The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
Lancet. 2011 Jul 2;378(9785):57-72. doi: 10.1016/S0140-6736(10)62173-3. Epub 2011 Mar 21.
Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects. Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes. Moreover, our fundamental understanding of the pathogenesis of this disease is inadequate. However, increased investment has allowed basic science and translational and applied research to produce new data, leading to promising progress in the development of improved tuberculosis diagnostics, biomarkers of disease activity, drugs, and vaccines. The growing scientific momentum must be accompanied by much greater investment and political commitment to meet this huge persisting challenge to public health. Our Seminar presents current perspectives on the scale of the epidemic, the pathogen and the host response, present and emerging methods for disease control (including diagnostics, drugs, biomarkers, and vaccines), and the ongoing challenge of tuberculosis control in adults in the 21st century.
每年约有 170 万人死于结核病，全球新发病例（超过 900 万例）高于历史上任何时期。22 个低收入和中等收入国家占全球活动病例的 80%以上。由于艾滋病毒对结核病易感性的破坏性影响，撒哈拉以南非洲受到的影响不成比例，每五例艾滋病毒相关结核病中就有四例发生在该地区。在许多结核病高度流行的地区，诊断仍然依赖于百年前的痰显微镜检查；没有足够有效率的疫苗，结核病的治疗方案漫长且有产生毒性作用的风险。东欧、亚洲和撒哈拉以南非洲日益增加的耐多药结核病率现在有可能破坏全球结核病控制规划取得的成果。此外，我们对这种疾病发病机制的基本了解还不够。然而，增加投资使基础科学和转化及应用研究产生了新的数据，为改进结核病诊断、疾病活动生物标志物、药物和疫苗的开发带来了有希望的进展。日益增长的科学势头必须伴随着更大的投资和政治承诺，以应对这一对公共卫生构成的巨大持续挑战。我们的研讨会介绍了当前对该疾病流行规模、病原体和宿主反应、目前和新出现的疾病控制方法（包括诊断、药物、生物标志物和疫苗）的看法，以及 21 世纪成人结核病控制的持续挑战。
