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尽管耐多药结核病(MDR-TB)的流行是最近出现的问题,但是已经有许多研究试图了解它。我们现在已经很好的估计了当前的负担(全世界约500000例MDR-TB),并且正在预测MDR-TB控制策略对这些数字的影响。估算的结核(TB)与MDR-TB的发病率趋势是不一样的。耐药的危险因素分为2类:(1)社区中促使耐药选择的因素;(2)可以增加某些病人对耐药易感性的特定条件。每个国家之间流行病学形势有很大差别,但主要的原因都是治疗不合理、结核病防治规划在过去(甚至目前,只是程度较轻)执行差。最近的报道显示,国家结核病防治规划有效地使用现有的药物,可以推迟甚至逆转MDR-TB的流行。本文还分析了其他流行病学相关的因素。认识到MDR-TB流行的因素、鉴别出MDR-TB高危人群有助于明确病人发现的重点。从个体角度,接受过含利福平的一线治疗方案治疗失败的病例以及MDR-TB接触者有最高的耐药风险。接受过治疗的结核病人,以及本文中分析的其他危险因素在病人发现时应优先考虑。
Although the prevalence of multidrug-resistant tuberculosis (MDR-TB) is a recent problem, many studies have attempted to understand it. We now have a good estimate of the current burden (about 500,000 MDR-TB cases worldwide) and are predicting the impact of MDR-TB control strategies on these numbers. The estimated trend of tuberculosis (TB) and MDR-TB is not the same. The risk factors for drug resistance fall into two categories: (1) factors that drive drug resistance in the community; and (2) specific conditions that may increase the susceptibility of some patients to drug resistance. The epidemiological situation varies greatly from country to country, but the main reason is irrational treatment, and tuberculosis control programs have been poorly implemented in the past (and to the only extent). Recent reports indicate that effective use of existing drugs in national TB programs can delay or even reverse the prevalence of MDR-TB. This article also analyzes other epidemiological related factors. Recognizing the prevalence of MDR-TB and identifying at-risk MDR-TB populations can help define the focus of patient discovery. From an individual point of view, patients who have failed first-line treatment with rifampicin and those who have MDR-TB exposure have the highest risk of drug resistance. Tuberculosis patients who have been treated, and other risk factors analyzed in this article, should be prioritized when they are discovered.