全球儿童结核病防控策略的变迁

doi:10.3969/j.issn.1000-6621.2018.02.003

摘要/Abstract

摘要：

针对儿童结核病的现状,世界卫生组织、各国的卫生部等机构出台了一系列指南和建议,对规范当前儿童结核病的诊断、治疗、预防、管理起到了非常重要的指导作用。儿童结核病的防控是全球结核病控制的重要方面,笔者对世界卫生组织自1991年DOTS策略提出后至今的指南、建议、声明等出版材料中有关儿童结核病的内容进行梳理和总结,其中包括4个指南、10个建议、2个声明、2个手册、2个路线图和1个综述,以了解儿童结核病防控策略的变化,加强儿童结核病的早期诊断、早期治疗,及时解决当前存在的问题,同时也有助于指南方针的普及和推广。

关键词: 儿童, 结核, 指南, 诊断, 综合预防, 治疗应用

Abstract:

In response to the current situation of pediatric tuberculosis (TB), a series of guidelines and re-commendations have been published by World Health Organization (WHO) and Ministry of Health in various countries, which provide important guidance to regulate the diagnosis, treatment, prevention and management of pedia-tric TB. The management of children with TB is an important aspect of global TB control. The summary of pediatric TB teased from the publications of WHO since DOTS strategy proposed in 1991, including 4 guidelines, 10 recommendations, 2 statements, 2 handbooks, 2 roadmaps and 1 review, is useful to understand the changes in the prevention and control strategies for children with TB, promote the early diagnosis and treatment, solve current problems, and facilitate the popularization of the guidelines.

Key words: Child, Tuberculosis, Guidebooks, Diagnosis, Universal precautions, Therapeutic uses

孙琳,申阿东. 全球儿童结核病防控策略的变迁[J]. 中国防痨杂志, 2018, 40(2): 128-134. doi: 10.3969/j.issn.1000-6621.2018.02.003

Lin SUN,A-dong SHEN. Changes of pediatric tuberculosis control and prevention strategies[J]. Chinese Journal of Antituberculosis, 2018, 40(2): 128-134. doi: 10.3969/j.issn.1000-6621.2018.02.003

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参考文献 26

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结核病类别	药物及治疗方案
HIV高流行、异烟肼高耐药率地区:疑似或确诊肺结核或淋巴结结核	2H-R-Z-E/4H-R
HIV低流行、异烟肼低耐药率地区:肺部病变广泛	2H-R-Z-E/4H-R
HIV低流行、异烟肼低耐药率地区:HIV阴性、疑似或确诊的肺结核或淋巴结结核	2H-R-Z/4H-R
疑似或确诊儿童结核性脑膜炎	2H-R-Z-E/10H-R
疑似或确诊儿童骨关节结核	2H-R-Z-E/10H-R

结核病类别	药物及治疗方案
HIV低发(HIV阴性儿童)和异烟肼低耐药地区
涂阴肺结核	2H-R-Z/4H-R
肺内淋巴结结核	2H-R-Z/4H-R
外周淋巴结结核	2H-R-Z/4H-R
广泛肺部病变	2H-R-Z-E/4H-R
涂阳肺结核	2H-R-Z-E/4H-R
重症肺外结核(除外结核性脑膜炎和骨关节结核)	2H-R-Z-E/4H-R
HIV高发和(或)异烟肼高耐药地区
涂阳肺结核	2H-R-Z-E/4H-R
涂阴肺结核伴或不伴广泛实质病变	2H-R-Z-E/4H-R
除结核性脑膜炎和骨关节结核外的各类型肺外结核	2H-R-Z-E/4H-R
各个地区
结核性脑膜炎和骨关节结核	2H-R-Z-E/10H-R

药物分组药物名称	儿童日剂量(mg/kg)	儿童日最大剂量(mg)^a
第一组:一线口服药物^b
乙胺丁醇	15	-
吡嗪酰胺	-	-
第二组:注射类药物^c
氨基糖苷类
阿米卡星	15~22.5	1000
卡那霉素	15~30	1000
多肽类
卷曲霉素	15~30	1000
第三组:氟喹诺酮类
氧氟沙星	15~20	800,2次/d
左氧氟沙星	7.5~10	750
莫西沙星	7.5~10	400
第四组:二线口服药物^d
乙硫异烟胺或丙硫异烟胺	15~20	1000,2次/d
环丝氨酸或特立齐酮	10~20	1000,1次/d或2次/d
对氨基水杨酸^e	150	12000,2次/d或3次/d

药物分组	药物名称	注意事项
A组	左氧氟沙星	A组按优先选用原则从高到低排列
	莫西沙星
	加替沙星
B组	阿米卡星	当前3种药物无法使用时可选用链霉素替代,仅链霉素耐药不能定义为
	卷曲霉素	广泛耐药结核病
	卡那霉素
	(链霉素)
C组	乙硫异烟胺或丙硫异烟胺	C组按优先选用原则从高到低排列
	环丝氨酸或特立齐酮
	利奈唑胺
	氯法齐明
D组
D1	吡嗪酰胺
	乙胺丁醇
	高剂量异烟肼
D2	贝达喹啉	贝达喹啉或德拉马尼可加到长疗程方案中用于替代或加强其他二线药物
	德拉马尼
D3	对氨基水杨酸	碳青霉烯类和克拉维酸共同使用,在此配方中克拉维酸只和阿莫西林联
	亚胺培南或西司他丁	用;氨硫脲在使用前,需要检测患者的HIV结果且确保为阴性
	美罗培南
	阿莫西林-克拉维酸
	(氨硫脲)