NEJM：寻求抗击肺结核的新疗法

每年都有将近两百万人死于肺结核，肺结核目前在美国已经得到了有效控制，可是在世界上别的国家依然很严重。来自布莱根妇女医院的研究者表示，这种不均衡的健康状况应该迫使我们思考控制肺结核的新型方法了，研究者的研究论文刊登在了近日的国际杂志New England Journal of Medicine上。

Keshavjee医生表示，目前全球范围内缺少抵抗肺结核的方法，而且随着时间的延续，我们已经接受了这种在穷人和富人之间治疗上的分散和差异了。对于多重耐药的肺结核的治疗方案已经实施了十几年了，但是仅仅有0.5%的新诊断病人使用了这种疗法（美国的治疗标准）。很多人群都面临着由于肺结核致死的高风险，比如HIV患者，这些人中很少有人接受合适的治疗。目前缺少合适疗法会加速该疾病的流行，因为肺结核是通过空气进行传播的。

研究报告中，研究者Keshavjee和Farmer探索了关于肺结核的科学知识为何不能反映当前的全球肺结核形式的原因，对于研究者Keshavjee来说，理解当前的政策构成对于我们下一步控制疾病非常重要，他表示，我们想鼓励国际的肺结核团体来付出努力来克服肺结核，也就是说快速寻找那些患病者以及确保其被快速诊断和进行合适的治疗。

研究者Farmer表示，医生们、决策者以及研究者可以共同努力来解决这个世界难题，我们希望这篇文章的阐述可以帮助我们重新思考肺结核以及其它的慢性疾病，包括HIV等等。所有的致病菌：细菌、病毒和寄生虫，当其长时间面对抗生素后会发生基因突变，进而引发对公众的健康威胁。

这篇研究综述是帮助我们理解如何努力来战胜肺结核的第一步，我们希望其可以促成全世界范围内各个社区的交流，以便更好地组织因该疾病导致的死亡。

编译自：Call for a New Approach to Fighting Tuberculosis

doi:10.1056/NEJMra1205429
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Tuberculosis, Drug Resistance, and the History of Modern Medicine

Salmaan Keshavjee, M.D., Ph.D., and Paul E. Farmer, M.D., Ph.D.

Tuberculosis is a treatable airborne infectious disease that kills almost 2 million people every year. Multidrug-resistant (MDR) tuberculosis — by convention, a disease caused by strains of Mycobacterium tuberculosis that are resistant to isoniazid and rifampin, the backbone of first-line antituberculosis treatment — afflicts an estimated 500,000 new patients annually. Resistance to antituberculosis agents has been studied since the 1940s; blueprints for containing MDR tuberculosis were laid out in the clinical literature and in practice, in several settings, more than 20 years ago.1,2 Yet today, barely 0.5% of persons with newly diagnosed MDR tuberculosis worldwide receive treatment that is considered the standard of care in the United States.3 Those who have not received appropriate treatment continue to fuel a global pandemic that now includes strains resistant to most — and by some accounts all — classes of drugs tested. 4,5 Despite the enormity of the threat, investments to contain the epidemic and to cure infected patients have been halting and meager when compared, for example, with those made to address the acquired immunodeficiency syndrome (AIDS) pandemic. In this essay we seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis by examining the recent history of tuberculosis policy.