耐药结核病全口服短程治疗:从规范到实践

doi:10.19982/j.issn.1000-6621.20260388

摘要/Abstract

中图分类号:

杨丹, 聂文娟, 成诗明, 初乃惠. 耐药结核病全口服短程治疗:从规范到实践[J]. 中国防痨杂志, 2026, 48(10): 1451-1456. doi: 10.19982/j.issn.1000-6621.20260388

参考文献 41

[1]	World Health Organization. Global tuberculosis report 2025[R]. Geneva: World Health Organization, 2025.
[2]	World Health Organization. Global tuberculosis report 2024[R]. Geneva: World Health Organization, 2024.
[3]	Maier C, Chesov D, Schaub D, et al. Long-term treatment outcomes in patients with multidrug-resistant tuberculosis[J]. Clin Microbiol Infect, 2023, 29(6): 751-757. doi:10.1016/j.cmi.2023.02.013.
[4]	Conradie F, Diacon A H, Ngubane N, et al. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis[J]. N Engl J Med, 2020, 382(10): 893-902. doi:10.1056/NEJMoa1901814.
[5]	Dookie N, Ngema S L, Perumal R, et al. The Changing Paradigm of Drug-Resistant Tuberculosis Treatment: Successes, Pitfalls, and Future Perspectives [J]. Clin Microbiol Rev, 2022, 35(4): e0018019. doi:10.1128/cmr.00180-19.
[6]	World Health Organization. WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update[R]. Geneva: World Health Organization, 2016.
[7]	Nunn A J, Phillips P P J, Meredith S K, et al. A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis[J]. N Engl J Med, 2019, 380(13): 1201-1213. doi:10.1056/NEJMoa1811867.
[8]	Goodall R L, Meredith S K, Nunn A J, et al. Evaluation of two short standardised regimens for the treatment of rifampicin-resistant tuberculosis (STREAM stage 2): an open-label, multicentre, randomised, non-inferiority trial[J]. Lancet, 2022, 400(10366): 1858-1868. doi:10.1016/s0140-6736(22)02078-5. pmid: 36368336
[9]	Guglielmetti L, Khan U, Velásquez G E, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis[J]. N Engl J Med, 2025, 392(5): 468-482. doi:10.1056/NEJMoa2400327.
[10]	Nyang’wa B T, Berry C, Kazounis E, et al. Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial[J]. Lancet Respir Med, 2024, 12(2): 117-128. doi:10.1016/s2213-2600(23)00389-2.
[11]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 4: treatment-drug-resistant tuberculosis treatment, 2022 update[R]. Geneva: World Health Organization, 2022.
[12]	中华医学会结核病学分会, 耐多药结核病短程治疗中国专家共识编写组. 耐多药结核病短程治疗中国专家共识[J]. 中华结核和呼吸杂志, 2019, 42(1): 5-8. doi:10.3760/cma.j.issn.1001-0939.2019.01.004.
[13]	中国防痨协会, 《中国防痨杂志》编辑委员会, 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所. 耐药结核病全口服短程治疗专家共识[J]. 中国防痨杂志, 2025, 47(7): 830-839. doi:10.19982/j.issn.1000-6621.20250087.
[14]	中华医学会结核病学分会. 中国耐多药/利福平耐药结核病化学治疗指南(2026年版)[J]. 中华结核和呼吸杂志, 2026, 49(6): 623-643. doi:10.3760/cma.j.cn112147-20251104-00674.
[15]	Van Deun A, Maug A K, Salim M A, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis[J]. Am J Respir Crit Care Med, 2010, 182(5): 684-692. doi:10.1164/rccm.201001-0077OC.
[16]	Aung K J, Van Deun A, Declercq E, et al. Successful ‘9-month Bangladesh regimen’ for multidrug-resistant tuberculosis among over 500 consecutive patients[J]. Int J Tuberc Lung Dis, 2014, 18(10): 1180-1187. doi:10.5588/ijtld.14.0100.
[17]	Falzon D, Schünemann H J, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update[J]. Eur Respir J, 2017, 49(3): 1602308. doi:10.1183/13993003.02308-2016.
[18]	Conradie F, Bagdasaryan T R, Borisov S, et al. Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis[J]. N Engl J Med, 2022, 387(9): 810-823. doi:10.1056/NEJMoa2119430.
[19]	Nyang’wa B T, Berry C, Kazounis E, et al. A 24-Week, All-Oral Regimen for Rifampin-Resistant Tuberculosis[J]. N Engl J Med, 2022, 387(25): 2331-2343. doi:10.1056/NEJMoa2117166.
[20]	Conradie F, Badat T, Poswa A, et al. A Pragmatic Trial of a 6-Month Strategy for Rifampicin-Resistant Tuberculosis[J]. N Engl J Med, 2026, 394(24): 2429-2439. doi:10.1056/NEJMoa2503687.
[21]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 4: Treatment and care[R]. Geneva: World Health Organization, 2025.
[22]	Song Y, Shu W, Pei Y, et al. Nine months of bedaquiline, linezolid, levofloxacin, clofazimine, and cycloserine chemotherapy for rifampicin/multidrug-resistant tuberculosis: a multicenter, randomized, open-label non-inferiority trial in China[J]. BMC Med, 2024, 22(1): 401. doi:10.1186/s12916-024-03633-3. pmid: 39300460
[23]	Weng T, Sun F, Li Y, et al. Refining MDR-TB treatment regimens for ultra short therapy (TB-TRUST): study protocol for a randomized controlled trial[J]. BMC Infect Dis, 2021, 21(1): 183. doi:10.1186/s12879-021-05870-w. pmid: 33596848
[24]	Fu L, Zhang X, Xiong J, et al. Selecting an appropriate all-oral short-course regimen for patients with multidrug-resistant or pre-extensive drug-resistant tuberculosis in China: A multicenter prospective cohort study[J]. Int J Infect Dis, 2023, 135: 101-108. doi:10.1016/j.ijid.2023.08.001. pmid: 37567554
[25]	Zhang Y, Li Y, Ren Y, et al. Innovating shorter, all-oral, precise, individualized treatment regimen for rifampicin-resistant tuberculosis (INSPIRE TB): study protocol for a pragmatic randomised controlled trial[J]. BMC Infect Dis, 2026, 26(1): 828. doi:10.1186/s12879-026-13017-y.
[26]	Gao J, Gao M, Du J, et al. A pragmatic randomized controlled trial to evaluate the efficacy and safety of an oral short-course regimen including bedaquiline for the treatment of patients with multidrug-resistant tuberculosis in China: study protocol for PROSPECT[J]. Trials, 2024, 25(1): 227. doi:10.1186/s13063-024-07946-9. pmid: 38561815
[27]	Sun F, Li Y, Zhang Y, et al. A 6- to 9-months oral regimen for rifampicin-resistant tuberculosis: a randomized open-label noninferiority trial in China[J]. Clin Microbiol Infect, 2026, 32(3): 429-439. doi:10.1016/j.cmi.2025.11.015.
[28]	聂文娟, 孙峰, 王雪钰, 等. 含新药口服短程方案治疗利福平耐药肺结核患者的多中心随机对照临床试验[J]. 中国防痨杂志, 2024, 46 (11): 1313-1319. doi:10.19982/j.issn.1000-6621.20240281.
[29]	中国疾病预防控制中心结核病预防控制中心. 中国结核病防治工作技术指南[M]. 北京: 人民卫生出版社, 2021.
[30]	中国防痨协会, 《中国防痨杂志》编辑委员会, 首都医科大学附属北京胸科医院. 抗结核药物所致QTc间期延长临床监测和管理专家共识[J]. 中国防痨杂志, 2024, 46(1): 8-17. doi:10.19982/j.issn.1000-6621.20230271.
[31]	Wu J, Pan H, Shen L, et al. Assessing the safety of bedaquiline: insight from adverse event reporting system analysis[J]. Front Pharmacol, 2024, 15: 1382441. doi:10.3389/fphar.2024.1382441.
[32]	Motta I, Cusinato M, Ludman A J, et al. How much should we still worry about QTc prolongation in rifampicin-resistant tuberculosis? ECG findings from TB-PRACTECAL clinical trial[J]. Antimicrob Agents Chemother, 2024, 68(7): e0053624. doi:10.1128/aac.00536-24.
[33]	Gerson S L, Kaplan S L, Bruss J B, et al. Hematologic effects of linezolid: summary of clinical experience[J]. Antimicrob Agents Chemother, 2002, 46(8): 2723-2726. doi:10.1128/aac.46.8.2723-2726.2002.
[34]	Tang S, Yao L, Hao X, et al. Efficacy, safety and tolerability of linezolid for the treatment of XDR-TB: a study in China[J]. Eur Respir J, 2015, 45(1): 161-170. doi:10.1183/09031936.00035114. pmid: 25234807
[35]	Imperial M Z, Nedelman J R, Conradie F, et al. Proposed Linezolid Dosing Strategies to Minimize Adverse Events for Treatment of Extensively Drug-Resistant Tuberculosis[J]. Clin Infect Dis, 2022, 74(10): 1736-1747. doi:10.1093/cid/ciab699.
[36]	Lifan Z, Sainan B, Feng S, et al. Linezolid for the treatment of extensively drug-resistant tuberculosis: a systematic review and meta-analysis[J]. Int J Tuberc Lung Dis, 2019, 23(12): 1293-1307. doi:10.5588/ijtld.18.0822. pmid: 31931914
[37]	Khan U, Rich M, Franke M F, et al. The Frequency and Incidence of QT Prolongation With Extended Use of Bedaquiline or Delamanid in a Large, Multi-Country Multidrug-Resistant/Rifampicin-Resistant Tuberculosis Cohort[J]. Clin Infect Dis, 2025, 81(1): 153-158. doi:10.1093/cid/ciae601.
[38]	姚琳, 顾斌斌, 张建平. 抗结核药物所致药物不良反应的临床表现及其处置的研究进展[J]. 抗感染药学, 2023, 20(12): 1229-1234. doi:10.13493/j.issn.1672-7878.2023.12-001.
[39]	阮云洲, 苏伟, 张慧, 等. 我国利福平耐药结核病防治的历史沿革及展望[J]. 中国防痨杂志, 2024, 46(10): 1166-1170. doi:10.19982/j.issn.1000-6621.20240336.
[40]	刘巧, 李忠奇, 竺丽梅, 等. 中国结核病防治服务体系运行现状、问题与对策研究[J]. 中国防痨杂志, 2025, 47(5): 559-568. doi:10.19982/j.issn.1000-6621.20240544.
[41]	梁月新, 李丽媛, 吕柳英, 等. 基于“三位一体”管理体系与传染病全程管理平台的耐药结核病患者主动服务模式应用效果研究[J]. 新发传染病电子杂志, 2026, 11(1): 81-86. doi:10.19871/j.cnki.xfcrbzz.2026.01.013.

耐药结核病全口服短程治疗:从规范到实践

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 41

相关文章 15

编辑推荐

Metrics

本文评价

[1]	钟乐萍, 秦世炳, 沙巍, 邓国防, 林明贵. 超声电导透皮给药在结核病辅助治疗中的应用与展望[J]. 中国防痨杂志, 2026, 48(9): 1245-1249.
[2]	黄欢, 王小敏, 宋喆, 李雪林, 丁峰, 王瑾, 曾剑锋, 吴海武, 钟新光, 卢水华. 世界卫生组织《结核病筛查测试产品的目标产品特征》解读[J]. 中国防痨杂志, 2026, 48(9): 1250-1258.
[3]	任飞林, 金玫华, 童照威, 郑平明. 《基层医疗卫生机构结核病预防性治疗门诊建设规范》团体标准解读[J]. 中国防痨杂志, 2026, 48(9): 1259-1265.
[4]	白燕, 陈禹, 高绪胜, 梁建琴, 曾谊, 王芸, 范琳. 老年药物敏感肺结核临床特征及影响治疗转归因素分析[J]. 中国防痨杂志, 2026, 48(9): 1266-1276.
[5]	李程, 吴春丽, 夏凡, 于汶朵, 刘振国, 易恒仲, 文新民, 唐志冈, 黄晟, 李瑶, 陈梦施, 容鹏飞. 肠道菌群与耐药肺结核患者发生药物性肝损伤的关联性研究[J]. 中国防痨杂志, 2026, 48(9): 1277-1289.
[6]	许超艳, 韦姣姣, 李姗姗, 姚琳, 李凌, 高孟秋. 胞内分枝杆菌肺病早期诊断模型构建及临床评价[J]. 中国防痨杂志, 2026, 48(9): 1290-1299.
[7]	马良, 伊力亚尔·巴吐尔, 古甫丁, 唐伟, 周文正, 地里下提·阿不力孜, 米尔扎提·艾沙, 秦威. 晚期膝关节结核一期病灶清除全膝关节置换21例回顾分析[J]. 中国防痨杂志, 2026, 48(9): 1300-1306.
[8]	张爱华, 许萌, 杨宇英, 苏爽, 宋磊, 马丹丹, 魏素霞, 程俊伟, 付朝红. 878例艾滋病合并结核病患者发生贫血状况及相关影响因素分析[J]. 中国防痨杂志, 2026, 48(9): 1307-1314.
[9]	薛允莲, 李思婕, 江雪, 刘贵浩, 吴惠忠, 汪婷婷, 周湛淇, 纪链容, 王嘉雯, 吴星华, 吴粤, 周琳. 1990—2021年吸烟相关结核病全球疾病负担研究[J]. 中国防痨杂志, 2026, 48(9): 1315-1323.
[10]	黄丽萍, 顾雯菊, 包赔煜, 沈佳怡, 宋言峥, 张林. 颈部淋巴结结核患者术前焦虑现状及其影响因素[J]. 中国防痨杂志, 2026, 48(9): 1324-1330.
[11]	赵雨川, 陈燕梅, 张晨晨, 余美玲, 彭柯皓, 徐镠粤, 梁鸿迪, 陈珣珣. 基于结核分枝杆菌检测的数字PCR平台的性能比较及选型策略研究[J]. 中国防痨杂志, 2026, 48(9): 1331-1337.
[12]	古力加马丽·热西丁, 古丽娜·巴德尔汗, 王明哲, 帕孜丽亚·艾尼, 伊帕尔·艾海提, 王乐, 刘年强, 董晓, 王森路. ARIMA模型和Holt-Winters指数平滑法对新疆维吾尔自治区肺结核发病情况的预测价值[J]. 中国防痨杂志, 2026, 48(9): 1338-1345.
[13]	谢赐福, 宋丽新, 尹鹏亮, 熊姿. 网络有奖竞答对居民肺结核防治核心信息的干预效果评估[J]. 中国防痨杂志, 2026, 48(9): 1356-1363.
[14]	周然, 邓晶, 陈海怡, 张婷, 郑登虎. 重庆市利福平敏感肺结核患者家庭灾难性支出的风险预测研究[J]. 中国防痨杂志, 2026, 48(9): 1364-1374.
[15]	黄全将, 黄敏莹, 崔哲哲. 基于熵权-TOPSIS与RSR法的广西壮族自治区结核病防治工作质量评价[J]. 中国防痨杂志, 2026, 48(9): 1375-1385.