculosis
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DOI：
10.1183/09031936.02.00401302
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发表时间：
2002-07-01
影响因子：
24.3
通讯作者：
Brendel, A
中科院分区：
文献类型：
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作者：
Loddenkemper, R;Sagebiel, D;Brendel, A
耐多药结核病（MDR-TB）是指至少对异烟肼和利福平产生耐药性的结核病，其上升对一些高流行率国家的结核病控制构成了严重威胁，并可能对低流行率地区产生一些影响。世界卫生组织估计，全世界有5000万人感染了MDR-TB，2000年有273人感染了MDR-TB，在870万新发结核病病例中，耐多药结核病病例占3.1%。1998年，新病例中耐多药结核病率和合并（新病例和以前治疗过的病例）耐多药结核病率最高的是爱沙尼亚（14.1%和18.1%），中国河南省（10.8%和15.1%）、拉脱维亚（9.0%和12.0%）、俄罗斯联邦伊万诺沃州（9.0%和12.3%）和托木斯克州（6.5%和13.7%）。NIDR-TB的风险因素是以前的治疗或复发，起源于“热点”地区，监禁史，无家可归，可能还有人类免疫缺陷病毒。由于副作用和长达3年的治疗时间，耐多药结核病的治疗是困难的，这是昂贵的，而且往往不成功。因此，迫切需要治疗和预防耐多药结核病的战略。这就需要有效的结核病控制方案（短期直接观察治疗），并在一些流行率高的国家，在适当的敏感性测试基础上采用二线药物（短期直接观察治疗+）。只有未来才能证明这颗“滴答作响的定时炸弹”能否拆除。
The rise of multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis showing resistance to at least isoniazid and rifampicin, is a serious threat to tuberculosis control in some high prevalence countries and may have some impact on low prevalence regions as well.The World Health Organization estimates that 50 million people worldwide are infected with MDR-TB, and that, in the year 2000, 273,000 (3.1%) MDR-TB cases were among the 8.7 million new tuberculosis cases. In 1998, the highest MDR-TB rates among new cases and the highest combined (new and previously treated cases) MDR-TB rates were found in Estonia (14.1 and 18.1%.), Henan province in China (10.8 and 15.1%), Latvia (9.0 and 12.0%), and Ivanovo Oblast (9.0 and 12.3%) and Tomsk Oblast (6.5 and 13.7%) in the Russian Federation. The risk factors for NIDR-TB are previous treatment or relapse, originating from "hot spot" areas, a history of imprisonment, homelessness and possibly also human immunodeficiency virus.The treatment of multidrug-resistant tuberculosis is difficult due to side-effects and a treatment duration of up to 3 yrs, which is expensive and often unsuccessful. Therefore, strategies for the treatment and prevention of multidrug-resistant tuberculosis are urgently required. This requires functioning tuberculosis control programmes (directly observed treatment short course), and, in some high prevalence countries, the introduction of second-line drugs on the basis of appropriate susceptibility testing (directly observed treatment short course-Plus). Only the future will show whether this "ticking time bomb" can be defused.