肺结核病的诊断和控制耐药结核的新思维

New thinking in pulmonary tuberculosis diagnosis and drug-resistant tuberculosis treatment

结核病是严重危害公众健康的全球性公共卫生问题，我国是全球第二大结核病高负担国家。第5次全国流行病学调查显示，我国约5．5亿人口曾感染结核，每年新发生活动性肺结核110万～150万例，其中传染性肺结核65万例。耐药结核仍较严重，耐多药结核（MDR-TB）患者12万例，耐多药（MDR）率6．8％，广泛耐药（XDR）率2．1％。对结核病的早期诊断、规范治疗及控制耐药结核是降低结核发病率的有效措施。由于临床表现不典型、潜伏性结核感染及结核耐药问题导致我国的结核疫情防控形势依然严峻。实验室检查是诊断结核的重要手段，常用的实验室诊断技术包括细菌学检测方法、分子生物学检测方法、免疫学检测方法等。在治疗过程中，需要考虑的重要因素有：早期正确的治疗、督导用药及耐药的尽早发现。对于 MDR-TB患者治疗期间，建议使用痰涂片和培养检查进行治疗监测。对耐药结核患者应及早异烟肼和利福平耐药基因检测及快速结核菌培养药物敏感性试验。

Tuberculosis is a global problem that seriously harms public health.China is the second largest number of high tuberculosis（TB）burden in the world.According to the fifth national TB epidemiological survey,there are about 550 million people who are infected with TB,as well as some 11-15 million new cases,including 6.5 million active TB patients.Drug-resistant TB is still serious,there are 120 thousand multi drug resistant TB（MDR-TB） patients,in which multi drug resistant（MDR）rate is 6.8%,extensively drug resistant（XDR）rate is 2.1%.Early diagnosis,standard treatment and drug-resistant tuberculosis control are the effective measures to reduce the incidence of tuberculosis.The situation of tuberculosis prevention and control is still severe,due to lack of typical clinical manifestations,latent tuberculosis infection and drug resistance.The laboratory examination is the most important approach to TB diagnosis.The laboratory diagnosis technique involved bacteriology,molecular biological,immunological methods,and others.In the course of treatment,consideration includes the factors such as correct early treatment, steering medication,early diagnosing and avoiding drug resistance.During the treatment of patients with MDR-TB,the use of sputum smear and culture examination are suggested for treatment monitoring.For drug-resistant tuberculosis patients should get early detection of isoniazid and rifampicin resistant gene,and they should have rapid bacterial culture and drug sensitive test.