Yew W W, Chau C H
Tuberculosis & Chest Unit, Grantham Hospital, Aberdeen, Hong Kong.
Eur Respir J. 1995 Jul;8(7):1184-92. doi: 10.1183/09031936.95.08071184.
There has been an upsurge of tuberculosis in many parts of the world in the past decade. The high rates of drug-resistant tuberculosis currently reported in many countries are alarming. The most catastrophic phenomenon is the emergence of multidrug-resistant strains of Mycobacterium tuberculosis. These organisms have caused epidemic outbreaks in nosocomial and health-care settings in the USA and some European countries. In addition to immigration, poverty, alcoholism and intravenous substance abuse, human immunodeficiency virus (HIV) infection has also had a significant impact on the prevalence of drug resistance, since amongst these patient groups a common factor giving rise to drug resistance is noncompliance. Rapid drug susceptibility tests are needed, and effective chemotherapy regimens with newly developed drugs in combination with traditional second-line antituberculosis agents for established multidrug-resistant tuberculosis are urgently being sought. There is also a quest for other novel modalities of therapy. Measures should be actively adopted to prevent the development of drug resistance. Well formulated short-course chemotherapy as initial treatment and ensurance of compliance are the most important components. The organization of a national tuberculosis control programme with a sound and adequately functioning infrastructure remains the most effective strategy to combat the resurgence of tuberculosis and to curtail drug resistance.
在过去十年中，世界许多地区结核病发病率呈上升趋势。目前许多国家报告的耐药结核病高发病率令人担忧。最具灾难性的现象是结核分枝杆菌多重耐药菌株的出现。这些病菌在美国和一些欧洲国家的医院及医疗保健机构引发了疫情爆发。除了移民、贫困、酗酒和静脉注射药物滥用外，人类免疫缺陷病毒（HIV）感染也对耐药性的流行产生了重大影响，因为在这些患者群体中，导致耐药性的一个共同因素是不遵医嘱。需要快速药敏试验，并且迫切在寻找针对已确诊的多重耐药结核病的有效化疗方案，将新开发的药物与传统二线抗结核药物联合使用。还在探索其他新颖的治疗方式。应积极采取措施预防耐药性的产生。精心制定的短程化疗作为初始治疗以及确保患者遵医嘱是最重要的组成部分。组织一个拥有健全且运作良好基础设施的国家结核病控制规划仍然是抗击结核病复发和减少耐药性的最有效策略。
