浅谈儿童耐多药结核病估计发病率新鲜出炉

在世界结核病日(3月24日)前在线发表的一项研究显示，儿童与初治成人的耐多药结核病风险似乎相近。本研究首次对儿童耐药性疾病的发病率做出全球性和区域性估测。

波士顿布里格姆妇女医院的Helen E. Jenkins医生及其同事计算了儿童结核病发病率，并进行了一项系统综述，估算了耐多药疾病的发病风险。据他们判断，近100万儿童在2010年发生了结核病，该数字大大多于2011年世界卫生组织的估计值，其中有将近32,000人患耐多药疾病。儿科结核病和耐药性疾病在东南亚最为高发。

在随刊述评中，澳大利亚悉尼大学Marie Bashir 传染性疾病与生物安全研究所的Ben J. Marais博士将该研究称为“迄今为止提供儿童结核病和耐多药结核病实际估测的最严谨的研究”，并称其可能会对该领域今后的研究提供一个基准。他表示，由于耐多药结核病患儿的治疗结局极佳(临床治愈率在80%以上)，每项努力都应该以缩小巨大的病例检测差距及阐释在诊断和治疗方面未满足的主要需求为目的。

作者们和Marais博士声明无竞争性利益冲突。儿童耐多药结核病估计发病率新鲜出炉，本研究由美国国立全科医学研究所、国立过敏及传染性疾病研究所以及多个组织团体资助。

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By: BIANCA NOGRADY, Internal Medicine News Digital Network

The risk of multidrug-resistant tuberculosis appears similar in children and treatment-naive adults, according to a study published online ahead of World Tuberculosis Day, which is March 24.

This study provides the first global and regional estimates of the incidence of drug-resistant disease in children.

Researchers led by Helen E. Jenkins, Ph.D., of Brigham and Women’s Hospital, Boston, calculated the incidence of tuberculosis in children and conducted a systematic review to estimate the risk of multidrug-resistant disease. They concluded that nearly 1 million children developed tuberculosis in 2010 – a figure substantially higher than the 2011 World Health Organization estimates. Of those, nearly 32,000 had multidrug-resistant disease.

The highest concentrations of pediatric tuberculosis and drug-resistant disease were in Southeast Asia, according to Dr. Jenkins and her associates (Lancet 2014 March 24 [doi: 10.1016/S0140-6736(14)60195-1]).

In an accompanying editorial, Dr. Ben J. Marais of the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia, called the study the "most rigorous effort to date to provide contextualized estimates of both tuberculosis and multidrug-resistant tuberculosis incidence in children," and said it was likely to provide a benchmark for future studies in the area.

"Given that treatment outcomes for children with multidrug-resistant tuberculosis are excellent (clinical cure rates in excess of 80%), every effort should be made to reduce the massive case-detection gap and address the vast unmet need for diagnosis and treatment," he said (Lancet 2014 March 24 [doi: 10.1016/S0140-6736(14)60489-X]).

The authors and Dr. Marais declared that they had no competing interests. Funding for the study was provided by awards from the U.S. National Institute of General Medical Sciences and the National Institute of Allergy and Infectious Diseases, as well as various fellowships.

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