摘要
随着流动人口增加、环境破坏、耐药结核、免疫缺陷疾病传播流行以及变异菌的出现,使结核病在全球范围内高发,致残率、致死率逐年上升,严重危害人类健康。目前临床相当一部分结核病患者由于耐多药结核(MDR-TB)迁延不愈及复发,不愈患者又因长期携带MDR-TB菌株,成为MDR-TB传播者,进而导致区域性流行,增加了结核病防治难度。分析MDR-TB流行的原因:其一,结核局部病灶产生一种致密性的硬化壁,阻挡了抗结核药物进入病灶,患者机体内有效抗菌浓度明显下降,导致结核病灶迁延不愈或反复复发。此外,长期接受低于有效杀菌浓度的抗菌药物,有可能引起继发性耐药。异烟肼、利福平、吡嗪酰胺等抗结核药物浓度达不到最低抑菌浓度,难以杀灭结核骨性病灶中的结核菌群。其二,骨关节结核需手术修复,临床缺乏行之有效的人工植骨材料。彻底切除病灶硬化壁,亟须尝试开发出高效、无或低毒的局部药物缓释系统—载抗结核药物,提高结核疾病病灶局部抗结核药物浓度,预防继发性MDR-TB发生。故本文拟综述耐多药结核(MDR-TB)的流行现状、载抗结核药物系统的定义、抗结核药物的选择、高分子生物材料、缓释剂的研究及应用进展。
With the increase of floating population,environmental damage,spread of DR-TB,immune deficiency diseases and emergence of mutant bacteria,tuberculosis has become a disease with high incidence,high disability and mortality rate in the world,seriously endangering human health.The traditional treatment of tuberculosis has been in a dilemma,now plenty of tuberculosis patients are delayed and relapsed due to multi drug resistant tuberculosis(MDR-TB).Because of long-term carrying of MDR-TB strains,non cured patients become MDR-TB communicators,resulting in regional epidemic and increasing the difficulty of tuberculosis control.There are two reasons for prevalence of MDR-TB,first,tuberculosis locally produces a dense sclerotic wall,blocking the entry of anti tuberculosis drugs into lesions,effective antibacterial concentration in body of patients decreased significantly,leading to prolonged healing or recurrence of tuberculosis;in addition,long-term use of antibiotics lower than effective bactericidal concentration may cause secondary drug resistance.The concentration of anti tuberculosis drugs such as isoniazid,rifampicin,pyrazinamide can’t reach the minimum inhibitory concentration,so it is hard to kill tuberculosis bacteria in bone with tuberculosis.Second,tuberculosis of joint needs to be repaired surgically,there is a lack of effective artificial bone implant.It is urgent to develop a drug delivery system(DDS)with high efficiency,no or low toxicity,which can carry anti tuberculosis drugs,improve concentration of anti tuberculosis drugs and prevent occurrence of secondary MDR-TB.The paper reviews status of MDR-TB,definition of anti tuberculosis drug delivery system,selection of anti tuberculosis drugs,polymer biomaterials,progress in research and application of sustained-release agents.
作者
苗瑞瑞
张文龙
MIAO Ruirui;ZHANG Wenlong(NATCM Key Laboratory of Epidemic Prevention and Treatment with Traditional Chinese Medicine, Haihe Hospital, Tianjin 300350, China)
出处
《中国老年保健医学》
2021年第3期104-106,共3页
Chinese Journal of Geriatric Care
基金
天津市津南区科技计划项目(编号:20190102)。
关键词
载抗结核
抗结核药物
研究
进展
delivery of anti tuberculosis,anti tuberculosis drugs
research
progress
