现代结核病控制策略的实施进展及系统评价

目的 描述及评价DOTS策略的实施情况。方法 由邀请的专家和文献检索人员讨论后确定检索的文献内容和检索词，共检索12个数据库、4个卫生机构网站和搜索引擎Google Scholar，纳入1999-2010年所有描述或评价已经实施的DOTS策略、成本-效益分析、防控经验等的文章记录共2182条，并对文章信息进行提取。结果 共纳入26篇文章及WHO年报,其中WHO年报11篇，评价DOTS策略实施的文章10篇,对DOTS策略实施进行成本-效益分析文章5篇。通过实施DOTS策略患者治愈率提高了13.1%～92.1%不等、治疗成功率提高到了92.4%～95.0%不等、登记率增加了163.0%～217.8%不等；降低了患病率30.0%～50.0%及丢失率73.0%～52.6%不等，同时实施DOTS策略提高了成本-效益。结论 强有力的政府承诺是保持DOTS策略可持续实施的前提，DOTS策略的实施有效地控制了结核病的疫情，同时具有良好的成本-效益。

Systematic review and implemention progress of DOTS strategy

Objective To describe and review the implementation progress of DOTS strategy.Methods Through discussion with the invited experts,we determined the Key words of retrival literature,and searched 12 database,4 health agencies websites and Google Scholar.A total of 2182 papers between 1990—2010 were searched out including papers describing or evaluating DOTS strategy,cost-effectiveness analysis,experience on prevention and control.Results Of the 26 studies included in the analysis,11 studies were WHO annual reports,10 studies aimed to describe and evaluate DOTS strategy,5 studies aimed to evaluate the effectiveness of DOTS strategy;the implementation of the DOTS strategy raised the cure rates by 13.1%-92.1%,the treatment success rate increased to 92.4%-95.0%,the registration rate increased by 163.0%-217.8%;prevalence rate and the loss rate decreased by 30.0%-50.0% and 73.0%-52.6% respectively.In addition,implementation of the DOTS strategy improved the cost-effectiveness as well.Conclusion The strong government commitment is prerequisite for sustainable implementation of the strategy,effective implementation of the DOTS strategy put the TB under control,meanwhile has a good cost-effectiveness.