改善索马里结核病治疗结局：策略、挑战与政策建议的叙述性综述
本文为叙述性综述，检索PubMed、Google Scholar、Scopus及WHO和人道组织灰色文献，纳入2010至2024年15项符合标准的研究。综述指出索马里结核病负担高且耐药结核（DR-TB）显现，强调分散化社区诊疗、快速分子诊断、多模式依从支持、全口服短程DR-TB方案及结核服务与营养和人道支持整合的重要性。
要点
- 分散化与社区为基础的照护、快速分子诊断和多模式依从支持是改善治疗结局的关键策略。
- 全口服短程DR-TB方案及结核服务与营养、人道支持的整合值得推广。
- 需加强卫生系统韧性并优先覆盖脆弱人群，以维持治疗结局的改善。
核心结论
- 索马里结核病负担高且耐药结核显现，需通过分散化社区照护、快速分子诊断、依从支持及全口服短程DR-TB方案等策略改善治疗结局。
- 加强卫生系统韧性并优先覆盖脆弱人群，对维持脆弱环境下的结核治疗结局改善至关重要。
研究设计与样本
- 叙述性综述，检索PubMed、Google Scholar、Scopus及WHO和人道组织灰色文献，时间范围为2010至2024年。
- 共识别35项研究，其中15项符合纳入标准并纳入最终综合。
主要发现
- 索马里结核病由长期冲突、人口流离失所、卫生系统脆弱及不良社会健康决定因素驱动。
- 尽管药物敏感结核治疗结局有所改善，但国家仍面临高结核负担和新出现的耐药结核。
- 持续挑战包括诊断延迟、治疗中断、灾难性患者费用、儿童结核照护缺口及对外部捐助资金的依赖。
临床怎么用
- 在脆弱环境中优先采用分散化、社区为基础的结核照护模式，并结合快速分子诊断与多模式依从支持。
- 对耐药结核可考虑全口服短程方案，并将结核服务与营养及人道支持整合。
- 政策层面应加强卫生系统韧性，并将脆弱人群纳入优先覆盖范围。
局限性
- 本文为叙述性综述，非系统评价，纳入研究仅15项，证据综合可能受选择偏倚影响。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Risk Manag Healthc Policy. 2026 Apr 17;19:595510. doi: 10.2147/RMHP.S595510. eCollection 2026. ABSTRACT Tuberculosis (TB) remains a major public health concern in Somalia, driven by prolonged conflict, population displacement, fragile health systems, and adverse social determinants of health. Although Somalia has made progress in expanding TB services and achieving favourable treatment outcomes for drug-susceptible TB, the country continues to experience a high TB burden and emerging drug-resistant tuberculosis (DR-TB). Persistent challenges include delayed diagnosis, treatment interruption, catastrophic patient costs, paediatric TB care gaps, and reliance on external donor funding. This narrative review synthesizes evidence from peer-reviewed articles, programmatic reports, and international guidelines to examine TB treatment outcomes, key challenges, and current strategies in Somalia. Literature was searched in PubMed, Google Scholar, and Scopus databases, as well as relevant grey literature from the World Health Organization and humanitarian organizations. Publications between 2010 and 2024 were considered, and 35 studies were identified, of which 15 met the inclusion criteria and were included in the final synthesis. The findings highlight the importance of decentralized and community-based care, rapid molecular diagnostics, multimodal adherence support, shorter all-oral DR-TB regimens, and integration of TB services with nutrition and humanitarian support. Strengthening health system resilience and prioritizing vulnerable populations are essential for sustaining improvements in TB treatment outcomes in Somalia and other fragile settings. PMID: 42022926 | PMC: PMC13098548 | DOI: 10.2147/RMHP.S595510
引用
- 指南共识 · 支气管扩张与结核：Improving Tuberculosis Treatment Outcomes in Somalia: A Narrative Review of Strategies, Challenges, and Policy Recommendations
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。