中国耐多药/利福平耐药结核病化学治疗指南（2026版）
中华医学会结核病学分会组织专家制定2026版指南，针对耐多药/利福平耐药结核病化疗更新推荐，涵盖耐药定义、短程与长程方案选择及调整、治疗监测、特殊人群管理和不良反应处理，共给出14条推荐，每条附循证依据与实施建议。
要点
- 青少年（≥14岁）及成人MDR/RR-TB推荐6个月BPaLM方案优于9个月或18个月方案（1，B）。
- MDR/RR-TB患者无论氟喹诺酮是否耐药（含各年龄儿童、孕产妇）推荐6个月BDLLfxC方案（1，B）。
- 氟喹诺酮敏感的MDR/RR-TB推荐9个月全口服方案优于对照方案（推荐等级未在摘要中完整给出）。
核心结论
- 2026版指南针对MDR/RR-TB化疗给出14条推荐，覆盖方案选择、监测、特殊人群和不良反应管理，为规范化治疗提供循证依据。
研究设计与样本
- 中华医学会结核病学分会召集专家组制定，基于全球循证医学进展并结合中国具体情况。
- 每条推荐附循证依据、所针对的临床问题及实际实施建议。
主要发现
- 推荐1：青少年（≥14岁）及成人MDR/RR-TB推荐6个月BPaLM方案优于9个月或更长（18个月）方案（1，B）。
- 推荐2：MDR/RR-TB患者无论是否氟喹诺酮耐药（含各年龄儿童、妊娠及哺乳期妇女）推荐6个月BDLLfxC方案（1，B）。
- 推荐3：氟喹诺酮敏感的MDR/RR-TB推荐9个月全口服方案[4-6 Bdq(6m)-Lfx(Mfx)-Pto(Lzd2m)-Cfz-E-H高剂量-Z/5Lfx(Mfx)-Cfz-E-Z]优于对照方案。
关键数值与推荐
- 推荐1证据等级为（1，B），适用对象为≥14岁青少年及成人MDR/RR-TB。
- 推荐2证据等级为（1，B），适用对象包括各年龄儿童、妊娠及哺乳期妇女。
- 推荐3方案组成为4-6 Bdq(6m)-Lfx(Mfx)-Pto(Lzd2m)-Cfz-E-H高剂量-Z/5Lfx(Mfx)-Cfz-E-Z，适用氟喹诺酮敏感者。
临床怎么用
- 对≥14岁青少年及成人MDR/RR-TB可优先选用6个月BPaLM方案。
- 对含儿童、孕产妇在内的MDR/RR-TB患者可考虑6个月BDLLfxC方案。
- 对氟喹诺酮敏感的MDR/RR-TB可选用9个月全口服方案。
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
Zhonghua Jie He He Hu Xi Za Zhi. 2026 Jun 12;49(6):623-643. doi: 10.3760/cma.j.cn112147-20251104-00674. ABSTRACT Multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant tuberculosis (RR-TB) pose significant challenges to global tuberculosis prevention and treatment efforts. At present, the chemotherapy of MDR/RR-TB is still hampered by prolonged treatment duration and suboptimal success rates. In 2019, the Chinese Medical Association Tuberculosis Branch issued the Chinese Expert Consensus on the Treatment of MDR-TB and RR-TB, which has provided essential guidance for standardizing the diagnosis, treatment, and clinical management of MDR/RR-TB in China. In response to recent advances in global evidence-based medicine and in consideration of China's specific context, the Chinese Medical Association Tuberculosis Branch recently convened a panel of experts to develop the Chinese Guidelines for the Chemotherapy of MDR/RR-TB (2026 Edition) . This guideline provides updated recommendations regarding the definition of drug-resistant tuberculosis, selection and adjustment of short-course and long-course regimens, treatment monitoring, management of special populations, and standardized management of adverse drug reactions. Each recommendation is supported by an evidence-based rationale, the clinical questions addressed, and practical implementation suggestions. A total of 14 recommendations are presented, aiming to provide a robust clinical evidence base and to support informed decision-making for the standardized treatment of MDR/RR-TB. The key recommendations are as follows. Recommendation 1: For adolescents (aged 14 years and above) and adults with MDR/RR-TB, the 6-month regimen comprising bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) is recommended over the 9-month or longer (18-month) regimens (1, B). Recommendation 2: For MDR/RR-TB patients with or without fluoroquinolones resistance (including children of all ages, pregnant and breastfeeding women), the 6-month regimen comprising bedaquiline, delamanid, linezolid, levofloxacin, and clofazimine (BDLLfxC) is recommended (1, B). Recommendation 3: For MDR/RR-TB patients susceptible to fluoroquinolones, the 9-month all-oral regimen comprising bedaquiline, levofloxacin (or moxifloxacin), protionamide (or linezolid for two months), clofazimine, ethambutol, high-dose isoniazid, and pyrazinamide [4-6 Bdq (6m)-Lfx (Mfx)-Pto (Lzd2m)-Cfz-E-H high-dose -Z/5Lfx (Mfx)-Cfz-E-Z] is recommended over
引用
- 指南共识 · 支气管扩张与结核：Chinese guideline for the chemotherapy of multidrug-resistant/rifampicin-resistant tuberculosis (2026 edition)
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。