耐多药和广泛耐药结核病。

Multidrug and extensively drug-resistant tuberculosis.

机构信息

Centre d'immunologie et des maladies infectieuses, Sorbonne universités, UPMC université Paris 06, Inserm, UMR 1135, 91, boulevard de l'Hôpital, 75013 Paris, France.

Centre d'immunologie et des maladies infectieuses, Sorbonne universités, UPMC université Paris 06, Inserm, UMR 1135, 91, boulevard de l'Hôpital, 75013 Paris, France; Laboratoire de bactériologie-hygiène, centre national de référence des mycobactéries, CHU Pitié-Salpêtrière, AP-HP, 47, boulevard de l'Hôpital, 75013 Paris, France.

出版信息

Med Mal Infect. 2017 Feb;47(1):3-10. doi: 10.1016/j.medmal.2016.07.006.

DOI:10.1016/j.medmal.2016.07.006

PMID:27637852

Abstract

The emergence of drug-resistant tuberculosis (TB) compromises global tuberculosis control. The incidence of multidrug-resistant strains (MDR) defined as resistant to the two main antituberculosis drugs, rifampicin and isoniazid, was raised in the 1990s. Ten percent of these strains have developed additional resistance to the main second-line antituberculosis drugs: fluoroquinolones and aminoglycosides. These strains are defined as extensively drug-resistant (XDR). The prognosis of MDR-TB and XDR-TB is poor due to limited therapeutic resources. However, many new innovations may lead to a radical change in this field. Genotypic testing is now able to detect drug resistance within a few hours. Genotypic diagnosis of rifampicin resistance is now recommended in France for each new case of TB. The currently recommended treatment for MDR-TB is long (18-24 months) and toxic. It is, however, on the verge of being replaced by a 9-month treatment. New antituberculosis drugs such as bedaquiline and delamanid should also improve the prognosis of MDR-TB and XDR-TB.

摘要

耐药性结核病（TB）的出现危及全球结核病控制。20 世纪 90 年代，耐多药菌株（MDR）的发病率上升，定义为对两种主要抗结核药物利福平（rifampicin）和异烟肼（isoniazid）耐药。其中 10%的菌株对氟喹诺酮类和氨基糖苷类主要二线抗结核药物产生了额外的耐药性。这些菌株被定义为广泛耐药性（XDR）。由于治疗资源有限，MDR-TB 和 XDR-TB 的预后较差。然而，许多新的创新可能会彻底改变这一领域。基因检测现在可以在几个小时内检测出药物耐药性。目前，法国建议对每个新的结核病病例进行利福平耐药的基因诊断。目前推荐的 MDR-TB 治疗时间长（18-24 个月）且毒性大。然而，这种治疗方法即将被 9 个月的治疗方法所取代。新型抗结核药物，如贝达喹啉（bedaquiline）和德拉马尼（delamanid），也应改善 MDR-TB 和 XDR-TB 的预后。