今天是第29个“世界防治结核病日”，今年的主题是“你我共同努力 终结结核流行”。
世界卫生组织发布的《2023年全球结核病报告》显示，2022年全球有1060万新发结核病患者，我国新发结核病患者人数约为74.8万。
结核病是一种由结核分枝杆菌引起的传染病。结核病可以发生在身体的多个部位，但最常见的是肺结核。肺结核的症状包括咳嗽、咳痰、咯血、胸痛、呼吸困难等，同时患者还可能出现全身症状，如发热、盗汗、乏力、体重减轻等。如果不及时治疗，肺结核可能导致肺损毁、气道狭窄等严重的健康问题，甚至死亡。
结核病细菌主要通过呼吸道飞沫传播，与肺结核患者密切接触的人有可能感染结核分枝杆菌。出现肺结核可疑症状，如咳嗽或发热两周以上、咯血、盗汗等，应及时就医，接触结核患者应进行体检筛查。
治疗结核病需要规范全程治疗，通常采用多种药物联合治疗，疗程一般为6个月以上。如果不按疗程完成正规治疗，肺结核可能转化为难治的耐药结核，增加了患者痛苦以及治疗难度、治疗费用。
近十年，我国在结核病防治上取得了长足的进展，结核病发病率下降25%，下降速度超过全球平均水平的两倍，结核病患者治愈率保持在90%以上。
CCTV4《健康中国》邀请到了国家传染病医学中心主任、复旦大学附属华山医院感染科主任张文宏，详细拆解结核病的发展历程。
张文宏：结核菌感染非常隐匿
在众多著名影视作品和文学作品中，肺痨是一个“出镜率”很高的疾病，肺痨其实就是肺结核。它的表现往往是止不住的咳嗽和白色手帕上鲜红的血。《红楼梦》中林黛玉得的竟是结核病？
这样极具冲击力的画面所展现的情况在19世纪40年代以前是令人绝望的。随着科技的发展，结核病的治疗迎来了曙光，但也有新的困局。2022年，中国估算新发结核病患者数为74.8万，相较2021年下降4.1%，但是这距离2035年消除结核病流行的目标还有很长的路要走。
张文宏说，结核病一旦发病，90%的病灶会集中在肺部，产生发热咳嗽甚至是咯血的情况，整个肺部将会被严重破坏。而且结核病菌也会散布在其他脏器，引起严重的并发症，这可能导致非常严重的后果。
导致结核病发作的元凶是什么？
这个像香肠一样的东西，看起来人畜无害，实则暗藏杀机，它就是结核分枝杆菌。
一到四微米的长度使得它可以飘浮在空气中，通过空气媒介进行传播。当它进入我们的身体后，强大的巨噬细胞将会发起首次进攻，但却无法将其根除，于是结核分枝杆菌便进入了潜伏期。这个潜伏期的长短因人而异，抵抗力弱的人，巨噬细胞的进攻可能都会显得软弱无力。
打了卡介苗还会得结核病吗？
据说99%的中国人胳膊上都有一块疤，它有名有姓——“卡疤”，这是专门针对结核病的一种疫苗，卡介苗留下的疤痕。事实上，绝大部分人对于自己是否注射过卡介苗并不知情。因为在你出生的第一天就会完成注射。
那注射了卡介苗就万事大吉吗？答案是否定的。
张文宏医生解释道：随着时间的推移，卡介苗的保护作用会逐渐减弱。虽然不能万事大吉，但卡介苗降低了结核病的发病率，并且使重症的概率大幅降低，卡介苗的应用是十分必要的。
瘦人更容易得结核病
还是结核病容易让人消瘦？
首先要明白的是，瘦，并非单指人体的形态，而是指营养状态。张文宏医生介绍印度的一项研究表明：给结核病高危人群补充营养后，发病率可以下降36%。因此，增强免疫力是关键，通过保证充足的营养来维持健康是最佳选择。正如张文宏医生所说：瘦可以，瘦弱不行。
结核病竟然可能会影响生育？
虽然结核病最常见的是肺结核，但结核分枝杆菌会影响的器官并不仅仅是肺部。结核感染后不及时治疗，极有可能造成女性生殖器结核，易引起某些并发症，而这些并发症中可能包括不孕症。
张文宏表示，结核病是导致不孕不育的原因之一。在结核病高发地区，这种疾病引起的不孕不育更为常见，做好辅助生殖前的筛查很重要。
张文宏医生解释道：结核病引起的不孕不育，如果接受辅助生殖前的筛查，可以帮助不孕不育的人群提早发现，提早治疗。许多活动性结核病患者在治疗后能够恢复生育能力。
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255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, 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rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--appmsgExtra-BG: #121212}}@media(prefers-color-scheme:dark){body:not([data-weui-theme=light]).my_comment_empty_data{background-color:#111}}body,.wx-root{--weui-BG-6: rgba(0, 0, 0, .05);--weui-ACTIVE-MASK: rgba(0, 0, 0, .05)}body,.wx-root{--weui-REDORANGE: #ff6146;--weui-BG-0: #ededed;--weui-BG-1: #f7f7f7;--weui-BG-2: #fff;--weui-BG-3: #f7f7f7;--weui-BG-4: #4c4c4c;--weui-BG-5: 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