Rubin S A
Department of Radiology, University of Texas Medical Branch, Galveston, Texas, USA.
Radiol Clin North Am. 1995 Jul;33(4):619-39.
The intent of this review was to familiarize the reader with the fascinating history of TB. I quote from Robert Louis Stevenson: "It is not a hard thing to know what to write; the hard thing is to know what to leave out." Also, this review by its very nature must be incomplete. It is certain that TB was present before the beginning of recorded history; it also is certain that we have not yet seen the end of the white plague. In the United States, the number of reported cases of TB decreased from 84,304 in 1953 to 22,201 in 1985, an average annual decline of 5.8%. Unfortunately, however, the number of cases has been increasing since 1985. These cases are predominantly in racial/ethnic minorities, persons from 25 to 44 years of age, men, and immigrants. Human immunodeficiency virus infection is at least partly responsible for the increasing number of cases. Additionally, new strains of M. tuberculosis that are resistant to multiple antituberculous drugs are being seen more and more frequently. In the mid-twentieth century, it was widely believed that advances in antituberculous chemotherapy and radiographic diagnosis might result in eradication of TB; this hope has not been realized. It is obvious that new challenges exist, and that others may lie ahead. One hopes that further advances will be made that will enable us to control this greatest killer of mankind, "The Captain of All These Men of Death."
这篇综述的目的是让读者熟悉结核病引人入胜的历史。我引用罗伯特·路易斯·史蒂文森的话：“知道写什么并不难；难的是知道省略什么。”此外，就其本质而言，这篇综述必然是不完整的。可以肯定的是，结核病在有记录的历史开始之前就已存在；同样可以肯定的是，我们尚未看到这场白色瘟疫的终结。在美国，报告的结核病病例数从1953年的84304例降至1985年的22201例，年均下降5.8%。然而，不幸的是，自1985年以来病例数一直在增加。这些病例主要集中在少数种族/族裔群体、25至44岁的人群、男性以及移民中。人类免疫缺陷病毒感染至少是病例数增加的部分原因。此外，对多种抗结核药物耐药的新型结核分枝杆菌菌株越来越常见。在二十世纪中叶，人们普遍认为抗结核化疗和放射诊断的进展可能会导致结核病的根除；但这一希望并未实现。显然，新的挑战存在，而且未来可能还会有其他挑战。人们希望能取得进一步进展，使我们能够控制这一人类最大的杀手，“所有这些死亡之人的首领”。
