多重抗藥性結核病之現況

Multi-Drug Resistant Tuberculosis: The Current View

楊文達(Wen-Ta Yang) ； 黃丞正(Chen-Cheng Huang)

《內科學誌》 24卷5期 (2013/10) Pp. 357-365

https://doi.org/10.6314/JIMT.2013.24(5).01

摘要

多重抗藥性結核病（Multi-Drug Resistant Tuberculosis；MDR-TB）以往多因結核個案未遵照醫囑規則服藥或醫師用藥不當而產生，近年來社區內感染已成為病人來源的另一個隱憂。根據世界衛生組織（World Health Organization；WHO）統計，近年全球多重抗藥性結核病佔年度新發生結核個案的比率有下降趨勢，顯示全球在多重抗藥性結核病的防治努力已見初步成效，但世界衛生組織估計2011年仍有22萬至40萬MDR-TB新個案產生。由於MDR-TB的傳染期長，平均治療時間需18－24個月，治療花費及死亡率較高，多重抗藥性結核病仍然是全球重要的公共衛生與經濟議題。由於多重抗藥性結核病在診斷、治療與藥物副作用處理的複雜性，經驗不足的醫師容易因使用不適當的治療處方，製造抗菌譜更廣的泛抗藥性結核病（Extreme-Drug Resistant Tuberculosis；XDR-TB），世界衛生組織及國際抗癆暨肺病聯盟（International Union Against Tuberculosis and Lung Disease；IUATLD）均建議將抗藥性結核個案轉介給對MDR-TB治療有經驗的專家或治療團隊做整體性的評估。MDR-TB的治療除了強調健全的處方內容外，更強調要在直接觀察治療（Directly Observed Therapy；DOT）下按規服藥的重要性，如何透過醫療機構與公共衛生系統協調合作，提升MDR-TB診斷品質、治療及管理的效率，實為每個國家及全球結核病防治計劃的重點工作。

關鍵字

多重抗藥性結核病 ； 直接觀察治療 ； 藥物敏感性試驗

並列摘要

The majority of Multi-Drug Resistant Tuberculosis (MDR-TB) cases are arising from mismanagement in a previous treatment episode. Howevever, increasing proportion of new cases from transmission of drug-resistant strains among previously untreated patients had provided equal contribution to MDR-TB occurrence recently. According to WHO reports in 2011, the proportion of MDR-TB among new TB cases appears to be declining in recent years. It indicated that MDR-TB prevention programs implemented worldwide are gaining positive response. Nonetheless, there were still an estimated 220,000-400,000 new MDR-TB cases reported worldwide in 2011. Due to the facts of longer treatment course (at least 18 months after sputum culture conversion), longer communicable duration, high mortality rate in resource limited countries and high expense of treatment cost, MDR-TB remains a significant public health and economic issue globally. In general, the complexity of diagnosis and treatment in MDR-TB patients are highly dependent on the physicians' experience. The amateur physicians are prone to delay early detection of MDR-TB and initiate improper management, inadequate regimen may further broaden the resistance scope to produce XDR-TB. Therefore, earlier transference of suspicious drug-resistant patient to experienced physician or consortium is highly recommended by global TB guidelines. Moreover, successful treatment of MDR-TB are highly depend not only on a sound regimen but also on the delivery of medication consistent with workable DOT (Directly Observed Therapy). Therefore, Scaling up the quality and efficiency of MDR-TB diagnosis, treatment and case management are of paramount priority at the country level for prevention and control of MDR-TB.

並列關鍵字

Multi-Drug resistant Tuberculosis (MDR-TB) ； Directly Observed Therapy (DOT) ； Drug Susceptibility Testing (DST)