耐药结核病的研究进展

Research progress of drug-resistant tuberculosis

耐药结核病是当今世界非常严峻的公共卫生问题,它直接影响着全球结核病疫情的控制。除我们常见的耐多药结核病外,近年来耐药结核病的定义和类型也在不断变化并增加,如超广泛耐药、全耐药等。耐药结核病的诊断主要通过常规的细菌学和核酸检测方法在实验室中确定。部分药物敏感的病例由于对抗结核药物不能耐受而使治疗方案受限,表现为与耐药结核病相同的治疗结果,可称之为"临床耐药结核病"。对耐药结核病的预防主要寄望于现有抗结核药物的个性化使用,用足核心药物异烟肼和利福平是关键。抗结核新药的出现有助于我们控制耐多药结核病,但现阶段仍要注意实施综合疗法,加大病灶局部的抗结核药物浓度,立足于现有药物,个性化治疗耐多药结核病才是正确的道路。

Drug-resistant tuberculosis is a severe global public health problem currently, and it influences the control of global tuberculosis epidemics. In addition to known multi-drug resistant tuberculosis, the definitions and types of drug-resistant tuberculosis have been increased recently, such as super extensively drug-resistant the definitions and totally drug-resistant tuberculosis. For the diagnosis of drug-resistant tuberculosis, many methods such as regular bacteriology and nucleic acid analysis are used. Some drug-sensitive cases are limited in the therapy and show an incurable result just because of unbearable to anti-tuberculosis drugs. We name this phenomenon as ＂clinical resistance＂. The prevention of drug-resistant tuberculosis depends on individualized chemotherapy with first-line anti-tuberculosis drugs, and the core drugs including isoniazide and rifampicin will play a key role. Though novel anti-tuberculosis drugs will help controlling the multi-drug resistant tuberculosis, comprehensive treatment therapy and local high-dose injection of anti-tuberculosis drugs should still be better methods. Depending on the currently available drugs, individualized treatment of multi-drug resistant tuberculosis is a potential better methods.