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中国已成耐药结核病疫情最严重的国家之一
http://www.qianlong.com/2010-08-21 12:49:39千龙网
卫生部指出，目前我国的结核病防治工作仍面临着新的挑战，结核防治工作出现了三大新难点：首先，经济发展，人口流动加剧，造成结核菌的广泛传播；其次，艾滋病感染人数增加，感染了艾滋病病毒的人免疫力明显下降，使结核病发病人数增多；再有就是由于结核病患者治疗不规范导致耐药性的产生，使部分结核病又回升到从前的“不治之症”。仅2009年全国传染病网络直报系统报告的肺结核患者就达100余万例。
耐药结核危害超过艾滋病
卫生部提供的统计显示：中国是全球22个结核病高负担国家之一，患者数量位居全球第二，其中耐多药结核病疫情非常严重。据全国耐药结核病基线调查结果估算，全国每年新发肺结核患者的耐多药率为8.32%，广泛耐药率为0.68%；每年新发耐多药结核患者12万，广泛耐药患者近1万，其危害远远超过艾滋病。
“尤其值得关注的是，耐多药结核病在中国农村特别是西部地区尤为严重，由于人口流动频繁，对公共卫生造成极大危险。”在“礼来全球工作场所结核病预防中国项目”总结会上，中国疾控中心结核病预防控制中心政策法规部姜世闻主任不无担忧地说。
所谓耐药性结核是指用目前标准的药物治疗方案已无疗效。世卫组织的统计数据显示，在俄罗斯西北部某地区新确诊的结核病病例中有28%为耐药性结核，这是世卫组织迄今为止记录到的最为严重的耐药性结核发病情况。
从患者总数来看，世卫组织说，亚洲的耐药性结核病例最多，而非洲的耐药性结核病例估计达6.9万例，只是其中绝大多数没能得到确诊。从全球来看，耐药性结核病例估计仅有7%被确诊。
致病菌出现变异
20世纪40年代以后，结核病患者曾经渐渐地脱离了由它带来的“恐怖”，原因是有了链霉素。这种抗生素大大降低了结核病致死率。美国1904年以前，每10万肺结核患者中死亡188人，到1953年这一数字仅为4人。
这并不能让我们乐观，因为自上世纪80年代开始，结核病致病菌的结构发生了变化。这种突变后的致病菌能抵抗绝大多数药物的细菌，它所引起的疾病被称为耐多药结核病。
据世界卫生组织最新完成的《耐多药结核病和广泛耐药结核病：2010年全球监测与反应报告》估计，2008年，全球范围内有44万人患有耐多药结核病，其中有三分之一已死亡。
报告还估计，全世界将近50%的耐多药结核病病例发生在中国和印度。
而在2009年全球耐多药/广泛耐药结核病高负担国家部长级会议上，卫生部部长陈竺通报了中国的情况：中国目前耐多药结核的发病率为8.32%，总数约12万人！
在今年“两会”上，全国人大代表、南开大学医学院教授朱天慧提交《关于将多药耐药结核病纳入补充医疗保险的议案》，呼吁要从国家层面下大力度解决结核病这一公共卫生问题，不管是初治结核病还是耐药、广泛耐药结核病的治疗费用都应该纳入国家免费治疗的范围内。
75%的病人为中青年
“结核病正在死灰复燃。中国疾控中心结核病预防控制中心数据显示，目前80%的结核病人在农村，75%的病人为中青年。”姜世闻透露。
从临床来看，可分3个高峰年龄段，分别是20—25岁、45岁、75岁。
近些年，15岁至35岁人群成为我国最易感染肺结核的群体，这和年轻人大多在空调环境办公以及社交活动频繁有关。医学研究证明，结核杆菌侵入人体后是否发病，不仅取决于细菌的数量和毒性，更主要取决于人体对结核杆菌的抵抗力。在机体免疫力低的情况下，入侵的结核菌不能被机体防御系统消灭而不断繁殖，引起结核病。
据有关资料统计，大中城市结核感染率可高达50%—70%，也就是说城市人群的感染率高于农村。“农民工进入大城市，生活相对贫困，居住环境拥挤狭小，卫生状况不容乐观，加上工作劳动强度大，疲劳过度，营养跟不上，长期处于这种生活状态，导致机体抵抗力下降，使他们成为结核病的高发人群。”姜世闻说，“一些农民工进城前已患结核病或感染过结核菌，还有一些来自边远山区的农民工，缺乏对结核菌的特异性免疫力，使他们成为易感人群
结核病防治规划即将完成
一项调查显示，在中国1.5亿流动人口中，北京和上海报告的结核病患者分别为40%和50%，而深圳则高达80%。这部分人群的高流动性导致其中结核病可疑症状者的诊断率很低，为70%；其中的治疗成功率更低，北京、上海两市均为20%。因此，迫切需要在当前流动人口持续增加、流动人口感染风险仍然很高的情况下控制流动人口的结核病发病率。
近日，从中国疾病预防控制中心结核病预防控制中心传来消息称，《全国结核病防治规划(2011—2020)》正在制定。
据介绍，过去10年来，我国对于结核病防治工作的政策和经费投入逐年加强，各方面措施得到有力执行。现代结核病防治策略覆盖率、结核病患者发现率和治愈率三个核心指标分别达100%、70%和85%。
结核病预防控制中心目前正组织各方面专家学者和实施人员共同研讨制定下一个十年的结核病防治规划。为应对当前结核病防治面临的诸如耐多药结核病、结核菌／艾滋病病毒双重感染和流动人口结核病等新问题，《全国结核病防治规划(2011—2020)》将着重从提高现代结核病防治策略实施质量、健全防治体系、与医疗改革相结合等方面加强结核病防治工作力度，保障人民健康。
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Drug-resistant TB epidemic in China has become one of the most serious
http://www.qianlong.com/2010-08-21 12:49:39 Qianlong
Ministry of Health pointed out that, at present the work of tuberculosis control in China is still faced with new challenges, and tuberculosis control efforts have been three major New Difficulties: First, economic Fa Zhan, population mobility had increased, Zaocheng TB of widespread; secondly, AIDS infections increasing people infected with HIV decreased immunity to TB is increasing; and then there was no standard treatment of TB patients as result of drug resistance to tuberculosis and bounced back to some old "incurable." Only in 2009 the National Network Reporting System reports of infectious diseases of tuberculosis patients reached more than 100 million cases.
Against drug-resistant TB than HIV
Ministry of Health statistics show that: China is the world's 22 TB high-burden countries, the world's second highest number of patients, including multi-drug resistant TB epidemic is very serious. According to the National Baseline Survey of drug-resistant TB is estimated annually to emerging multi-drug resistant tuberculosis patients was 8.32%, extensively drug-resistant rate of 0.68%; each new issue of MDR-TB patients 120,000, nearly 1 in patients with extensively drug-resistant million, the harm far more than AIDS.
"Of particular concern is that MDR-TB in rural China, especially in the western region is particularly serious, because the population flow, causing great danger to public health." In "ceremony to the global workplace TB prevention projects in China," concluded the meeting China CDC Tuberculosis Prevention and Control Center of Policy and Regulations World news director Kang said not without concern.
The so-called drug-resistant tuberculosis refers to the current standard drug treatment is no longer effective. WHO statistics show that a region in northwest Russia, the new TB cases diagnosed, 28% of drug-resistant tuberculosis, which is recorded in the WHO so far the most serious incidence of drug-resistant tuberculosis.
The total number from the patient perspective, WHO says drug-resistant TB cases in Asia the most, while drug-resistant TB cases in Africa, an estimated 69,000 cases, but most of them could not be confirmed. Globally, drug-resistant TB cases is estimated that only 7% have been diagnosed.
Pathogenic mutation occurs
After 40 years of the 20th century, TB has gradually brought out by its "terrorist", because with streptomycin. This antibiotic significantly reduced mortality rates of TB. The United States before 1904, patients with pulmonary tuberculosis per 100,000 people died in 188, to 1953, this figure was only 4.
This does not make us optimistic, because since the last century 80's, the TB bacteria's structure has changed. This mutation of bacteria resistant to most drugs, bacteria, diseases caused it to be known as MDR-TB.
According to the latest World Health Organization to complete the "MDR-TB and XDR-TB: 2010, Global Monitoring and Response Report" estimates that in 2008, there were 44 million people worldwide suffering from MDR-TB, of which one third have died.
The report also estimated that nearly 50% of the world of MDR-TB cases have occurred in China and India.
In 2009, the Global MDR / XDR-TB high-burden countries, the Ministerial Meeting, Health Minister Chen Zhu reported on the situation in China: China is the incidence of MDR-TB rate of 8.32%, a total of some 12 million people!
In this year's "two sessions", the National People's Congress, Nankai University School of Medicine, Professor Zhu Tianhui submit "on the multi-drug resistant TB into the supplementary medical insurance bill," calling for great efforts from the national level to solve this public health problem of tuberculosis, Whether newly diagnosed or resistant tuberculosis, XDR-TB treatment costs should be included in the context of the national free treatment.
75% of patients are middle-aged
"TB is making a comeback. Tuberculosis Prevention and Control Center of China CDC data show that 80% of the current TB in rural areas, 75% of patients are young." Jiang said the world heard.
From a clinical point of view, the peak can be divided into three age groups, namely 20-25 years, 45 years old, 75 years old.
In recent years, people aged 15 to 35-year-old became the groups most vulnerable to tuberculosis, which most of the air-conditioned environment and young people and social activities that we have the office. Medical research shows that whether the incidence of Mycobacterium tuberculosis invades the human body, depends not only on the quantity and toxicity of bacteria, but also depends on the resistance of the human body to tuberculosis. In the case of low immunity, invasion of M. tuberculosis can not be eliminated by the body defense system of constant propagation, causing tuberculosis.
According to statistics, the TB infection rate in cities up to 50% -70% can be, that the infection rate among urban than rural. "Migrant workers into major cities, lived in poverty, crowded living environment, small, health status is not optimistic, together with the work of labor intensity, fatigue Guo Du, Ying Yang can not keep up, Zhang Qi in Zhezhong living conditions, Daozhi decreased body resistance, Shi They became high risk of TB. "Jiang Shi Wen said," some of Migrant Workers before the TB or had TB infection, and some migrant workers from remote mountainous areas, the lack of specific immunity against TB, so that they become susceptible
TB control program to be completed
A survey, 150 million floating population in China, Beijing and Shanghai reported TB patients were 40% and 50%, while the Shenzhen as high as 80%. This part of the high mobility of population which led to the diagnosis of suspicious cases of tuberculosis is low, 70%; one of the lower rate of treatment success, Beijing and Shanghai are 20%. Therefore, the urgent need to continue to increase in the current floating population, the risk of infection remains high floating population of migrants under control of TB incidence.
Recently, from the Chinese Centre for Disease Control and Prevention Tuberculosis Prevention and Control Center came news that the "National TB Control Programme (2011-2020)" is being developed.
According to reports, over the past 10 years, China's policies for TB prevention and financial investment each year to strengthen all aspects of the implementation of measures to be effective. Coverage of modern TB control strategies, TB detection and cure rates of three core indicators were 100%, 70% and 85%.
Tuberculosis Prevention and Control Center are now scholars and specialists from various fields to discuss the implementation of staff development for the next decade of tuberculosis control program. In response to the current TB face, such as MDR-TB, TB / HIV dual infection and tuberculosis, and other new problems the floating population, "the National TB Control Programme (2011-2020)" will focus from implementation to improve the quality of modern TB control strategies, sound control system, and combining health care reform, to strengthen TB control efforts to protect people's health.
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