廣泛抗藥性結核病

Extensively Drug Resistant Tuberculosis (XDR-TB)

10.6320/FJM.202207_26(4).0012

程詩茹(Shih-Ju Chen)；杜美玉(Mei-Yu Tu)；王誠一(Cheng-Yi Wang)；劉彥宏(Yen-Hung Liu)；林恒毅(Hen-I Lin)

廣泛抗藥性結核病 ； 多重性抗藥性結核病 ； XDR-TB (extensively drug resistant tuberculosis) ； MDR-TB(multi-drug resistant tuberculosis)

台灣醫學

26卷4期（2022 / 07 / 25）

477 - 482

繁體中文

在2021年，世界衛生組織定義廣泛抗藥性結核病（extensively drug resistant tuberculosis，XDR-TB）為同時符合三個條件：（1）對isoniazid及rifampicin有抗藥性；（2）對任何一種fluoroquinolone有抗藥性：（3）對bedaquiline或linezolid有抗藥性。導致廣泛抗藥性結核病（XDR-TB）盛行的原因主要有：（1）在治療期間原來不具抗藥性的菌株，轉變成抗藥性菌株（獲得抗藥性）；（2）由於不適當的藥物治療，導致抗藥性菌株的發展（增強抗藥性）；（3）獲得抗藥性基因的案例（傳遞型抗藥性）。臺灣的抗藥性監測資料在2006年底以前是來自於各醫院的研究資料收集得知，其中多重抗藥性結核病（MDR-TB）的比率從0.2%（1984-1990）一直逐年往上升至2%（1997-2000）。為有效控制多重抗藥性結核病（MDR-TB）疫情，避免演化成廣泛抗藥性結核病（XDR-TB）的危機，從2006年起臺灣建立MDR-TB（multi-drug resistant tuberculosis）通報系統，到現今所推動進階都治計畫（DOTS-Plus）以及時監控所有多重抗藥性結核病（MDR-TB）的病患，避免衍生出更多廣泛抗藥性結核病（XDR-TB）之病患。

In 2021, the World Health Organization defines XDR-TB (Extensively Drug Resistant Tuberculosis) as resistant to (1) isoniazid and rifampicin, (2) any type of fluoroquinolone, and (3) bedaquiline or linezolid. The reasons to cause XDR-TB to disseminate are illustrated below. (1) Strains without drug resistance become drug-resistant during treatment (gain drug resistance), (2) Inappropriate medical treatment causes drug-resistant strains to develop (enhance drug resistance), and (3) gain drug resistance from cases with resistant strains. The anti-microbial resistance monitoring data was collected from hospitals' research by the end of 2006, with the morbidity rate increasing annually from 0.2% (1984-1990) to 2% (1997-2000). To effectively control the MDR-TB epidemic and prevent it from becoming the crisis of XDR-TB, Taiwan, since 2006, has established a multi-drug resistant tuberculosis reporting system and a DOTS-Plus plan to timely monitor MDR-TB patients and prevent them from deteriorating into XDR-TB.