世界卫生组织《全球结核病报告2022》解读

doi:10.16150/j.1671-2870.2023.01.004

摘要/Abstract

摘要：

世界卫生组织（World Health Organization, WHO）发布了新的《全球结核病报告2022》（以下简称报告），报告指出新型冠状病毒感染加重了结核病的负担，严重影响了全球结核病控制的进程。2021年，WHO共批准6项用于结核病诊断和抗结核药物耐药性检测的分子诊断技术，推荐3种用于筛查结核病的基于结核分枝杆菌抗原的新型皮肤试验。为减轻患者和医疗系统的负担，WHO推荐了“4个月方案”治疗药物敏感结核病和4套耐多药和利福平耐药结核病(multidrug resistant/rifampicin resistant-tuberculosis，MDR/RR-TB)短程方案，治疗耐药结核病。目前有26种抗结核药物处于临床试验阶段，至少有22项临床试验在开展治疗结核感染的药物和方案的评估。我国的结核病疫情仍十分严重，2021年，我国结核病新发患者数在30个结核病高负担国家中排第3位。2021年，全国共报告肺结核病例639 548例，死亡1 763例，报告发病率为45.37/10万，报告死亡率为0.13/10万，MDR/RR-TB患者例数居全球第4位。WHO推荐治疗耐药性结核病方案是否适合我国，尚需验证。

关键词: 结核病, 利福平耐药, 疾病负担, 流行病学

Abstract:

Global Tuberculosis Report 2022 (hereafter referred to as “report”), newly published by the World Health Organization (WHO), states that the coronavirus (COVID-19) pandemic has increased the tuberculosis (TB) disease burden and severely affected global TB prevention and control. In 2021, WHO approved a total of six molecular diagnostic technologies for TB diagnosis and anti-TB drug resistance detection, and three new TB antigen-based skin tests for TB screening were recommended. To reduce the burden on patients and the health system, WHO recommends a 4-month regimen for drug-susceptible TB and four shorter regimens for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). In addition, there were 26 drugs for TB treatment in clinical trials, and at least 22 clinical trials evaluating drugs and drug regimens for TB treatment were underway. In 2021， the TB epidemic remains severe in China, with the number of newly diagnosed cases ranking third among the 30 countries. In 2021, a total of 639 548 TB cases and 1 763 deaths were reported nationwide, with an incidence of 45.37/100 000 and a mortality of 0.13/100 000. China has the fourth largest number of MDR/RR-TB patients in the world. However, it is necessary to verify whether the regimens for MDR/RR-TB treatment recommended by WHO are suitable for patients in China.

Key words: Tuberculosis, Rifampicin resistance, Burden of disease, Epidemiology

中图分类号:

R521

梁晨, 于佳佳, 唐神结. 世界卫生组织《全球结核病报告2022》解读[J]. 诊断学理论与实践, 2023, 22(01): 21-30.

LIANG Chen, YU Jiajia, TANG Shenjie. Interpretation of the Global Tuberculosis Report 2022 by World Health Organization[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(01): 21-30.

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项目	里程碑		目标
项目	2020年	2025年	2030年	2035年
因结核病死亡人数下降的百分比（与2015年基线相比）	35%	75%	90%	95%
结核病发病率下降的百分比（与2015年基线相比）	20%	50%	80%	90%
受结核病影响的家庭因结核病而面临灾难性成本的百分比（2015年水平未知）	0	0	0	0

指标	目标
2018年至2022年（5年内）接受治疗的结核病患者例数	4 000万例患者（包括350万儿童)，其中有150万耐药结核病病例（包括115 000例耐药结核病儿童）
2018年至2022年（5年内）接受结核病预防性治疗者例数	至少3 000万人，包括400万名与结核病患者有家庭接触的5岁以下的儿童；2 000万名与结核病患者有家庭接触的老年人；600万例HIV感染者
为普及结核病的高质量预防、诊断、治疗和护理提供年度资金	截至2022年，每年至少130亿美元
结核病研究的年度资助	2018年至2022年这5年内，每年20亿美元

国家	估算发病率/100 000 （95% CI）	估算发病人数 (×1 000 000) （95% CI）	全球份额
印度	210（178~244）	3（2.500~3.400）	28.0%
印度尼西亚	354（318~391）	0.969（0.872~1.100）	9.2%
中国	55（47~63）	0.780（0.665~0.905）	7.4%
菲律宾	650（352~1 000）	0.741（0.401~1.200）	7.0%
巴基斯坦	264（192~347）	0.611（0.445~0.803）	5.8%
尼日利亚	219（143~311）	0.476（0.305~0.664）	4.4%
孟加拉国	221（161~291）	0.375（0.273~0.493）	3.6%
刚果	370（231~542）	0.022（0.013~0.032）	2.9%