耐药结核病的现状与治疗策略
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摘要
结核病是全世界重大公共卫生问题之一,严重威胁着人类健康和生命安全。随着人口流动性增大、抗结核药物使用不规范,耐药结核所占比例逐年增加。面对耐药结核患者充满了挑战,临床表现复杂多变,往往症状较轻,主要依靠结核分枝杆菌药物敏感试验诊断,给临床诊断带来很大难度。由于抗结核药物选择有限,而且需同时使用多种药物联合化疗,疗程较长,病人依从性较差,一旦出现广泛耐药结核病,临床治疗就显得束手无策。本文就近年来耐药结核病的研究进展进行综述。
Tuberculosis(TB)is one of the major public health problem in the world,which seriously threaten to human health and life safety.With the growing mobility of the population and using non-standard of the anti-TB drugs,the proportion of drug-resistant tuberculosis(DR-TB)increases year by year.Doctor face to the patients with DR-TB is full of challenges,because of the complicated clinical manifestation and the light symptom.DR-TB mainly relies on drug sensitivity test which brings great difficulty to clinical diagnosis.Once it becomes extensively-resistant tuberculosis(XDR-TB),clinical treatments will seem helpless.This article reviewed the progress in the study of DR-TB in recent years.
Tuberculosis(TB)is one of the major public health problem in the world,which seriously threaten to human health and life safety.With the growing mobility of the population and using non-standard of the anti-TB drugs,the proportion of drug-resistant tuberculosis(DR-TB)increases year by year.Doctor face to the patients with DR-TB is full of challenges,because of the complicated clinical manifestation and the light symptom.DR-TB mainly relies on drug sensitivity test which brings great difficulty to clinical diagnosis.Once it becomes extensively-resistant tuberculosis(XDR-TB),clinical treatments will seem helpless.This article reviewed the progress in the study of DR-TB in recent years.
引文
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[21]Lauzardo M,Peloquin CA.Tuberculosis therapy for 2016and beyond[J].Expert Opin Pharmacother,2016,17(14):1859-1872.
[22]Parmar A,Iyer A,Vincent CS,et al.Efficient total syntheses and biological activities of two teixobactin analogues[J].Chem Commun(Camb),2016,52(36):6060-6063.
[23]Kling A,Lukat P,Almeida DV,et al.Antibiotics.Targeting DnaN for tuberculosis therapy using novel griselimycins[J].Science,2015,348(6239):1106-1112.
[24]肖和平.耐药结核病化学治疗指南(2009)[J].中国防痨杂志,2015,37(5):421-469.
[25]黄学锐,唐神结.耐药结核病的综合治疗[J].医药导报,2016,(03):257-259.
[26]张雍容,刘建,王勇等.IL-2和GM-CSF免疫治疗耐多药结核病的研究[J].中国科学:生命科学,2012,(10):801-808.
[27]邹良能,黄继义,叶志忠,等.化疗联合免疫调节优化治疗耐多药结核病的疗效观察[J].中国医院用药评价与分析,2014,(08):698-700.
[28]杨日耀.CT引导经皮肺穿刺注药治疗耐多药空洞型肺结核[J].中国药物经济学,2014,(02):215-216.
[29]吕康言,刘桑,岳静.经皮肺穿刺空洞内置管注药治疗耐多药空洞肺结核疗效观察[J].临床肺科杂志,2011,(10):1550-1551.
[30]结核病临床诊治进展年度报告(2012年)[J].中国防痨杂志,2013,(06):405-426.
[31]Siroka A,Ponce NA,Lnnroth K.Association between spending on social protection and tuberculosis burden:aglobal analysis[J].Lancet Infect Dis,2016,16(4):473-479.
[2]Zhao Y,Xu S,Wang L,et al.National survey of drug-resistant tuberculosis in China[J].N Engl J Med,2012,366(23):2161-2170.
[3]周欢.耐多药结核病的诊断和治疗方法探讨[J].临床医药文献电子杂志,2016,(15):3133-3134.
[4]李文文,冯喜英,关巍.结核病诊断与治疗的研究进展[J].中华肺部疾病杂志(电子版),2016,(02):204-206.
[5]结核病临床诊治进展年度报告(2012年).结核病临床诊断(第一部分)[J].中国防痨杂志,2013,(06):405-426.
[6]Maitra A,Bhakta S.TB Summit 2014:prevention,diagnosis,and treatment of tuberculosis-a meeting report of a Euroscicon conference[J].Virulence,2014,5(5):638-644.
[7]Chapman HJ,Lauzardo M.Advances in diagnosis and treatment of latent tuberculosis infection[J].J Am Board Fam Med,2014,27(5):704-712.
[8]Mitnick CD,Rodriguez CA,Hatton ML,et al.Programmatic Management of Drug-Resistant Tuberculosis:An Updated Research Agenda[J].PLoS One,2016,11(5):0155968.
[9]Drobniewski F,Cooke M,Jordan J,et al.Systematic review,meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis[J].Health Technol Assess,2015,19(34):1-188.
[10]江丽娜,傅衍勇.耐多药结核病的诊断方法及其新型药物概述[J].中国慢性病预防与控制,2016,(06):470-473.
[11]Kontsevaya I,Ignatyeva O,Nikolayevskyy V,et al.Diagnostic accuracy of the genotype MTBDRsl assay for rapid diagnosis of extensively drug-resistant tuberculosis in HIV-coinfected patients[J].J Clin Microbiol,2013,51(1):243-248.
[12]Ignatyeva O,Kontsevaya I,Kovalyov A,et al.Detection of resistance to second-line antituberculosis drugs by use of the genotype MTBDRsl assay:a multicenter evaluation and feasibility study[J].J Clin Microbiol,2012,50(5):1593-1597.
[13]Eichbaum Q,Rubin EJ.Tuberculosis.Advances in laboratory diagnosis and drug susceptibility testing[J].Am J Clin Pathol,2002,118Suppl:S3-17.
[14]李文丽,李金明.结核病实验室诊断新进展[J].实用医院临床杂志,2012,(03):11-14.
[15]Detjen AK,Keil T,Roll S,et al.Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis[J].Clin Infect Dis,2007,45(3):322-328.
[16]Mazurek GH,Jereb J,Vernon A,LoBue P,Goldberg S,Castro K.Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection-United States[J].MMWR Recomm Rep,2010,59(RR-5):1-25.
[17]李红,唐神结,史祥等.全血γ-干扰素释放试验对涂阴肺结核诊断价值的研究[J].中华临床医师杂志(电子版),2012,(16):4894-4897.
[18]Wilson JW,Tsukayama DT.Extensively Drug-Resistant Tuberculosis:Principles of Resistance,Diagnosis,and Management[J].Mayo Clin Proc,2016,91(4):482-495.
[19]张海,焦月琴,朱增红.利奈唑胺治疗广泛耐药性结核的临床疗效分析[J].中国医学工程,2015,(11):56+60.
[20]王莎莎,孙希霞,张宏军.利奈唑胺治疗耐药性结核的临床疗效分析[J].中国医药指南,2014,(33):233.
[21]Lauzardo M,Peloquin CA.Tuberculosis therapy for 2016and beyond[J].Expert Opin Pharmacother,2016,17(14):1859-1872.
[22]Parmar A,Iyer A,Vincent CS,et al.Efficient total syntheses and biological activities of two teixobactin analogues[J].Chem Commun(Camb),2016,52(36):6060-6063.
[23]Kling A,Lukat P,Almeida DV,et al.Antibiotics.Targeting DnaN for tuberculosis therapy using novel griselimycins[J].Science,2015,348(6239):1106-1112.
[24]肖和平.耐药结核病化学治疗指南(2009)[J].中国防痨杂志,2015,37(5):421-469.
[25]黄学锐,唐神结.耐药结核病的综合治疗[J].医药导报,2016,(03):257-259.
[26]张雍容,刘建,王勇等.IL-2和GM-CSF免疫治疗耐多药结核病的研究[J].中国科学:生命科学,2012,(10):801-808.
[27]邹良能,黄继义,叶志忠,等.化疗联合免疫调节优化治疗耐多药结核病的疗效观察[J].中国医院用药评价与分析,2014,(08):698-700.
[28]杨日耀.CT引导经皮肺穿刺注药治疗耐多药空洞型肺结核[J].中国药物经济学,2014,(02):215-216.
[29]吕康言,刘桑,岳静.经皮肺穿刺空洞内置管注药治疗耐多药空洞肺结核疗效观察[J].临床肺科杂志,2011,(10):1550-1551.
[30]结核病临床诊治进展年度报告(2012年)[J].中国防痨杂志,2013,(06):405-426.
[31]Siroka A,Ponce NA,Lnnroth K.Association between spending on social protection and tuberculosis burden:aglobal analysis[J].Lancet Infect Dis,2016,16(4):473-479.