结核病管理模式的实施方法研究

摘要/Abstract

摘要： 目的分析各国结核病患者的管理策略，探索结核病患者有效管理模式。方法以结核病、控制、管理、策略为中文检索词；以tuberculosis、management、control、strategy、policy为英文检索词。检索CHKD中国医院知识仓库、万方数据资源系统、PubMed 3个数据库，世界卫生组织、美国疾病预防控制中心、中华人民共和国卫生部、中国疾病预防控制中心4个卫生机构网站和搜索引擎Google Scholar。共检索出384条文献，包括论文和政策性文件，按照纳入与排除标准，最终纳入所有描述或评价实施结核病患者管理策略的文章25篇，并对文章信息进行分析。其中3篇文献与结核病防治立法相关，14篇文献与直接面视下的督导化疗相关，8篇文献与开展公立-私立机构及公立-公立机构合作相关。结果日本、俄罗斯等国家通过结核病防治专项立法，明确政府责任、落实主要防治措施，通过这些法规有效预防控制结核病，降低了结核病疫情。1995—2011年，全球5500万例结核病患者接受DOTS管理，接受DOT管理的患者提高了治愈率（中国初治肺结核治愈率达96.8%，复治肺结核治愈率达91.1%），降低耐药率（美国降低93%），增加无家可归等治疗依从性差患者治疗完成率（西班牙DOT管理患者75.2%完成治疗，自服药患者仅26.7%完成治疗）。在卫生资源匮乏的地区，开展家庭督导、社区督导也能取得很好的效果［坦桑尼亚社区督导与医务人员DOT对照，患者治疗成功率分别是81%、72%（P＜0.001）］。2009年全球有15个国家实施了PPM-DOTS项目，PPM提高了患者报告率（印度提高了12%），提高了治疗成功率（尼泊尔治疗成功率超过90%，患者丢失率低于1%），增加患者规则服药率（中国规则用药率达到了90%），增加患者治疗依从性（孟加拉国治疗依从性达到了98%）。结论应尽快制订结核病防治法，因地制宜的选择督导方式管理患者服药，加强医防合作，提高结核病防治效果。

关键词: 结核/药物疗法, 病人依从, 药物疗法管理, 直接观察疗法

Abstract: Objective To analyze the management strategies of tuberculosis (TB) patients in different countries, and to explore the effective management model. Methods Three databases (CHKD, Wanfang Data and PubMed), four websites of health institutions (WHO, USCDC, China MOH and CDC) and searching engine Google Scholar were applied with key words “tuberculosis, management, control, strategy, policy”.A total of 384 literatures were retrieved including both papers and policy documents, 25 papers were ultimately included in the analysis for the description or evaluation of TB management strategies according to the inclusion and exclusion criteria，of which 3 papers were related to TB legislation, 14 papers were related to the management of TB patients through Directly observed treatment(DOT) and 8 papers were related to public-private mix strategy and public-public mix strategy. Results Some countries such as Japan and Russia have developed special TB legislations to figure out the responsibility of government and major measures to control TB. The legislations were effective to control TB and the prevalence of TB decreased. There were 55 million TB patients received DOT during 1995 to 2011. DOT increased the cure rate (the cure rate of new pulmonary TB patients reached 96.8% and that of retreatment patients reached 91.1% in China), decreased the drug-resistant rate (which was decreased by 93% in USA) and improved the treatment completed rate of homeless with poor treatment compliance (which was 75.2% for DOT management group and 26.7% for self-management group in Spanish). In resource-limited region, family or community supervision can also achieve good effect. There were 15 countries implemented PPM-DOTS in 2009, which increased the registration rate (with 12% increased in India), the treatment successful rate (which exceeded 90% and the lost rate was lower than 1% in Nepal), the regular treatment rate (which reached 90% in China) and treatment compliance (which reached 98% in Bengal). Conclusion It is urgent to develop TB legislation, selecting suitable model of TB treatment management according to local situation and strengthening the public-public mix cooperation in order to control TB effectively and decrease the prevalence.

Key words: Tuberculosis/drug therapy, Patient compliance, Medication therapy management, Directly observed therapy

周林薛晓王芳刘二勇成诗明王黎霞万利亚. 结核病管理模式的实施方法研究[J]. 中国防痨杂志, 2013, 35(2): 120-124.

ZHOU Lin, XUE Xiao, WANG Fang, LIU Er-yong, CHENG Shi-ming, WANG Li-xia, WAN Li-ya. Research on effective model of tuberculosis patients management[J]. Chinese Journal of Antituberculosis, 2013, 35(2): 120-124.

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