Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK.
Imperial College Healthcare NHS Trust, London, UK.
Clin Med (Lond). 2019 Mar;19(2):135-139. doi: 10.7861/clinmedicine.19-2-135.
Of the 10 million incident cases of tuberculosis (TB) globally in 2017, around 558,000 cases were rifampicin-resistant of which 82% were multidrug-resistant (MDR) TB. In England, 5,102 cases were recorded of which 55 cases (1.8%) were MDR-TB. MDR-TB cases have worse outcomes and are a serious public health issue.Polymerase chain reaction (PCR) tests allow a faster approach to diagnose TB and predict drug susceptibility. The emerging use of whole genome sequencing may improve the diagnostic workflow compared with standard drug susceptibility testing, with more rapid molecular sensitivity results and more precise contact investigation of linked cases.Treatment of MDR-TB remains a challenge as it relies on prolonged second-line drug treatments that are less effective and more toxic than first-line treatments. Two new drug treatments have been approved; bedaquiline and delamanid. In addition, a shorter treatment regimen of 9-12 months can be considered instead of the conventional 20-24 month regimen.
在 2017 年全球 1000 万例结核病（TB）发病病例中，约有 55.8 万例为利福平耐药病例，其中 82%为耐多药（MDR）TB。在英国，共记录了 5102 例病例，其中 55 例（1.8%）为 MDR-TB。MDR-TB 病例的预后更差，是一个严重的公共卫生问题。聚合酶链反应（PCR）检测可更快地诊断结核病并预测药物敏感性。全基因组测序的新兴应用可能会改善与标准药敏检测相比的诊断工作流程，获得更快速的分子敏感性结果，并更精确地对相关病例进行接触调查。MDR-TB 的治疗仍然是一个挑战，因为它依赖于延长二线药物治疗，这些药物的疗效不如一线药物，而且毒性更大。已经批准了两种新的药物治疗方法；贝达喹啉和德拉马尼。此外，还可以考虑采用 9-12 个月的较短治疗方案，而不是常规的 20-24 个月方案。
