结核病(TB)无疑是在整个历史上对人类造成最大损害的疾病。它已导致死亡和疾病大约20,000年1and, as a rule, has affected the poorest strata of society. Such a long time of common life with men has endowedMycobacterium tuberculosis,在所有已知的人类病原体中具有最佳适应性的因果因素。因此,它一直保持在大量个体中的静止状态,既不产生症状也不疾病,而是生存和等待更合适的攻击条件2。Today, it isestimated that one-third of the global population, around 2,000 million people3,生活在这种微生物,已知的Koch的芽孢杆菌中,代表了任何给定的感染性疾病的最大储层健康,感染的载体。令人不安的是,在新千年的开始以及上个世纪的许多重大发展之后,人们必须承认,由于世界上健康的感染者的数量以及由世界上的健康感染者,以及由TB仍然是主要的传染病。该病有800万人,每年仍会造成200万人死亡3。A number of reasons could explain this worrying situation, but ahead of all of these is the enormous inequality in the global distribution of wealth, which constantly increases the fraction of people living in extreme poverty, the most suitable condition for TB dissemination2。Moreover, the burden of AIDS has further degraded the situation in areas where TB had not been effectively controlled2-4。In addition, there is great disparity in the global distribution of TB. Some wealthy countries anticipate a probable elimination of TB in the next few decades, while poor nations witness a worsening of their problem every year, in spite of the resources devoted to TB control2。欧洲是这种差异的一个很好的例子,因为一些西方国家报告说,在过去十年中,欧洲的发病率低和有利的进化,而一些东部国家的疾病率更高,在过去的10年中显示出较高3。
TB is, perhaps, the most written about disease in the history of medicine2。重要的是,结核病不仅是肺部医学和胸外科手术的起源,而且是其他医学专业的起源。然而,从历史的角度看这些知识,人们意识到经验主义一直盛行,直到最近相对较近2。Up until 1882 the cause of the disease remained unknown, and some defended the theory of its inherited origin. However, research on TB during the twentieth century has yielded multiple and major developments, indeed at a slower pace during the last 10 yrs, than research on other diseases. The fact that TB is a disease of the poor has always played against its chances for research investment. Nevertheless, important knowledge has been acquired regarding its epidemiological behaviour, its virulence and pathogenesis, and also concerning potential diagnostic, therapeutic and control procedures. In spite of this significant progress, a critical look will disclose the following major deficiencies: 1) the basis of the current pathogenic rationale is >40 yrs old; 2) the diagnosis still depends on sputum microscopy and culture, which has been in use for >120 yrs; and 3) rifampin, the last drug included in initial treatment schemes, was developed back in 1963. Nevertheless, the message should be optimistic, since we face a disease that is simple to diagnose in advanced forms (sputum microscopy) and curable in nearly all cases with treatment regimens that, although inconveniently long, cost no more than 10.
在过去几十年中进行的大量结核病研究要么产生仅适用于富裕国家的知识2,,,,which endure the smallest share of the burden (the industrialised countries contribute altogether to only 6% of the global cases of tuberculosis3),或未得到充分验证。此外,这项新研究中的一些挑战了先前接受的关于结核病的知识。这些有争议的问题中的一些目前引起了人们的极大兴趣,这完全证明了一系列的出版,其中最重要,最有争议的主题将由合适的专家进行深入审查和分析。当前系列分析以下九个有趣的主题:1)M. tuberculosis-latent bacilli5;2) annual risk of infection withM. tuberculosis;3)诊断为TB的非惯例和新方法:该领域的可行性和适用性;4)结核病的耐药性;5)TB中的药物敏感性测试:方法,阳性预测价值和结果的解释;6)在感染HIV和未感染的个体中,结核病治疗和控制是否应有不同的解决?7)在重新治疗中管理多药的结核病和患者;8)移民和难民中结核病控制策略的成本效益;9)对TB的新疫苗的梦想:改善或取代Bacille Calmette-Guérin?
我们希望该系列能够阐明对每个经过治疗的受试者的怀疑,并将提高意识,以鼓励在结核病领域进行必要的研究,这是一个简单而复杂的知识领域。
- Received2004年9月24日。
- 公认2004年9月28日。
- © ERS Journals Ltd