重症肺结核诊断和治疗专家共识

·诊疗方案·

# 重症肺结核诊断和治疗专家共识

中华医学会结核病学分会

通信作者:李亮,首都医科大学附属北京胸科医院 北京市结核病胸部肿瘤研究所,北京101149, Email: liliang69@vip.sina.com

【摘要】 肺结核患者进展为重症后预后差、病死率高,为提高重症肺结核诊疗的科学性和规范性,中华医学会结核病学分会组织国内相关专家制订了《重症肺结核诊断和治疗专家共识》。本共识在以下12方面共形成19条推荐意见,希望为提高重症肺结核诊疗的科学性和规范性决策依据。(1)重症肺结核定义:重症肺结核是指出现严重的肺组织损伤或功能不全伴严重低血肌症,伴或不伴严重并发症的肺结核。(2)重症肺结核分型:分为严重肺组织损伤型、严重并发症型、危重症型三型。(3)重症肺结核高危因素:糖尿病、高龄、营养不良、免疫抑制状态、肾功能不全、耐多药结核病。(4)重症肺结核的治疗:强调尽早启动抗结核治疗,在标准化方案基础上可依据患者的具体病情选用高效、低毒二线药物,需关注合并脓毒性休克者药代动力学和药效学的变化,建议对合并胃肠道功能障碍者早期给予静脉滴注抗结核药物治疗;(5)药物相互作用:多种抗结核药物是CYP3A4的诱导剂或抑制剂,可与多种抗真菌药物、抗逆转录病毒药物间存在相互作用导致药物活性和浓度的改变,可能诱发严重的不良反应,强调合理用药;合并HIV的重症肺结核患者在启动抗结核治疗2周内需尽快开始抗逆转录病毒治疗,疗程至少与HIV阴性患者相同,推荐固定复合剂量给药;(6)糖皮质激素的使用:对于合并急性呼吸窘迫综合征(ARDS)的重症肺结核患者,在抗结核治疗有效的前提下可给予糖皮质激素辅助治疗;(7)重症肺结核的营养支持治疗:需对重症肺结核患者行营养筛查,危重症患者早期采用允许性低热量营养策略,治疗中需遵循五阶梯治疗原则,推荐对无肠内营养禁忌证并且血流动力学稳定的重症肺结核患者早期进行肠内营养;(8)大咯血的处理:对于重症肺结核合并大咯血者,必须快速解除呼吸道梗阻,保证氧气吸入,待病情稳定后完善CT血管造影检查,行血管介入或外科手术治疗。(9)循环支持治疗:对重症肺结核合并循环功能障碍者可早期给予晶体液复苏及血管活性药物支持,对合并脓毒症休克者建议早期启动细胞因子吸附治疗;(10)肝脏、肾脏支持治疗:重症肺结核患者肝损伤风险高,根据肝损伤程度给予对症支持治疗;合并肾功能不全时可行肾脏替代治疗;(11)呼吸支持治疗及院感防控:重症肺结核导致呼吸衰竭时推荐实施个性化的呼吸支持方式,同时需注意呼吸治疗相关高风险操作的感控管理,对于合并重度ARDS的重症肺结核患者可采用体外膜氧合治疗;(12)康复治疗:对于重症肺结核患者建议实施早期康复治疗,康复前进行安全性评估,实时监测生命体征变化,必要时及时中止。

基金项目:国家重点研发计划(2022YFC2304800);北京市卫生健康委员会高层次公共卫生技术项目建设(学科带头人-03-11);北京市医院管理中心“登峰”人才培养计划(DFL20221401)

# Expert consensus on the diagnosis and treatment of severe pulmonary tuberculosis

Chinese Society of Tuberculosis, Chinese Medical Association

Corresponding author: Li Liang, Beijing Chest Hospital, Capital Medical University, Institute of Tuberculosis and Thoracic Tumor, Beijing 101149, China. Email: liliang69@vip.sina.com

【Abstract】 Patients with pulmonary tuberculosis (PTB) progressing severe conditions have

DOI: 10.3760/cma.j.cn112147-20250722-00429

收稿日期 2025-07-22 本文编辑 高洁

引用本文:中华医学会结核病学分会.重症肺结核诊断和治疗专家共识[J].中华结核和呼吸杂志,2025,48(12): 1127-1143. DOI: 10.3760/cma.j.cn112147-20250722-00429.

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a poor prognosis and high mortality. To enhance the scientificity and standardization of the diagnosis and treatment of severe PTB, the Chinese Society of Tuberculosis of Chinese Medical Association organized domestic experts to formulate the "Expert Consensus on the Diagnosis and Treatment of Severe Pulmonary Tuberculosis". The consensus presents 19 recommendation statements across the following 12 aspects, aiming to provide a decision-making basis for improving the management of severe PTB.

# The recommendations are listed below:

Recommendation 1: Severe pulmonary tuberculosis refers to PTB accompanied with severe pulmonary parenchymal damage or functional impairment with severe hypoxemia, with or without serious complications (2, C).

Recommendation 2: Based on clinical characteristics, severe PTB can be classified into the following three types, with diagnostic criteria as follows:

Type I: Severe Pulmonary Parenchymal Damage Type: Both of the following criteria must be met: (1) PTB lesion extent involving ≤2 lung fields accompanied by caseous consolidation, cavitary necrosis, etc., OR lesion extent involving ≥3 lung fields, OR tracheal stenosis; (2) Oxygenation index ($PaO_2$/FiO₂) ≤300 mmHg or arterial partial pressure of oxygen ($PaO_2$) ≤60 mmHg (1 mmHg=0.133 kPa).

Type II : Severe Complication Type: PTB with any one of the following severe complications, concurrently with PaO₂/FiO₂≤300 mmHg or PaO₂≤60 mmHg: (1) Central airway stenosis; (2) Massive hemoptysis; (3) Tension pneumothorax; (4) Respiratory rate ≥30 breaths/min; (5) Heart failure; (6) Liver failure; (7) Renal failure; (8) Impaired consciousness and/or disorientation.

Type III: Critical Illness Type: PTB with shock or multiple organ failure requiring admission to the ICU for respiratory, circulatory, or other organ support (2, C).

Recommendation 3: Diabetes mellitus, advanced age, malnutrition, immunosuppressed status, renal insufficiency, and multidrug-resistant tuberculosis (MDR-TB) are high-risk factors for severe PTB (1, B).

Recommendation 4: The anti-tuberculosis treatment for severe PTB follows the principles of early, combined, regular, adequate, full-course, and individualized therapy. Based on standardized first-line regimens, high-efficacy, low-toxicity second-line anti-TB drugs may be selected based on the patient's specific condition (2, B).

Recommendation 5: For patients with severe PTB, it is recommended to initiate anti-TB treatment as early as possible when the clinical condition permits. Drug selection should be appropriate based on the patient's organ function (2, B).

Recommendation 6: For severe PTB patients complicated with gastrointestinal dysfunction, it is recommended to initiate intravenous administration of anti-TB drugs early to rapidly achieve and maintain therapeutic blood drug levels, transitioning to oral administration gradually once the condition stabilizes (2, C).

Recommendation 7: Interactions exist between anti-TB drugs and various antifungal agents. It is recommended to select anti-TB and antifungal drugs based on the patient's condition and the type of drug interactions (1, B).

Recommendation 8: For severe PTB patients with HIV infection, antiretroviral therapy (ART) should be initiated as soon as possible, preferably within 2 weeks of initiating anti-TB treatment. The selection of anti-TB and antiretroviral drugs should be based on the patient's condition and drug interactions (1, B).

Recommendation 9: For severe PTB patients with acute respiratory distress syndrome (ARDS), corticosteroid adjuvant therapy may be administered, under the premise of effective anti-tuberculosis treatment(1, B).

Recommendation 10: Nutritional risk screening is recommended for patients with severe PTB. Early enteral nutrition for hemodynamically stable patients can improve prognosis and reduce mortality (1, B).

Recommendation 11: For severe PTB patients with massive hemoptysis, rapid relief of airway obstruction and ensuring oxygen delivery are mandatory. After stabilization, computed tomography angiography (CTA) of the chest should be performed. Vascular interventional therapy or surgical intervention should be considered if necessary (1, C).

Recommendation 12: For severe PTB patients with circulatory dysfunction, non-invasive/invasive hemodynamic monitoring should be performed, accompanied by fluid

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resuscitation and vasoactive drug support therapy (1, B).

Recommendation 13: For patients with septic shock, early initiation of cytokine adsorption therapy is suggested (2, C).

Recommendation 14: For severe PTB patients with severe renal failure, renal replacement therapy should be considered (2, B).

Recommendation 15: For severe PTB patients with hepatic injury, close monitoring is essential. Drugs with a high incidence of hepatotoxicity should be discontinued, and comprehensive treatment including hepatoprotective therapy and supportive care should be provided (2, B).

Recommendation 16: For severe PTB patients with respiratory failure, personalized respiratory support modalities is recommended (1, B).

Recommendation 17: Attention must be paid to infection control management related to high-risk respiratory therapy operations for severe PTB patients (2, C).

Recommendation 18: Extracorporeal membrane oxygenation (ECMO) therapy can be considered for severe PTB patients with ARDS (2, C).

Recommendation 19: Early rehabilitation therapy is recommended for severe PTB patients. Safety assessment should be conducted prior to rehabilitation, with real-time monitoring of vital signs and rehabilitation should be terminated promptly if necessary(2, B).

Fund program: National Key Research and Development Program of China (2022YFC 2304800); Beijing Municipal Health Commission High Level Public Health Talent Construction Project (Discipline Leader 03-11); Beijing Hospital Management Center "Dengfeng" Talent Training Program (DFL20221401)

肺结核是世界范围内严重危害人类健康和造成社会经济负担的疾病之一,2023年,全球新发肺结核患者1080万例,中国新增病例数为74.1万例(占全球发病数的6.8%),在30个结核病高负担国家中排第3位[1-2]。因结核病或并发症死亡的人数多达125万,结核病重返全球单一传染病死因首位[1]。重症结核核合并呼吸衰竭、脓毒性休克、大咯血、多脏器功能不全等各种严重并发症,需入住重症监护病房(intensive care unit, ICU)进行加强治疗[3-5],尽管给予积极治疗,其病死率仍在22%~74%[4, 6, 7],给患者家庭和社会带来巨大的经济负担,对我国结核病防治工作以及实现世界卫生组织(World Health Organization, WHO)2035年结核病病死率降低95%的目标带来了巨大的挑战。

近年来,重症肺结核相关研究呈逐年递增趋势,但重症肺结核的诊疗却存在定义不明确、诊断标准不统一、治疗方案不规范、疗效和预后较差等诸多问题[8],这在很大程度上阻碍了重症肺结核患者的早期发现、早期诊断和及时治疗,从而严重影响了其疗效和预后。因此,重新审视重症肺结核相关定义,总结国内外重症肺结核的诊治经验及研究成果,制订相关的诊治规范,以更合理、有效地解决目前我国重症肺结核存在的相关问题迫在眉睫。基于此,中华医学会结核病学分会组织国内相关领域的专家就重症肺结核的定义、诊断和治疗等方面内容进行讨论并形成《重症肺结核临床诊断和治疗

专家共识》(简称本共识),旨在提高我国广大临床医生对重症肺结核的认识,规范重症肺结核的诊疗,提升重症肺结核的治疗效果。

一、共识制订方法

本共识由中华医学会结核病学分会发起,本共识专家组包括撰写组、方法学组、秘书组、文献证据组和审核组,涵盖重症、结核、呼吸、影像、检验、药学等领域的专家以及共识制订方法学专家。全体成员均以书面形式对与共识主题相关的经济利益及非经济利益进行申报,利益冲突声明表由专家组进行审定和评估,所有成员均书面声明不存在利益冲突。

本共识在国际实践指南注册与透明化平台注册(PREPARE-2025CN987)。共识范围及临床问题的提出由撰写组起草,根据临床实践总结归纳重症肺结核诊疗相关问题,按照人群、干预、对照、结局(population, intervention, comparison, outcome, PICO)原则对最终纳入的19个临床问题进行解构,并根据解构的具体问题进行文献调研,纳入重症肺结核诊治相关研究,基于临床循证医学证据进行质量等级评估,并使用德尔菲法征集不同领域专家意见,采用专家投票形式确定共识的推荐等级,经由专家组讨论审定。共识专家组通过收集意见、查阅文献,于2024年8月召开第一次线下专家讨论会确定指南范围及优先的临床问题,后于2025年1月、5月、7月、8月进行5轮线下和线上专家研讨会讨

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论,初步形成共识。形成的初步推荐意见及依据说明,经外审组专家会议审议并提出改进意见。针对证据解读或推荐强度分歧,通过德尔菲法采用线上问卷的形式,专家对推荐意见进行评价,采用0~9分的打分方法,0~1分:非常不同意,2~3分:比较不同意,4~5分:一般同意,7~8分:比较同意,9分:非常同意;同时,问卷设计为开放式,请专家提供修改建议。开展多轮匿名评议与反馈,逐步集中专家意见,最终实现一致性结论;本共识专家组对共识终稿进行评审、完善和批准。

本共识涉及的诊断和治疗的部分内容,采用了评估、制订和评价的分级方法,即GRADE(Grading of recommendation, Assessment, Development and Evaluation, GRADE),将证据质量分为“高、中、低、极低”4个等级,分别用A、B、C、D表示;将推荐意见分为“强推荐、弱推荐”2个级别,分别用1和2表示。见表1。

表1 证据质量与推荐强度分级

|分级|具体描述| |---|---| |证据质量分级|| |高(A)|非常有把握观察值接近真实值| |中(B)|对观察值有中等把握:观察值有可能接近真实值,但也有可能差别很大| |低(C)|对观察值的把握有限:观察值可能与真实值有很大差别| |极低(D)|对观察值几乎没有把握:观察值与真实值可能有极大差别| |推荐强度分级|| |强(1)|明确显示干预措施利大于弊或弊大于利| |弱(2)|利弊不确定或无论质量高低的证据均显示利弊相当|

二、重症肺结核的定义、分型及诊断标准

临床问题1:重症肺结核的定义是什么?

推荐意见1:重症肺结核是指出现严重的肺组织损伤或肺功能不全伴严重低氧血症,伴或不伴严重并发症的肺结核(2,C)。

重症肺结核目前尚无公认的准确而全面的定义。尽管近10年来关于重症肺结核的研究逐年增多,但各项研究在定义和诊断标准方面存在多样性。一篇关于重症肺结核定义的Meta分析[8]结果将当前研究中出现频次最多的纳入重症肺结核的诊断标准归纳为:(1)病灶范围大于3个肺野;(2)病灶斑片状并伴有坏死、空洞、实变等病变。部分研究还将严重合并症、结核中毒症状、呼吸衰竭等作为纳入要素。2022年WHO提出了进展期肺

结核的概念[2],其定义为胸部影像学检查提示双肺空洞性病变或存在广泛肺实质损伤;对于15岁以下的儿童,定义为肺部有空洞或存在双肺病变。根据2017—2021年国内外相关研究做出概况性评价,发现用于定义重症肺结核频次较多的临床特征包括:肺结核类型、肺组织损伤[2,9]、呼吸功能损伤、合并细菌真菌感染及严重并发症[10-11]、多器官损伤等。综上所述,由于定义的多样性、缺乏统一的诊断标准、疾病本身的复杂性、技术和方法的进步以及流行病学和公共卫生需求的变化等因素,重症肺结核尚无得到广泛认可且在临床中得以实践的定义和诊断标准。明确重症肺结核的诊断标准,有利于临床医生界定肺结核严重程度的范畴,避免过度诊断或治疗不及时。根据临床实践并结合上述研究,本共识的德尔菲专家打分中,81.25%的专家打分在7分及以上,故确定为弱推荐。

临床问题2:重症肺结核的分型及诊断标准是什么?

推荐意见2:根据重症肺结核临床特点可将其分为以下三种类型。诊断标准如下。I型:严重肺组织损伤型:需同时符合以下两条:(1)肺结核病灶范围≤2个肺野外干酪样实变、空洞坏死等病变或病灶范围≥3个肺野,或气管狭窄;(2)氧合指数≤300 mmHg或动脉血氧分压(PaO₂)≤60 mmHg(1 mmHg=0.133 kPa)。II型:严重并发症型:肺结核合并以下严重并发症之一,同时氧合指数≤300 mmHg或PaO₂≤60 mmHg:(1)中央气道狭窄;(2)大咯血;(3)张力性气胸;(4)呼吸频率≥30次/min;(5)心力衰竭;(6)肝衰竭;(7)肾功能衰竭;(8)意识障碍和(或)定向障碍。III型:危重症型:合并休克或合并多器官功能衰竭需要入住ICU获取呼吸、循环或其他脏器支持者(2, C)。

重症肺结核患者影像学表现中病灶范围超过3个肺野的发生率为74.95%[8],也有研究提示重症肺结核患者影像学表现为广泛肺内病变占61.56%[12],本共识专家组推荐肺部病灶≥3个肺野或≥50%肺野为影像学广泛受累[8, 12-13];《新型冠状病毒感染诊疗方案》[14]及《成人社区获得性肺炎基层诊疗指南(2018年)》[15]临床分型中对于重症患者的诊断中均合并呼吸功能不全:气促,呼吸频率≥30次/min;静息状态下,吸空气时指氧饱和度≤93%;PaO₂/吸氧浓度(FiO₂)≤300 mmHg;临床症状进行性加重,肺部影像学病灶明显进展。对于合并重要脏器功能不全的重症肺结核患者,推荐参考心

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力衰竭、肾功能衰竭、肝衰竭诊断标准[16-18];除中枢神经系统所致的意识障碍外,重症肺结核患者还可因呼吸衰竭、脓毒性休克、电解质紊乱等导致出现意识障碍。研究显示,重症肺结核患者中,10.0%~38.6%出现头痛、呕吐、嗜睡、意识障碍、定向障碍等中枢神经系统症状[19]。目前关于重症肺结核及严重并发症等相关文献较少,对重症肺结核的分型无相关推荐,结合临床实践及德尔菲专家打分,给予弱推荐。

三、重症肺结核的高危因素

临床问题3:重症肺结核的高危因素包括哪些方面?

推荐意见3:糖尿病、高龄、营养不良、免疫抑制状态、肾功能不全、耐多药结核病是重症肺结核的高危因素(1,B)。

合并糖尿病或高血糖的肺结核患者,机体炎症反应失调,导致结核病易感性的增加,同时也影响疾病的严重程度和预后[20]。研究结果表明,糖尿病与结核病的潜伏感染及肺结核患者的病情严重程度相关[21-22]。老年人免疫系统的功能下降,重症肺结核发生风险更高[23]。结核病患者往往伴随有营养不良,继而影响患者的免疫功能,一项多中心、前瞻性队列分析显示营养不良可能导致抗结核药物的吸收不良或增加药物毒性,影响治疗效果,导致疾病进展[24]。国内外多项研究发现免疫抑制状态是发生重症肺结核的危险因素[25-26], HIV感染、自身免疫性疾病患者及接受免疫抑制治疗的患者,更易发展为重症肺结核。合并慢性肾脏疾病也会影响机体的免疫反应及影响抗结核药物应用,是重症肺结核的危险因素[27]。耐多药结核病(multidrug-resistant tuberculosis, MDR-TB)治疗难度大、疗程长,病情迁延不愈、合并症多易形成重症,治愈率低、病死率高[28]。综上,目前国内外大量文献提示以上因素为重症肺结核的高危因素,故为强推荐。

四、治疗

临床问题4:重症肺结核患者抗结核药物治疗原则是什么?

推荐意见4:重症肺结核的抗结核治疗方案遵循早期、联合、规律、适量、全程、个体化原则。在标准化一线抗结核治疗方案基础上可依据患者的具体情况酌情选用高效、低毒二线抗结核药物(2,B)。

抗结核药物治疗是重症肺结核患者治疗的核心手段。WHO及国内共识均推荐首选一线抗结核治疗标准化方案,如果存在患者不耐受或出现并发

症,或出现耐药结核病时,可酌情选用二线抗结核药物[29-30]。但重症肺结核患者治疗过程中面临诸如给药途径影响药物吸收与生物利用度、肝肾功能不全需调整剂量,与其他治疗药物发生复杂相互作用,易发生药物不良反应等多重挑战[31]。因此重症肺结核患者多难以按照常规推荐方案进行治疗,应根据抗结核药物治疗监测、并发症管理、脏器功能保护、辅助治疗等因素制订精准的个体化治疗方案,在标准化一线抗结核治疗方案基础上依据患者的病情特点、药物敏感性、耐受性和可及性等因素,酌情选用高效低毒二线抗结核药物,如氟喹诺酮类药物[32]、利奈唑胺等[33-34],从而保证抗结核治疗效果以及改善预后。目前已有高质量研究证实以上二线抗结核药物在敏感型肺结核治疗中的有效性,但缺少重症肺结核治疗相关研究,故为弱推荐。

临床问题5:重症肺结核抗结核治疗时机及药物该如何选择?

推荐意见5:对重症肺结核患者建议在病情允许时尽早开始抗结核治疗,推荐根据患者的脏器功能情况合理选择药物(2,B)。

重症肺结核患者病情复杂,药物不良反应较多,由于诊断和治疗的延迟,病死率较高[4]。一项来自德国的研究显示,ICU内肺结核患者病死率为26%,其中50%的患者于32d内死亡,积极的抗结核治疗是影响患者预后的重要因素,未接受异烟肼和利福平治疗的患者病死率较高[4,6]。多项研究均表明,合并呼吸衰竭的重症肺结核患者(包括合并HIV)延迟治疗与高病死率相关[4,35]。目前重症肺结核治疗及预后等相关研究多为回顾性研究,证据质量较低,故为弱推荐。

液体复苏及系统性炎症反应综合征的存在,导致合并脓毒性休克的重症肺结核患者药代动力学和药效学的变化。重症患者多合并重要脏器功能障碍,影响抗结核治疗方案的选择[36]。建议根据患者病变部位、既往史、饮酒史、治疗史、耐药情况、肝肾功能、血常规、胃肠道功能等制订个性化的抗结核治疗方案,并进行血药浓度监测。重症肺结核患者抗结核药物使用注意事项参考表2[33, 37-43]。

临床问题6:对重症肺结核患者该如何选择抗结核药物给药方式?

推荐意见6:对合并胃肠道功能障碍的重症肺结核患者建议早期静脉给予抗结核药物治疗,尽快达到和维持治疗性血液药物浓度水平,待病情稳定后逐步过渡为口服(2,C)。

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五、展望与未来需要深入研究的问题

本共识仍存在一定的局限性,首先,虽然专家们在共识制订过程中广泛参与讨论,但尚缺乏高质量RCT研究作为循证依据。其次,在重症肺结核发病机制、鉴别诊断和评估标志物、肺结核进展加重的精准干预策略制订等方面缺乏依据,因此未能纳

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入共识。尽管对重症肺结核的认识不断加深,但是无论在重症肺结核发生机制的深入探究,已有诊断工具、治疗手段的合理应用,还是新型诊断方法和干预措施的研发方面,都有大量待开展的工作。

第一,亟待深入阐明重症肺结核的加重机制:尽管部分研究从宿主编码基因的角度揭示了巨噬细胞在抗核核免疫中的调控机制,但肺结核向重症进展的分子机制仍未明确;其进展可能与结核分枝杆菌毒力、宿主免疫状态以及病原体-宿主间相互作用等多种因素相关,需要多学科合作,对该过程中的调控机制进行深入探索。第二,建立重症肺结核的预警与预后评估体系;包括提升快速诊断的效率,寻找有助于评估疾病严重程度的新型生物学标志物,建立敏感度更高且操作更简便的病情评估与预后评价工具,优化相关并发症的临床管理策略等。第三,推动新型干预措施的研究与临床应用:当前,多种治疗手段,包括不同模式的血液净化技术、二氧化碳清除技术、ECMO,介入治疗等,均已显示出其应用价值,然而仍有待通过大规模、前瞻性、多中心的队列研究加以验证,从而为早期诊断和制订治疗策略提供循证依据。

总之,重症肺结核患者病死率高,亟需深入了解其风险和干预手段,促进规范化疾病管理,最终改善患者生活质量、延长生存期。随着未来国内外重症肺结核相关的高质量研究的完成,本共识也将进一步更新完善。

北京胸科医院药学部)、杜英臻(解放军总医院第二医学中心疾病预防控制科)、段鸿飞(首都医科大学附属北京胸科医院结核科)、高静韬(首都医科大学附属北京胸科医院机构办公室)、耿爽(武汉市中心医院呼吸内科)、胡彦(重庆市结核病防治所检验科)、刘阳(首都医科大学附属世纪坛医院外科重症医学科急危重症医学中心)、邱君克(杭州红十字医院结核科)、曲歌平(解放军总医院第二医学中心呼吸与危重症医学科)、孙文青(山东省公共卫生临床中心重症医学科)、徐凯进(浙江大学医学院附属第一医院感染病科)、姚洪祥(解放军总医院第二医学中心放射科)、叶寰(首都医科大学附属北京胸科医院呼吸与危重症医学科)、俞朝贤(广州市胸科医院重症医学科)、袁国丹(重庆市公共卫生医疗救治中心重症医学科)、张乐(昆明市第三人民医院重症医学科)

审核组(按姓氏拼音排序):陈燕飞(浙江大学医学院附属第一医院感染病科)、代冰(中国医科大学附属第一医院呼吸与危重症医学科)、高孟秋(首都医科大学附属北京胸科医院结核科)、高岩(复旦大学附属华山医院感染科)、黄颖新(长春市传染病医院重症医学科)、韩晓黎(重庆医科大学附属第一医院呼吸内科)、焦洋(海军军医大学第一附属医院呼吸内科)、刘硕(首都医科大学附属北京胸科医院药学部)、李宁(河北省胸科医院重症医学科)、李雪英(武汉市中心医院呼吸内科)、林霏申(南京市第二医院结核科)、潘建亮(潍坊市第二人民医院重症医学科)、逢宇(首都医科大学附属北京胸科医院科技处/细菌免疫室)、沈涛(蚌埠医学院第二附属医院重症医学科)、施伎蝉(温州市中心医院结核科)、孙德斌(沈阳市胸科医院结核科)、孙勤(同济大学附属上海市肺科医院结核科)、王桂荣(首都医科大学附属北京胸科医院检验科)、夏金根(中日友好医院呼吸与危重症医学科)、谢菲(解放军总医院第八医学中心呼吸与危重症医学部)、徐思成(新疆医科大学第一附属医院重症医学科)、杨江华(皖南医学院弋矶山医院感染科)、张培泽(深圳市第三人民医院肝病四科)、张伟(上海长海医院呼吸与危重症医学科)、张晓林(上海市公共卫生临床中心重症医学科)

利益冲突 所有作者声明无利益冲突

本共识专家组名单

牵头人:李亮、唐神结、杜建(首都医科大学附属北京胸科医院)

执笔作者:张智健(解放军总医院第二医学中心呼吸与危重症医学科)、刘秋月(首都医科大学附属北京胸科医院重症医学科)、薛玉(首都医科大学附属北京胸科院急诊科)、陈志(解放军总医院第八医学中心结核病医学部)、安莉(解放军总医院第二医学中心呼吸与危重症医学科)

共识组秘书:张鑫(首都医科大学附属北京胸科医院重症医学科)、郭东霖(解放军总医院第八医学中心结核病医学部)、王丹(解放军总医院第二医学中心呼吸与危重症医学科)、王亚飞(武汉市中心医院呼吸内科)

文献证据组:姜慧(首都医科大学附属北京胸科医院图书情报室)、王睿泽(首都医科大学附属北京胸科医院重症医学科)、李民晟(解放军总医院第二医学中心呼吸与危重症医学科)、熊晓苗(解放军总医院第二医学中心呼吸与危重症医学科)

方法学组:刘宇红(首都医科大学附属北京胸科医院临床中心)、柳芳超(首都医科大学附属北京胸科医院流行病和临床方法学中心)

撰写组(按姓氏拼音排序):贝承丽(长沙市中心医院结核病研究所)、陈华(江门市结核病防治所结核科)、程凯(首都医科大学附属

参考文献

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中华结核和呼吸杂志2025年12月第48卷第12期 Chin J Tuberc Respir Dis, December 2025, Vol. 48, No. 12

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