儿童药物敏感肺结核治疗方案的研究进展

doi:10.19982/j.issn.1000-6621.20250358

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (1): 148-152.doi: 10.19982/j.issn.1000-6621.20250358

儿童药物敏感肺结核治疗方案的研究进展

付娅楠¹, 杨小涛¹, 刘晓梅¹(), 申阿东¹^,²()

¹昆明市儿童医院,云南省儿童医学中心,昆明医科大学附属儿童医院,昆明650100
²国家儿童医学中心,首都医科大学附属北京儿童医院,北京市儿科研究所,儿科学国家重点学科,国家呼吸系统疾病临床医学研究中心,儿科重大疾病研究教育部重点实验室,儿童呼吸道感染性疾病研究北京市重点实验室,北京100045

收稿日期:2025-09-07 出版日期:2026-01-10 发布日期:2025-12-31
通信作者: 刘晓梅,申阿东 E-mail:1043443230@qq.com;shenad16@hotmail.com
基金资助:
“十四五”云南省临床重点专科建设项目(N08901346);昆明市临床重点专科建设项目(N08901449)

Research progress in drug-susceptible pulmonary tuberculosis treatment regimens for children

Fu Yanan¹, Yang Xiaotao¹, Liu Xiaomei¹(), Shen Adong¹^,²()

¹Kunming Children’s Hospital, Yunnan Provincial Children’s Medical Center, Affiliated Children’s Hospital of Kunming Medical University, Kunming 650100, China
²National Center for Children’s Health, Beijing Children’s Hospital Affiliated with Capital Medical University, Beijing Institute of Pediatrics, National Key Discipline of Pediatrics, National Clinical Research Center for Respiratory Diseases, Ministry of Education Key Laboratory for Research on Major Pediatric Diseases, Beijing Key Laboratory for Research on Pediatric Respiratory Infectious Diseases, Beijing 100045, China

Received:2025-09-07 Online:2026-01-10 Published:2025-12-31
Contact: Liu Xiaomei,Shen Adong E-mail:1043443230@qq.com;shenad16@hotmail.com
Supported by:
“14th Five-Year Plan” Yunnan Provincial Key Clinical Specialty Construction Project(N08901346);Kunming Municipal Key Clinical Specialty Construction Project(N08901449)

摘要/Abstract

摘要：

药物敏感肺结核(drug-susceptible pulmonary tuberculosis, DS-PTB)在儿童群体发病率高,随着临床研究的逐渐深入,治疗方案也不断向着短程化、精准化方向更新优化。本文旨在对儿童和青少年DS-PTB药物治疗方案的发展历程及优化与革新进行综述,以期为提出适用于我国儿童及青少年科学化、规范化的DS-PTB治疗方案提供参考。

关键词: 结核,肺, 儿童, 抗结核药, 治疗应用, 综述文献(主题)

Abstract:

Drug-susceptible pulmonary tuberculosis (DS-PTB) exhibits a high incidence rate among paediatric populations. With the progressive advancement of clinical research, treatment regimens are continually being updated and optimised towards shorter durations and greater precision. This paper aims to review the developmental trajectory, optimisation, and innovation of treatment regimens for DS-PTB in children and adolescents, with a view to providing reference for proposing scientific and standardized DS-PTB treatment protocols applicable to children and adolescents in China.

Key words: Tuberculosis, pulmonary, Child, Antitubercular agents, Therapeutic uses, Review literature as topic

中图分类号:

R521

付娅楠, 杨小涛, 刘晓梅, 申阿东. 儿童药物敏感肺结核治疗方案的研究进展[J]. 中国防痨杂志, 2026, 48(1): 148-152. doi: 10.19982/j.issn.1000-6621.20250358

Fu Yanan, Yang Xiaotao, Liu Xiaomei, Shen Adong. Research progress in drug-susceptible pulmonary tuberculosis treatment regimens for children[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 148-152. doi: 10.19982/j.issn.1000-6621.20250358

参考文献 47

[1]	胡鑫洋, 高静韬. 世界卫生组织《2024年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5 (6): 500-504. doi:10.19983/j.issn.2096-8493.2024164.
[2]	Zhang Y, Zhan B, Hao X, et al. Factors associated with diagnostic delay of pulmonary tuberculosis among children and adolescents in Quzhou, China: results from the surveillance data 2011-2021.. BMC Infect Dis, 2023, 23(1): 541. doi:10.1186/s12879-023-08516-1. pmid: 37596514
[3]	Starshinova A. Difficulties in diagnosing tuberculosis infection in childhood. Lancet Infect Dis, 2025, 25(2): 140-141. doi:10.1016/s1473-3099(24)00569-3.
[4]	World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. Geneva: World Health Organization, 2022.
[5]	World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2nd ed. Geneva: World Health Organization, 2014.
[6]	Graham SM, Amanullah F. Updated guidelines for child and adolescent TB. Int J Tuberc Lung Dis, 2022, 26(2): 81-84. doi:10.5588/ijtld.21.0747. pmid: 35086615
[7]	Gafar F, Wasmann RE, McIlleron HM, et al. Global estimates and determinants of antituberculosis drug pharmacokinetics in children and adolescents: a systematic review and individual patient data meta-analysis. Eur Respir J, 2023, 61(3). doi:10.1183/13993003.01596-2022.
[8]	White YN, Solans BP, Denti P, et al. Pharmacokinetics and Optimal Dosing of Levofloxacin in Children for Drug-Resistant Tuberculosis: An Individual Patient Data Meta-Analysis. Clin Infect Dis, 2024, 78(3): 756-764. doi:10.1093/cid/ciae024. pmid: 38340060
[9]	Burman W, Luczynski P, Horsburgh CR, et al. Representativeness and adverse event reporting in late-phase clinical trials for rifampin-susceptible tuberculosis: a systematic review. Lancet Infect Dis, 2025, 25(2): e86-e98. doi:10.1016/s1473-3099(24)00597-8.
[10]	Solans BP, Béranger A, Radtke K, et al. Effectiveness and Pharmacokinetic Exposures of First-Line Drugs Used to Treat Drug-Susceptible Tuberculosis in Children: A Systematic Review and Meta-Analysis. Clin Infect Dis, 2023, 76(9): 1658-1670fc. doi:10.1093/cid/ciac973. pmid: 36609692
[11]	Sabella-Jiménez V, Hoyos Mendez Y, Benjumea-Bedoya D, et al. Effectiveness and safety of available preventive tuberculosis treatment regimens for children and adolescents: protocol for a systematic review and network meta-analysis. BMJ Paediatr Open, 2022, 6(1). doi:10.1136/bmjpo-2022-001551.
[12]	Imperial MZ, Nahid P, Phillips PPJ, et al. A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis. Nat Med, 2018, 24(11): 1708-1715. doi:10.1038/s41591-018-0224-2. pmid: 30397355
[13]	Silva DR, Mello FCQ, Migliori GB. Shortened tuberculosis treatment regimens: what is new? J Bras Pneumol, 2020, 46(2): e20200009. doi:10.36416/1806-3756/e20200009.
[14]	Yerramsetti S, Cohen T, Atun R, et al. Global estimates of paediatric tuberculosis incidence in 2013-19: a mathematical modelling analysis. Lancet Glob Health, 2022, 10(2): e207-e215. doi:10.1016/s2214-109x(21)00462-9.
[15]	Prodanuk M, Silverberg SL, Piché-Renaud PP, et al. Adverse events of first-line therapy for pediatric tuberculosis: A systematic review and meta-analysis. Clin Infect Dis, 2025. doi:10.1093/cid/ciaf152.
[16]	Zhuang Z, Sun L, Song X, et al. Trends and challenges of multi-drug resistance in childhood tuberculosis. Front Cell Infect Microbiol, 2023, 13: 1183590. doi:10.3389/fcimb.2023.1183590.
[17]	Controlled trial of 4 three-times-weekly regimens and a daily regimen all given for 6 months for pulmonary tuberculosis. Second report: the results up to 24 months. Hong Kong Chest Service/British Medical Research Council. Tubercle, 1982, 63(2): 89-98. doi:10.1016/s0041-3879(82)80044-5.
[18]	World Health Organization. Treatment of tuberculosis: guidelines for national programmes, 2nd ed. Geneva: World Health Organization, 1997.
[19]	Girling DJ, Caulet P, Pamra SP, et al. Anti-tuberculosis regimens of chemotherapy. Recommendations from the Committee on Treatment of the International Union against Tuberculosis and Lung Disease. Indian J Chest Dis Allied Sci, 1988, 30(4): 296-304. pmid: 3076583
[20]	World Health Organization. Treatment of tuberculosis:Guidelines for national programmes:third edition. Geneva: World Health Organization, 2003.
[21]	World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva: World Health Organization, 2006
[22]	Driver CR, Munsiff SS, Li J, et al. Relapse in persons treated for drug-susceptible tuberculosis in a population with high coinfection with human immunodeficiency virus in New York City. Clin Infect Dis, 2001, 33(10): 1762-1769. doi:10.1086/323784. pmid: 11595988
[23]	World Health Organization. Rapid advice: treatment of tuberculosis in children. Geneva: World Health Organization, 2010.
[24]	焦伟伟, 申阿东. 儿童结核病药物治疗现状及进展. 中华实用儿科临床杂志, 2020, 35(10): 753-758. doi:10.3760/cma.j.cn101070-20200525-00883.
[25]	Menzies D, Benedetti A, Paydar A, et al. Effect of duration and intermittency of rifampin on tuberculosis treatment outcomes: a systematic review and meta-analysis. PLoS Med, 2009, 6(9): e1000146. doi:10.1371/journal.pmed.1000146.
[26]	Menzies D, Benedetti A, Paydar A, et al. Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis. PLoS Med, 2009, 6(9): e1000150. doi:10.1371/journal.pmed.1000150.
[27]	Thee S, Seddon JA, Donald PR, et al. Pharmacokinetics of isoniazid, rifampin, and pyrazinamide in children younger than two years of age with tuberculosis: evidence for implementation of revised World Health Organization recommendations. Antimicrob Agents Chemother, 2011, 55(12): 5560-5567. doi:10.1128/aac.05429-11. pmid: 21968358
[28]	Donald PR, Maritz JS, Diacon AH. The pharmacokinetics and pharmacodynamics of rifampicin in adults and children in relation to the dosage recommended for children. Tuberculosis (Edinb), 2011, 91(3): 196-207. doi:10.1016/j.tube.2011.02.004.
[29]	McIlleron H, Willemse M, Werely CJ, et al. Isoniazid plasma concentrations in a cohort of South African children with tuberculosis: implications for international pediatric dosing guidelines. Clin Infect Dis, 2009, 48(11): 1547-1553. doi:10.1086/598192. pmid: 19392636
[30]	Donald PR. Antituberculosis drug-induced hepatotoxicity in children. Pediatr Rep, 2011, 3(2): e16. doi:10.4081/pr.2011.e16.
[31]	World Health Organization. Ethambutol efficacy and toxicity: literature review and recommendations for daily and intermittent dosage in children. Geneva: World Health Organization, 2006.
[32]	徐彩红, 张文宏, 赵雁林. 《全国结核病防治规划(2024—2030年)》开启我国结核病防治工作新篇章. 中华传染病杂志, 2024, 42(12): 705-710. doi:10.3760/cma.j.cn311365-20250122-00026.
[33]	陈伟, 李雪, 刘小秋, 等. 《全国结核病防治规划(2024—2030年)》解读. 中国防痨杂志, 2025, 47(2): 130-136. doi:10.19982/j.issn.1000-6621.20240585.
[34]	Gillespie SH, Crook AM, McHugh TD, et al. Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. N Engl J Med, 2014, 371(17): 1577-1587. doi:10.1056/NEJMoa1407426.
[35]	Merle CS, Fielding K, Sow OB, et al. A four-month gatifloxacin-containing regimen for treating tuberculosis. N Engl J Med, 2014, 371(17): 1588-1598. doi:10.1056/NEJMoa1315817.
[36]	Jindani A, Harrison TS, Nunn AJ, et al. High-dose rifapentine with moxifloxacin for pulmonary tuberculosis. N Engl J Med, 2014, 371(17):1599-1608. doi:10.1056/NEJMoa1314210.
[37]	Dorman SE, Nahid P, Kurbatova EV, et al. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis. N Engl J Med, 2021, 384(18): 1705-1718. doi:10.1056/NEJMoa2033400.
[38]	Turkova A, Wills GH, Wobudeya E, et al. Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children. N Engl J Med, 2022, 386(10): 911-922. doi:10.1056/NEJMoa2104535.
[39]	中华医学会结核病学分会. 抗结核药物超说明书用法专家共识(2023年更新版). 中华结核和呼吸杂志, 2023, 46(11): 1085-1102. doi:10.3760/cma.j.cn112147-20230809-00062.
[40]	贺晓新, 李波, 周林. 《4个月含利福喷丁抗结核治疗方案疗效观察》解读. 中国防痨杂志, 2021, 43(12): 1243-1247. doi:10.3969/j.issn.1000-6621.2021.12.004.
[41]	中国防痨协会, 中华医学会结核病学分会儿童结核病专业委员会, 中国研究型医院学会结核病学专业委员会, 等. 儿童和青少年药物敏感结核病化学治疗专家共识. 中华实用儿科临床杂志, 2024, 39(9): 641-645. doi:10.3760/cma.j.cn101070-20240529-00334.
[42]	World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment and care. Geneva: World Health Organization, 2025.
[43]	黄涛, 陈晴, 吴桂辉, 等. 世界卫生组织2025年版《结核病整合指南模块4:治疗与关怀》解读. 中华结核和呼吸杂志, 2025, 48(8): 708-718. doi:10.3760/cma.j.cn112147-20250512-00259.
[44]	Aguilar Diaz JM, Abulfathi AA, Te Brake LH, et al. New and Repurposed Drugs for the Treatment of Active Tuberculosis: An Update for Clinicians. Respiration, 2023, 102(2): 83-100. doi:10.1159/000528274.
[45]	Saluzzo F, Adepoju VA, Duarte R, et al. Treatment-shortening regimens for tuberculosis: updates and future priorities. Breathe (Sheff), 2023, 19(3): 230028. doi:10.1183/20734735.0028-2023.
[46]	Svensson RJ, Svensson EM, Aarnoutse RE, et al. Greater Early Bactericidal Activity at Higher Rifampicin Doses Revealed by Modeling and Clinical Trial Simulations. J Infect Dis, 2018, 218(6): 991-999. doi:10.1093/infdis/jiy242. pmid: 29718390
[47]	Ranganathan UD, Smith-Jeffcoat SE, Balaji S, et al. High-dose isoniazid for TB with low-to-moderate isoniazid resistance after 1 week of treatment. JAC Antimicrob Resist, 2025, 7(3): dlaf072. doi:10.1093/jacamr/dlaf072.

儿童药物敏感肺结核治疗方案的研究进展

Research progress in drug-susceptible pulmonary tuberculosis treatment regimens for children

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