据统计，全球95%以上的结核病例和死亡发生在发展中国家。除了因为发展中国家的卫生条件较差，容易实现结核病传播条件之外，发展中国家的结核病不合理治疗也是主要原因之一。
发展中国家的结核病患者身上压着两座大山，分别是治疗时间和治疗费用。早期、联用、适量、规律、全程是结核病治疗的五大原则，而结核病标准疗法的整个疗程最长达18-24个月，治疗费用也是很多家庭负担不起的，这些都会造成不贵的治疗，从到导致耐药性结核病的发生。
根据WHO发布的最新消息，有望通过一种快速的检测方法，来掀翻结核病治疗的这两座大山，从而使结核病的更有效治疗成为可能。
[color= ]Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients
[color= ]多重耐药结核患者的新希望——快速诊断法及更短更廉价的治疗方案
News release
新闻[color= ]12 MAY 2016 | GENEVA - New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.
[color= ]2016年5月12日，WHO于日内瓦发布新建议，旨在通过新的快速诊断检测和更短更廉价治疗方案，来加快和改善多重耐药结核(MDR-TB)的检测和治疗。
[color= ]“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”
[color= ]WHO全球结核病项目负责人Mario Raviglione 博士指出“这是应对MDR-TB公共卫生危机迈出的关键一步。WHO的新建议将会给成千上万的MDR-TB患者带来希望，这些患者可以通过一个测试快速确定是否合适进行短程疗法，且彻底治愈的的疗程和花费仅为原来治疗方案的一半。
Shorter treatment with better outcomes更短疗程，更好疗效
[color= ]At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
[color= ]新治疗方案的周期为9-12个月，且每名病人的花费不到1000美元。由于接受治疗的患者的依从性高和失访率低，新方法不仅比现有方案更廉价，而且能改善预后，还可能减少死亡。
[color= ]The conventional treatment regimens, which take 18–24 months to complete, yield low cure rates: just 50% on average globally. This is largely because patients find it very hard to keep taking second-line drugs, which can be quite toxic, for prolonged periods of time. They therefore often interrupt treatment or are lost to follow-up in health services.
[color= ]而传统治疗方案的周期长达18—24个月，且通常治愈率较低，全球的平均治愈率仅为50%。究其原因，主要是由于患者很难坚持使用二线药物，因为在很长一段时间内，其毒性可能相当大。因此，患者经常会放弃治疗或者在后续的卫生服务中失访。
[color= ]The shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB, for example those individuals whose MDR-TB is not resistant to the most important drugs used to treat MDR-TB (fluoroquinolones and injectables), known as “second-line drugs”. It is also recommended for individuals who have not yet been treated with second line drugs.
[color= ]这种短程治疗推荐用于无并发症的MDR-TB病人，比如，那些对用于治疗MDR-TB最重要二线药物（氟喹诺酮类注射剂）并不耐药的MDR-TB病人。此外，这种短程疗法还建议用于尚未使用二线药物治疗的患者。
[color= ]WHO’s recommendations on the shorter regimens are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries. WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen.
[color= ]WHO建议使用更短的治疗方案是基于一项涉及10个国家1200名普通MDR-TB患者的最初的规划研究。为强化应用这一方案的依据，WHO呼吁研究人员完成正在开展的随机对照临床试验。
Rapid diagnostic test to identify second-line drug resistance
快速诊断检测，以确定二线药物的耐药性
[color= ]The most reliable way to rule out resistance to second-line drugs is a newly recommended diagnostic test for use in national TB reference laboratories. The novel diagnostic test – called MTBDRsl – is a DNA-based test that identifies genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.
[color= ]对二线药物耐药最可靠的筛查方法是在国家结核病参考实验室中推荐使用新型诊断检测。这种称为MTBDRsl的新型诊断检测法是基于DNA的检测，能识别MDR-TB菌株的基因突变，这些突变常会导致对氟喹诺酮类药物和注射用二线抗结核药物耐药。
[color= ]This test yields results in just 24-48 hours, down from the 3 months or longer currently required. The much faster turnaround time means that MDR-TB patients with additional resistance are not only diagnosed more quickly, but can quickly be placed on appropriate second-line regimens. WHO reports that fewer than 20% of the estimated 480 000 MDR-TB patients globally are currently being properly treated.
经过3个月的改进，该检测时间大大缩短，能够在24-48小时之间报告结果。更快的周转时间意味着对其他药物同样耐药的MDR-TB患者，不仅可以更快确诊，也能够很快接受合适的二线治疗方案。WHO报告指出，估计目前全球480 000 MDR-TB的患者中，只有不到20%的患者接受了合适的治疗。
[color= ]The MTBDRsl test is also a critical prerequisite for identifying MDR-TB patients who are eligible for the newly recommended shorter regimen, while avoiding placing patients who have resistance to second-line drugs on this regimen (which could fuel the development of extensively drug-resistant TB or XDR-TB).
MTBDRsl检测同样是确定MDR-TB患者能否接受新推荐短程疗法的关键条件，同时避免将二线药物耐药的患者纳入此治疗，从而避免广泛耐药结核的发展。
[color= ]“We hope that the faster diagnosis and shorter treatment will accelerate the much-needed global MDR-TB response,” said Dr Karin Weyer, Coordinator of Laboratories, Diagnostics and Drug Resistance, WHO Global TB Programme. “Anticipated cost-savings from the roll out of this regimen could be re-invested in MDR-TB services to enable more patients to be tested and retained on treatment.”
WHO全球结核病项目耐药性诊断实验室协调员Karin Weyer博士认为“我们希望更快速的诊断和更短期的治疗，可以加快急需的全球MDR-TB应对方案。这一方案推出的预期节约成本，能够再用于MDR-TB的服务，从而使更多的患者能够接受检测并继续治疗。”
[color= ]WHO is working closely with technical and funding partners to ensure adequate resources and support for the uptake of the rapid test and shorter, cheaper regimen in countries.
WHO正在与技术和基金合作伙伴紧密合作，以确保获得充分的资源和支持，满足各国对快速测法，及更短期和更廉价治疗方案的需求。
Quick facts要闻速览[color= ]Resistance to standard TB drugs exists in most countries worldwide. Drug resistance, fuelled by inadequate treatment, can spread through the air, from person to person, in the same way as drug-susceptible TB.
全球大多数国家普遍存在结核药物的耐药性。耐药性的产生，通常由于不规范的治疗导致，耐药性结核的传播方式与药物敏感性结核相同，能通过空气在人与人之间进行传播。
[color= ]Multidrug-resistant TB (MDR-TB) is caused by TB bacteria that are resistant to at least isoniazid and rifampicin, the two most effective TB drugs. Based on figures from 2014, the latest year for which data are available, WHO estimates that 5% of TB cases are multidrug-resistant. This translates into 480 000 cases and 190 000 deaths each year.
多重耐药结核（MDR-TB）是由至少对异烟肼和利福平两种最为有效的抗结核药物中一种耐药的结核杆菌引起的，基于现有的2014年最新数据，WHO估计结核患者中的5%为多重耐药，这相当于每年有480000例病例，以及190000名患者死亡。
[color= ]Extensively drug-resistant TB (XDR-TB) is a form of MDR-TB that is also resistant to any fluoroquinolone and any of the second–line anti-TB injectable agents (i.e. amikacin, kanamycin or capreomycin). About 9% of MDR-TB patients develop XDR-TB, which is even more difficult to treat.
广泛耐药结核病（XDR-TB）是多重耐药结核病（MDR-TB）的一种，它对任何氟喹诺酮类药物和任何二线抗结核注射剂（如阿米卡星、卡那霉素、卷曲霉素）均耐药。约9%的MDR-TB患者会发展为这种更难治的广泛耐药结核病XDR-TB。
[color= ]The WHO "End TB Strategy", adopted by all WHO Member States, serves as a blueprint for countries to reduce TB incidence by 80% and TB deaths by 90%, and to eliminate catastrophic costs for TB-affected households by 2030.
世卫组织的“终结TB战略”得到世卫组织所有成员国的一直通过，将作为各国减少80%的结核发病率及90%病死率的蓝图，并在2030年前为被结核影响的家庭消除灾难性费用。
图片来源：百度图库 热点查找：王宁宁
翻译：王芙、王宁宁、刘立婷
编写：陈志锦 审核：唐文瑞、陈志锦
文章来源：http://www.who.int/mediacentre/n ... nt-tuberculosis/en/
本文图片来自于互联网，如有侵权请告知
图文编辑：周密
审稿：马嘉睿 高晓东
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