湖北日报讯 图为：我省结核病防治专家下乡为群众义诊。
记者 唐晓安 孔文莹 实习生 高婷 通讯员 罗军民
今天是“世界防治结核病日”，今年宣传主题是“遏制结核，共享健康。”
结核病是一种通过空气传播的传染病，现有患者基数大。一个不容忽视的现象是，由于科普知识缺乏，当前人们对防治结核病还存在许多认识误区：一些人因不了解结核病能防能治而闻“结核”色变，唯恐避之不及；一些人把早期结核病症状误认为是感冒、慢性支气管炎等，有病不就医，还增加了将疾病传播给他人的可能性；一些患者不听医嘱，用药停停用用，用用停停，导致耐药现象发生，增加了防治难度。
此外，随着人们生活工作节奏加快，人员流动大，结核病疫情出现了许多新特点，防治面临许多新挑战。
本期《健康》特地与省疾控中心联合开展专题防治宣传结核病，目的在于让人们了解我国和我省当前防治形势，宣传防治政策和知识，提高自我防护意识。
为调动广大人民群众参与防治结核病宣传的积极性，省疾控中心还特地开展结核病防治知识有奖问答活动，欢迎大家踊跃参与。
不容乐观的疫情形势
结核病包括骨结核、脑膜结核、肺结核等，前两者不具有传染性，后者只有痰中查出结核杆菌的肺结核病人才具有传染性，这些患者在咳嗽、打喷嚏、大声说话时，唾沫喷到他人脸上就可能造成传染。
省疾控中心专家介绍，结核病是一种通过空气传播的慢性传染病，多个世纪以来，结核病一直是人类的灾难。据世界卫生组织报告，目前全球大约有1/3的人感染了结核杆菌，每年约新发结核病900万人，因结核病死亡达300万人，结核病与艾滋病、疟疾成为三大传染病死因，所致的经济损失约占国民生产总值的4%-7%。
我省结核病疫情严重，近10年来，全省每年登记报告的肺结核病人达5万人，占报告的甲乙类传染病总人数的34.3%。结核病在农村发病多，贫困地区发病多，青壮年发病多。近年来随着城市化进程加快，以及大量务工人员进城，城市结核病疫情有上升的趋势。
防治之弦始终绷紧
省疾控专家介绍，国家和省委、省政府高度重视结核病防治工作，“十一五”期间，我省结核病防治取得了许多新的突破：建立和完善了结核病防治工作机制。各级政府制定了结核病防治规划，相继出台了一系列加强结核病防治工作的政策和措施，增加了结核病防治专项经费的投入，把结核病防治纳入当地政府和相关部门工作内容，实行目标责任制管理。形成了政府主导、部门配合、全社会参与的结核病防治工作格局。
具体表现为：出台了结核病防治服务政策。在对结核病患者实施“三免”政策（免费查痰、免费拍片和免费抗结核治疗）的基础上，逐步对涂阴肺结核患者进行免费治疗，对涂阳肺结核密切接触者进行结核病筛查，对未及时到结防机构就诊的疑似患者进行追踪，加强了综合医疗机构与结防机构之间的合作，将结核病门诊费用纳入当前医疗保障体系等。
积极开展了结核病新技术和新方法的研究。针对目前结核病防治新挑战，先后开展了耐多药、结核菌和艾滋病毒双重感染、流动人口结核病防治试点工作，特别是在耐多药结核病防治方面，摸索总结出“以地市为核心，以区县为枢纽，以社区为依托”的耐多药肺结核治疗管理服务模式，为全国开展耐多药肺结核防治工作提供了宝贵经验。此外，通过增加结防专业人员，更新了结核病诊断和管理的基本设备，加强了防治机构规范化管理，提升了服务能力和水平。
全省疫情呈现下降趋势。“十一五”期间，全省免费筛查疑似肺结核病人102.7万人，发现肺结核患者25万人，其中传染性肺结核15万人，已治愈23万人，有效遏制了结核病在社区传播。去年，我省8个流调点的初步调查结果显示，15岁以上人群活动性肺结核患病率较2000年下降31.5%。
防治从春天开始
省疾控专家介绍，春天属结核病的高发期，同时大量的进城务工人员和外出旅游人群使城市流动人口急剧增加，使结核病的控制增加了难度。因此，春天加强对流动人口结核病防治知识的宣传和教育迫在眉睫。
专家介绍，进城务工的流动人口是结核病的高发人群，主要原因在于流动人口劳动就业的压力大，工作紧张，生活条件、居住环境较差，感染结核菌后易发病。同时这类人群居住相对集中，容易造成大范围传染。此外，流动人口居无定所，不易管理，结核病人不规范治疗，引起耐药结核病的发生。
虽然流动人口是结核病的高发人群，但掌握正确的预防措施，依然可以很好的预防结核病：1，养成良好的生活习惯，不随地吐痰，坚持锻炼，提高自身免疫力。2，人口密集的地方注意通风，保持空气新鲜。3，控制传染源，积极发现和彻底治愈肺结核患者。4，密切接触者要及时接受相关检查，必要时高危人群要预防服药。
据介绍，目前我国结核病防治机构（结防所、疾控中心）在肺结核病的诊断、治疗和管理等方面已形成完整技术规范，国家对肺结核病可疑症状者实行免费检查，对活动性肺结核病人免费提供国家统一方案的抗结核药物。流动人口享受当地居民同等待遇，即在居住地可享受国家关于结核病诊疗的免费政策。
专家同时介绍，只要发现及时，并接受规范化治疗，85%以上的结核病都是可以治愈的。今年我省结防工作重点将进一步强化政府对结核病防治的重视，加强多部门合作；继续实施全球基金结核病项目；开展省级结核病综合防治示范区建设，探索防治新模式、新方法，同时通过防治知识教育进社区、进校园、进单位等活动，着力提高全人群的结核病知识知晓率和自我保护意识，形成全社会共同关注和参与的良好氛围。
结核菌/艾滋病病毒双重感染防治
结核菌/艾滋病病毒（TB/HIV）双重感染有两方面的含义：一是艾滋病病毒感染者同时感染了结核菌，但还没有发展成为活动性肺结核患者，称为“结核菌/艾滋病病毒双重感染”；二是当艾滋病病毒感染者或艾滋病患者同时患有活动性结核病时，即称为“艾滋病合并结核病患者”。
从理论上讲，未感染艾滋病病毒的人感染结核杆菌后，并不一定发生结核病，只有在抵抗力低的情况下才发病。正常人群中结核菌的感染者中，大约有10%的人在一生中可能发生结核病；但是一旦感染了艾滋病病毒后，结核病的发生概率将上升至50%左右。
如何预防艾滋病毒感染者发生结核？
预防艾滋病毒感染者发生结核病的最好方法是采用药物预防。艾滋病毒感染者有以下一项者，应进行药物预防：1、结素皮肤试验阳性反应；2、肺内有陈旧病灶；3、来自结核病高发地区。预防方法是服用异烟肼12个月。在结核病高发地区，受艾滋病毒感染但无症状的儿童可以用卡介苗预防；若母亲感染艾滋病毒，其自身表现正常的儿童也应该接种卡介苗。
结核病是如何传染和发病的？
结核病是呼吸道传染病，肺结核病人具有传染性，但每个肺结核病人的传染性的大小是不同的，经过研究证明痰涂片检查排菌（阳性）的肺结核病人对其密切接触者传染性最大，痰涂片检查不排菌（阴性）的肺结核病人对其接触者传染性相对较小，故痰涂片检查排菌的肺结核病人是结核病主要传染源。
结核病是怎样传染的？当肺结核病人咳嗽或打喷嚏时，将带有结核菌的飞沫散播于空气中，悬浮于空气中的结核菌可存活9个小时以上，健康人吸入带有结核菌的飞沫可受到结核菌的传染。
与结核病传染源接触的密切程度和周围环境中含结核菌飞沫的浓度可影响传染性的大小。家庭中父母或祖父母等长辈有结核病，密切接触的儿童较易受结核病的传染。通风换气不良的、较密闭的环境，特别是在集体生活和居住拥挤的群体中（如学校、工厂、监狱等），一旦有人患肺结核病，常会造成结核病传染和暴发流行。
人体初次受到结核菌感染后，大多数（90%）人没有任何症状，也不发生结核病。只是在进行结核菌素（PPD）皮肤试验时由阴性变为阳性或者进行胸部X线体检时发现肺部有钙化硬结病灶时才知道受到结核菌感染。
受到结核菌感染的人只有少数人发生结核病，感染后是否发生结核病，主要受到两种因素的影响，即受到感染结核菌毒力大小和身体抵抗力高低的影响，通常在受结核菌感染的人中发生结核病的概率约为10%，其中大多数是在感染后两年内发病，如结核感染者同时患有糖尿病或合并艾滋病病毒感染时，患结核病的机会大幅增加。
什么是耐（多）药结核病?
耐药结核病是指病人感染的结核分枝杆菌对任何一种或以上的抗结核药物耐药，耐多药结核病（MDR-TB）是指病人感染的结核分枝杆菌至少对异烟肼、利福平两种及以上的抗结核药物耐药，广泛耐药结核病(XDR-TB)，也称超级耐药结核病，是指在耐异烟肼以及利福平基础上，对两种最主要的二线抗结核药物注射剂以及氟喹诺酮类药物也耐药。
如今，耐药结核病已经成为全球结核病控制工作面临的三大挑战之一，据世界卫生组织估计，全球每年新产生耐多药结核病患者约50万人，广泛耐药结核病患者约5万人。由于治疗极其困难，病程迁延不愈，传染性强，治疗费用比一般结核病要高100倍。
预防耐多药结核病要正确理解导致耐药的原因，耐药主要是治疗不当导致其发生，包括治疗方案不合理，病人间断或中断治疗等。因此要采取有力措施落实传染性肺结核病人的治疗及管理，预防和减少耐药结核病的发生，要采用敏感药物和与之相关的监测措施。使用有效药物实行短程督导化疗，使结核病人治愈是防止和减少耐药性发生的最主要措施。
(本文来源：荆楚网-湖北日报 )
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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Photo: Stop TB share health
2011-03-24 05:54:00 Source: Sports Network - Hubei Daily (Wuhan)
Hubei Daily News Pictured: the province of experts to the countryside for the masses TB clinic.
High-Ting Tang Xiaoan Kong Wenying intern reporter correspondent Luo Junmin
Today is "World TB Day", this year's promotional theme is "Stop TB, sharing health."
TB is an airborne infectious disease, the existing large base of patients. Phenomenon can not be ignored, because of the lack of scientific knowledge, the current TB prevention and treatment of people there are still many misunderstandings: some people do not understand the anti-TB can cure but can be heard, "TB" pale, largely stayed away; some people early TB symptoms mistaken for flu, chronic bronchitis, the sick do not seek medical treatment, also increased the likelihood of disease transmission to others; some patients do not listen to medical advice, stop-use of medication use, with a stop-use, leading to drug resistance occurred, an increase of control difficult.
In addition, to accelerate the pace of work with people's lives, the movement of large tuberculosis outbreak occurred many new features, prevention and control faces many new challenges.
This month's "health" especially joint project with the provincial CDC TB prevention and control information, the purpose is to make people understand the current control situation in China and the province to promote prevention and control policies and knowledge and enhance self-protection awareness.
To mobilize the broad masses of people involved in TB advocacy initiative, the provincial CDC also specifically to carry out TB control activities in the knowledge quiz, welcome everyone to take part.
The epidemic situation is not optimistic
TB, including bone tuberculosis, meningeal tuberculosis and tuberculosis, the former two are not contagious, which is found only sputum Mycobacterium tuberculosis talent is contagious, the patient coughs, sneezes, speaks loudly, spittle spraying the face of others may cause infection.
Provincial CDC experts, TB is a chronic infectious disease spread through the air, many centuries, tuberculosis has been a human disaster. The World Health Organization, the world's approximately 1 / 3 of people infected with Mycobacterium tuberculosis, each year 900 million new TB, 300 million people died of tuberculosis, tuberculosis and AIDS, malaria as three major infectious cause of death, the economic loss caused by the gross national product accounts for about 4% -7%.
Serious TB epidemic in our province in recent 10 years, the province's annual report on tuberculosis patients registered up to 5 million people, accounting for type A and B reported 34.3% of the total number of infectious diseases. TB incidence in rural areas, poverty incidence areas and more disease and more young adults. With the fast urbanization in recent years, and a large number of workers into the city, the city tuberculosis on the rise.
Control of the string is always taut
Provincial disease control experts, national and provincial government attaches great importance to TB control, "Eleventh Five-Year" period, the province made a number of new TB breakthrough: the establishment and improvement of the tuberculosis control mechanism. Governments at all levels to develop a TB control program, has issued a series of strengthening tuberculosis prevention and control policies and measures to increase investment in TB prevention and treatment of special funds, the TB control into the local government and relevant departments of job content, the implementation of the target responsibility system management. Formed a government-led, departments, whole society to participate in TB control work pattern.
Specific performance: the introduction of the TB control services policy. The implementation of the TB patients in the "three free" policy (Sputum smear free, free film and free anti-TB treatment), based on gradually smear negative pulmonary tuberculosis patients with free treatment for smear positive tuberculosis screening of close contacts, for failure to timely treatment of suspected TB patients body tracking, medical institutions and strengthening the comprehensive cooperation between TB, TB out-patient costs would be included in the current health care system and so on.
Active TB of new technologies and new methods of. Present new challenges for TB control, has launched a multi-drug resistant, tuberculosis and HIV co-infection, TB control program for the floating population, especially in the prevention and treatment of MDR-TB, and explore concludes that "the cities as the core, District as the hub, community-based "treatment of MDR-TB management service model for a nationwide prevention and treatment of MDR-TB has provided valuable experience. In addition, by increasing TB professionals, update the TB diagnosis and management of the basic equipment to strengthen the prevention and control institutions standardized management, enhance capacity and level of service.
Epidemic show a downward trend in the province. "Eleventh Five-Year" period, the province's free screening patients with suspected tuberculosis 102.7 million, found that 25 million TB patients, of which 15 million infectious TB have been cured 23 people, to effectively curb the spread of TB in the community. Last year, the province epidemiological survey points 8 preliminary findings show that people over 15 years the prevalence of active pulmonary tuberculosis decreased 31.5% compared to 2000.
Control from the spring
Provincial disease control experts, the spring is a high incidence of TB, while a large number of migrant workers and people traveling dramatic increase in the urban floating population, the TB control more difficult. Therefore, the spring of the floating population, knowledge of TB prevention and control publicity and education is imminent.
Experts, the flow of migrant population is high risk of TB, largely because of migrant labor employment pressure, work stress, living conditions, poor living conditions, the infection easily after TB disease. The relative concentration of such people living in the same time, likely to cause widespread infection. In addition, the floating population of no fixed abode, easy management, TB treatment is not standardized, causing the occurrence of drug-resistant TB.
Although the current population is high risk of TB, but to master the correct preventive measures against tuberculosis still very good: 1, to develop good habits, do not spit, and exercise, to improve their own immunity. 2, the densely populated areas well ventilated to keep the air fresh. 3, 控制传染源, active detection and complete cure of tuberculosis patients. 4, close contacts should receive timely and relevant examination, if necessary, medication to prevent high-risk groups.
According to reports, the current organization of tuberculosis prevention and control (the TB, CDC) in TB diagnosis, treatment and management, has formed a complete technical specification, the state of suspicious cases of tuberculosis were the introduction of free checking, on the active pulmonary tuberculosis patients provide free anti-TB drugs program of national unity. Migrants enjoy the same treatment as local residents, that residence can enjoy the national policy on TB diagnosis and treatment free of charge.
Experts also introduced, as long as that time, and receive standardized treatment, 85% of the TB is curable. TB in our province this year, the focus will further strengthen the government's emphasis on TB control and strengthen multi-sectoral cooperation; continue to implement the Global Fund TB project; carry out the provincial TB prevention and control demonstration zones, and explore new prevention and treatment models, new ways, through prevention and treatment knowledge education into communities, into schools, into the unit and other activities, strive to improve the knowledge of the whole population of TB awareness and self-protection awareness of common concern to the whole society and participate in a good atmosphere.
TB / HIV dual infection control
TB / HIV (TB / HIV)-infection has two meanings: one is infected with HIV are also infected with the TB, but have not yet developed into active TB patients, referred to as "TB / HIV co-infection "; Second, when HIV infection or AIDS patients are also suffering from active tuberculosis, that is called" AIDS complicated by tuberculosis. "
In theory, people who are not infected with HIV-infected with TB bacilli, the TB does not necessarily occur only in circumstances of low resistance to disease. Normal population of M. tuberculosis infection, about 10% of TB occur in their lives; but once infected with the AIDS virus, the probability of occurrence of tuberculosis will increase to 50%.
How to prevent the occurrence of TB with HIV?
HIV prevention is the best way of TB with drug prevention. HIV-infected people who have one of the following should be carried out drug prevention: 1, Results prime positive skin test; 2, pulmonary lesions are old; 3, from the high incidence of tuberculosis. Prevention is to take isoniazid for 12 months. High incidence of TB, asymptomatic HIV-infected children, but BCG can prevent; if mother infected with HIV, the performance of normal children of their own should also be vaccinated against tuberculosis.
Tuberculosis infection and disease is how?
TB is a respiratory infection, tuberculosis is contagious, but each the size of infectious tuberculosis patients is different, studies have shown that sputum smear examination after row of bacteria (positive) tuberculosis patients are most infectious to their close contacts, sputum smears do not rule out bacteria (negative) of their contacts of infectious tuberculosis patients is relatively small, so the row of sputum smear tuberculosis bacteria is the main source of infection of tuberculosis.
What is TB infection? When the tuberculosis patient coughs or sneezes, the droplets with TB spread in the air, suspended in the air in the Mycobacterium tuberculosis can survive for more than 9 hours, healthy people can inhale droplets with TB by TB transmission.
Source of infection with TB and the extent of close contact with TB in the surrounding environment can affect the concentration of infectious droplet size. Parents or grandparents and other family elders have tuberculosis, close contact with children more susceptible to TB infection. Poor ventilation, more closed environment, particularly in the collective life and living in crowded groups (such as schools, factories, prisons, etc.), once someone suffering from tuberculosis, often result in TB transmission and outbreaks.
After the initial infection by the human TB, the majority (90%) people do not have any symptoms, does not occur and tuberculosis. Only during the tuberculin (PPD) skin test from negative to positive or a chest X ray examination was found when lung lesions that are calcified sclerosis TB infection.
By the person infected with TB only a few people with TB, TB infection has occurred, mainly by two factors, namely, the size of virulent M. tuberculosis infection and the impact of high and low body resistance, usually in people infected with TB TB occurs in about 10% probability, most of them within two years after the onset of infection, such as tuberculosis infection combined with diabetes or HIV infection, a significant increase opportunities for TB.
What is the resistance (and more) TB?
Drug-resistant TB is Mycobacterium tuberculosis infection in patients of any one or more anti-TB drug resistance, multidrug-resistant tuberculosis (MDR-TB) refers to patients infected with Mycobacterium tuberculosis to at least isoniazid, Lee Ping Fu of two or more anti-TB drug resistance, extensively drug-resistant TB (XDR-TB), also known as super drug-resistant TB is resistant to isoniazid and rifampicin means on the basis of the two most important injectable second-line anti-TB drugs and is also resistant to fluoroquinolones.
Today, drug-resistant TB has become a global TB control one of the challenges facing the three, according to World Health Organization estimates, the global number of new MDR-TB patients produced about 50 million people, the disease is about 5 million patients. As the treatment is extremely difficult, delayed healing of disease, contagious, and treatment of TB is higher than the average 100 times.
Prevention of MDR-TB resistant to correctly understand the reasons lead to drug resistance is mainly due to improper treatment of its occurrence, including the unreasonable treatment, the patient stopped or interrupted treatment. Therefore, effective measures should be taken to implement the treatment of infectious tuberculosis patients and management, prevention and reduction of the incidence of drug-resistant TB, to use sensitive monitoring of drugs and related measures. Effective drugs used to implement DOTS, the TB cure is to prevent and reduce the occurrence of resistance to the most important measures.
(This article Source: Sports Network - Hubei Daily)
