需要大力加强对耐药结核病的研究

需要大力加强对耐药结核病的研究
　　Drug-resistant TB needs massive research increase
　　Frank G. J. Cobelens及其同事在《公共科学图书馆·医学》杂志上写道，只有大力加强对耐多药结核病（MDR-TB）的研究，从而为卫生保健工作者提供合适的工具，MDR-TB的治疗项目才能成功。
　　Multidrug-resistant tuberculosis (MDR-TB) programmes can be successful, but only with a massive increase in research to equip healthcare workers with the appropriate tools, write Frank G. J. Cobelens and colleagues in PLoS Medicine.
　　耐药结核病是一个人为的问题，源于薄弱的结核病控制措施，诸如药物和疗法不充分、不良的病例管理，以及忽视了可预防的传染。
　　Drug-resistant TB is a man-made problem, resulting from weak TB control measures such as using inadequate drugs and regimens, poor case management and allowing preventable transmission.
　　这组作者说，在5个穷国进行的MDR-TB试点项目产生了59%到83%的治疗成功率，表明这类项目是可行的。但是把试点项目扩大到结核病控制项目还有许多挑战。需要首先既解决生物学的问题，又解决临床问题。
　　Pilot MDR-TB programmes in five poor countries have yielded treatment success rates of 59–83 per cent, showing that such programmes are feasible, say the authors. But there are many challenges in scaling up from pilot projects to TB control programmes. Both biological and clinical issues need to be addressed first.
　　需要改善药敏测试以及实验室支持，从而给患者正确的药物。需要更好的二线药物——其中一些已经在准备中了。而且需要在大规模的临床实验中检验治疗策略并使之标准化。也需要进行流行病学研究，从而发现高危区域。
　　Drug susceptibility testing, alongside the development of laboratory support, needs to be improved to give patients the correct drugs. Better second-line drugs — some are already in the pipeline — are needed, and treatment strategies should be tested and standardised in large clinical trials. Epidemiological studies are also required to identify areas of high risk.
　　这组作者说：“因此需要制定策略，以一种可持续的方式让治疗依从性最大化，需要对影响依从性的因素加以研究，包括不良事件的角色以及患者的支持程度。”
　　"Strategies therefore need to be developed that maximise treatment adherence in a sustainable way, and factors that affect adherence need to be studied, including the role of adverse events and levels of patient support," the authors say.