少见非结核分枝杆菌病药物治疗新方案的研究进展

doi:10.19871/j.cnki.xfcrbzz.2023.05.016

摘要/Abstract

摘要： 非结核分枝杆菌病呈全球增长之势,仍然是全球公共卫生问题之一,其发病率、病死率和经济成本仍居高不下。分枝杆菌对大多数抗生素具有固有耐药性,治疗难度较大,尤其免疫功能低下及合并慢性基础疾病的患者常需要使用多药联合治疗方案和延长疗程的应对策略,但非结核分枝杆菌病的治愈率较低,紧迫需要更加有效的治疗药物组成新的治疗方案。目前比较常见的非结核分枝杆菌如鸟分枝杆菌复合群、脓肿分枝杆菌复合群等导致的成人非结核分枝杆菌肺病的治疗有相关指南可供参考,但临床相关的少见非结核分枝杆菌如海分枝杆菌、戈登分枝杆菌、溃疡分枝杆菌、玛尔摩分枝杆菌、日内瓦分枝杆菌、隐藏分枝杆菌、猿分枝杆菌复合群、副戈登分枝杆菌、苏尔加分枝杆菌、嗜血分枝杆菌或瘰疬分枝杆菌等导致的临床疾病的治疗药物方案的选择却非常有限。目前无论是基于指南的治疗策略或个体化治疗策略,均需要多种药物组成的联合治疗方案,但免疫功能低下患者及合并慢性疾病患者的治疗成功率不到50%,急需高效和低毒的新治疗方案用于临床实践以挽救患者生命、提高疗效和降低药物的毒副作用。本文将近年来少见非结核分枝杆菌病的治疗药物及其治疗新方案的研究进展作一综述。

关键词: 非结核分枝杆菌, 新药物治疗方案, 进展

Abstract: The global trends of nontuberculous mycobacterial disease（NTMD）are increasing. NTMD is one of worldwide public health burden associated with mounting morbidity, case fatality rate , and economic costs. Mycobacterial pathogens are intrinsically resistant to many available antibiotics, making treatment extremely challenging, especially in immunocompromised individuals and patients with chronic underlying conditions. Even if with lengthy therapy and the use of a combination of antibiotics, the cure rate for NTMD is lower. The need for novel medication regimens that are effective against NTMD is very urgent. A few available management guidelines for patients with common nontuberculous mycobacterial pulmonary disease(NTM-PD) in adults caused by Mycobacterium avium complex, and Mycobacterium abscessus complex have been issued. However, management options for diseases caused by other clinically relevant less common non-tuberculous mycobacteria(NTM), including Mycobacterium marinum, Mycobacterium gordonae, Mycobacterium ulcerans, Mycobacterium malmoense, Mycobacterium genavense, Mycobacterium celatum, Mycobacterium simiae, Mycobacterium paragordonae, Mycobacterium szulgai, Mycobacterium haemophilum, Mycobacterium scrofulaceum, are very insufficiency. The patients with NTMD should need multi-drug therapy based on current guideline-based treatment strategies and individualized treatment strategies. However, most NTMs had inherent resistance to a variety of first-line anti-bacterial drugs. The cure rate for especially the patients with immunocompromised and chronic diseases was lower than 50% and the treatment of NTMD were challenging.To save the lives of these patients, to improve the efficacy and to reduce side effects, new medications and treatment regimens with high efficacy and low toxicity are expected to be used in clinic as soon as possible. A systematical review on updated medication regimens for less common NTMD was developed.

Key words: Nontuberculous mycobacterial, Updated medication regimens, Progress

中图分类号:

R372

胡毅, 唐莉歆, 李同心, 唐神结, 杨松. 少见非结核分枝杆菌病药物治疗新方案的研究进展[J]. 新发传染病电子杂志, 2023, 8(5): 85-91.

Hu Yi, Tang Lixin, Li Tongxin, Tang Shengjie, Yang Song. Research progress on the updated medication regimens for less common nontuberculous mycobacterial disease[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 85-91.

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