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麻风病联合化疗的进展 PowerPoint PPT Presentation


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麻风病联合化疗的进展. 李文忠 中国医学科学院皮肤病研究所 2005 年 3 月. 引 言. 麻风病是一种慢性传播病,在我国流行已 2000 多年。在以往相当长的时间由于缺乏有效的治疗方法,往往导致畸残且难以治愈,因此社会偏见十分严重。自 20 世纪 40 年代初发现砜类药物对麻风治疗有效及 80 年代初我国政府推行世界卫生组织( WHO )的联合化疗( MDT )方案以来,麻风病得到了明显控制。该病已成为一种可以治愈的疾病,麻风病人正面临着一个比过去更好的未来。. 麻风化学治疗的发展.

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麻风病联合化疗的进展

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4499915

20053


4499915

2000204080WHOMDT


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18731941


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19411980

1

Promin 1941, DDS 1946

50

B66319581962


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2

  • Shepard 1960

  • 1964

    239

    2040


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  • DDS

    1mg4699.9%

    MIC500

    1100mgMIC10


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  • B663DDS

  • RFP1968

    600mg1500mg99.9%

  • RFP


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3

1

19641966 0.2%

19732.5

198110

DDS3BI2

9510887


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Person1979

111765

Cellona1984

618472.6%

447775.6%

3610953.3%

2

20407087


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4RFP

1Jacobson2


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  • Guelpa-Lauras19849RFPRPFRPF5~72


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(2) Grosset(1986):8016RFP

  • 84RFP16/8419RFP

  • 5

  • 40mg/

    0.03%


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(3) RFP

3RFPDDSRFP

RFPRFPDDS

70RFPRFPDDSRFP


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B663

Rao20028B6632B6335DDSB6631RFPB663

ETH/PTH

ETH57/102


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  • Norman2003MDT45KarigiriDDSDDS80MDT1997MDTRPF


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  • Matsuoka2003MDT78MDT


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  • Rao20021988~1998Karigiri12229.5%RPF14.8% RFPB66314.8%RPFDDS


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RFP

1

2PCRrpoBDNARFP

3RPFDNARNA4rpoArpoBrpoCrpoD


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44 2 2 +

5RNA

6RFPRNA


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7RFPrpoBrpoB

8

folp1DDS

gyrA

23S RNA


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  • RFPB663DDS10-710-610-6RFPB6310-13RFPB663DDS1019109~10113


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DDS

DDS

DDS

DDS

DDS

DDS

DDS

DDS

DDS

DDS(1/106)

DDS

() ()


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RFP

RFP

RFP

RFP-DDS

DDS

RFP

RFP

RFP-DDS

RFP

RFP

RFP-DDS

RFP-DDS

() ()


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B663

B663

B663

B663

B663

RFP-DDS

RFP-DDS-B663

RFP-DDS-B663

B663

B663

RFP-DDS-B663

RFP-DDS-B663

()()


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RFP(10-6)

DDS(10-6)

RFP(10-6)

DDS(10-6)

(10-18)

B663(10-6)

(10-12)

RFP

B663

DDS

RFPDDS

RFPB663DDS


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RFP(103)

(104)

B663 (103)

DDS(103)


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7MDT

  • DDS

  • RFPRFPDDS


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  • Freerksen1972MDT

    RFP 600mg/

    Isoprodian 2/

    DDS 50mg

    PTH 175mg

    INH 175mg

    WHO

    1981MDT


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8Waters(1974)

1DDS10N

2

DDS 1012.5

B663 10

RFP 57.5

RFPB663 5

RFPB663DDS 2


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3MDT

MDT324

9

107

525104


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4

5


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9

  • DDS10910

    11

    DDS4210

    1


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RFP600mg-1500mg/4

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MDT

1981WHO


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MDT

DDS

  • 100mg/

  • 4699DDSB6631299.999%

  • 2~56~10


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DDS


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RFP

  • 600mg1500mg99.9%RFP600mgMDT600mg

  • RFP34

  • 600mg


Clofazimine b663

(Clofazimine B663)

  • DDS36

    B663 1200mgWHO MDTB663 300mg50mg/

    B663

  • 300mg50mg/


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Ofloxacin oflo

Ofloxacin,OFLO

  • RFPDDS

    2299.99%

  • 400mg/


Minocycline mino

minocycline,MINO

  • RFPOFLO

  • 100mg/


Clarithromycin clari

Clarithromycin,CLARI

  • 500mg28569999.9

  • 500mg/


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MDT

(1)WHO1981MBPB

MBBBBLLL2+

PBITTBT2+


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2WHO 1987

  • ,5,

  • ,,

    3WHO 1993

  • 51PB

  • 62MB

    4MB


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4

MDTWHO73

2-5

6


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WHO6(1987)621/4


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  • MDT


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  • RMPMDT


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WHO

  • PBWHOMDT

  • MBWHOMDT

  • PBROMPB


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  • WHO1981

    PBMDT6

    MBMDT2

  • WHO71994

    PBMDT6

    PBROM1

    MBMDT24


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WHO1998

MBMDT24MBMDT12WHOMBMDT2412

WHO TAG32002

MBPBWHOMDT6


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3.

  • 1(ROM)

  • (2~5)6

  • (6)216


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6

  • MBMDT

  • 1

  • MBMDT

    555


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1MBMDT1256

210MDT

3MDT1

4MBMDT

200292009


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MDT

1WHOMDT

2MBMDT

  • MBMDT

  • DDSB663MDT

  • DDSB663RFP

  • DDSRFPRFP


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1MDT

  • ROM

    RFP92.1%, OFLO60.2%ROM95

    PB1PBMDT

    PBMB1


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  • RPTMXFXMINO

    RPT99.6% MXFX92.1%

    RMM99.9%


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1

  • LEC30

  • 1830

  • PB1055


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2

  • MDT


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3 MDT

  • MBMDT

  • MBMDT 240.77%PBMDT 61.07%

  • WHO10MDT


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  • BI4.0MB2MDT

    Jamet38.9%

    Girdhar16.8%

  • 52

  • MBMDT4

  • MBMDT


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4.

  • 1997MDT: 98.4%

  • 1997MDT: 47276

    • : 6.362.83

    • 211MB131PB90

    • 0.47%

      0.73/1000

  • 0.39% P<0.01

    0.61/1000

  • 0.48%

    1.041/1000


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5

  • WHOMDT


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6MDT

  • MDT

  • MDT

  • RFP


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7MDTAMDT

MDTMDT


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MDT1MDT

  • AMDT


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8

MBMDT12

40

AMDT

MDT


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9

1


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2


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MDT

2000MDT:99%

1985-2002:1200

89%

2001MDT:

50,22>80%,14<10%


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RFP(rifapentinRPT)RFP

(moxifloxacin,MXFX)RFP


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