耐药结核病动力学模型研究综述：从传播机制到经济耦合

A Review of Dynamical Models of Drug-Resistant Tuberculosis: From Transmission Mechanisms to Economic Couplings

摘要: 耐药结核病是全球公共卫生领域的重大挑战，为了应对这一挑战，学者们运用许多工具理解其传播规律、评估防控策略，动力学模型也是其中之一。然而，现有模型多聚焦于生物学传播机制，对社会经济因素的耦合考虑不足，限制了其在资源有限环境下的决策支持功能。本文系统梳理了耐药结核动力学模型的研究进展，回顾了经典结核病模型向耐药领域的发展，分析了模型在描述耐药产生与传播、评估干预措施等方面的贡献，重点综述了耦合经济因素的传染病模型的探索性研究，分析了现有模型在处理经济变量时的主要局限，是将经济因素作为外生参数，缺乏对流行病与经济双向动态反馈的体现。在此基础上，我们提出未来研究应构建流行病与经济学的耦合模型，发展在资源约束条件下的最优控制策略，并结合中国的区域经济不平衡特征，为消除结核病的战略提供政策支持。

Abstract: Drug-resistant tuberculosis (DR-TB) poses a major challenge to global public health. To address this challenge, researchers have employed various tools to understand its transmission patterns and evaluate prevention and control strategies, with dynamical models being one such tool. However, existing models tend to focus primarily on biological transmission mechanisms and do not sufficiently account for the interaction with socioeconomic factors, thereby limiting their ability to support decision-making in resource-constrained settings. This paper systematically reviews the research progress in dynamical modeling of DR-TB, reviews the evolution of classical tuberculosis models into the drug-resistant domain, analyzes the contributions of these models in describing the emergence and transmission of drug resistance and evaluating intervention measures, and highlights exploratory research on infectious disease models that integrate economic factors. It also identifies the primary limitations of existing models in handling economic variables, namely treating economic factors as exogenous parameters and failing to reflect the bidirectional dynamic feedback between epidemiology and the economy. Based on this, we propose that future research should construct coupled epidemiological and economic models, develop optimal control strategies under resource-constrained conditions, and, taking into account China’s regional economic imbalances, provide policy support for tuberculosis elimination strategies.