93例非结核分枝杆菌肺病临床分析

doi:10.19982/j.issn.1000-6621.20220519

摘要/Abstract

摘要：

目的: 分析93例非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病特征,为临床诊治NTM肺病提供参考依据。方法: 回顾性分析2018年1月至2019年12月首都医科大学附属北京胸科医院确诊的93例NTM肺病患者临床资料。比较鸟-胞内分枝杆菌复合群、脓肿分枝杆菌肺病不同治疗方案的疗效差异。结果: 93例NTM肺病患者中胞内分枝杆菌感染49例,脓肿分枝杆菌感染28例,鸟分枝杆菌感染4例,堪萨斯分枝杆菌感染4例,蟾蜍分枝杆菌感染3例,胞内分枝杆菌与脓肿分枝杆菌混合感染2例,戈登分枝杆菌、偶发分枝杆菌、施氏分枝杆菌感染各1例。确诊NTM肺病前曾接受抗结核治疗的患者61例(65.59%)。90例(96.77%)患者有合并症,其中合并支气管扩张52例(57.78%),合并慢性阻塞性肺疾病12例(13.33%)。83例(89.25%)在确诊后接受抗NTM治疗,47例(56.63%)完成疗程。完成疗程的患者中,鸟-胞内分枝杆菌复合群肺病治疗成功率为51.85%(14/27)。脓肿分枝杆菌肺病治疗成功率为76.92%(10/13)。48例(57.83%)治疗过程中发生不同程度的药物不良反应,中断治疗15例(18.07%)。16例(19.28%)患者失访。结论: NTM肺病患者以胞内分枝杆菌感染多见,多合并支气管扩张、慢性阻塞性肺疾病等基础肺病,容易被误诊为肺结核,治愈率低,治疗中断率及失访率较高。

关键词: 分枝杆菌感染, 肺疾病, 疾病特征

Abstract:

Objective: To understand the characteristics of nontuberculous mycobacteria (NTM) pulmonary disease, and provide evidence for clinical diagnosis and treatment of NTM pulmonary disease. Methods: The clinical data of 93 patients with NTM pulmonary disease admitted to Beijing Chest Hospital affiliated to Capital Medical University between January 2018 and December 2019 were analyzed retrospectively. Treatment effectivenesses were compared for different treatment. Results: Among 93 patients with NTM pulmonary disease, there were 49 cases infected with Mycobacterium intracellular, 28 cases with Mycobacterium abscesses, 4 cases with Mycobacterium avium, 4 cases with Mycobacterium kansasii, 3 cases with Mycobacterium xenopi, 2 case co-infected with Mycobacterium abscesses and Mycobacterium intracellular, one case with Mycobacterium gordonii, Mycobacterium fortuitum or Mycobacterium stutzeri each. 61 patients (65.59%) had received antituberculosis treatment before the diagnosis of NTM pulmonary disease. 90 (96.77%) patients had complications, of which 52 (57.78%) patients had bronchiectasis, followed by 12 (13.33%) patients with chronic obstructive pulmonary disease (COPD). 83 cases (89.25%) received anti-NTM treatment, and 47 cases (56.63%) completed the course of treatment among whom the success rate of the treatment of pulmonary disease with Mycobacterium avium complex was 51.85% (14/27) while the treatment success rate of Mycobacterium abscesses pulmonary disease was 76.92% (10/13). 48 cases (57.83%) had adverse drug reactions of different degrees during the treatment, and 15 cases (18.07%) discontinued the treatment. 16 patients (19.28%) were lost to follow-up. Conclusion: Mycobacterium intracellular lung disease is the most common NTM pulmonary disease. Most patients were complicated with bronchiectasis, COPD and other basic lung diseases. The clinical characteristics of NTM pulmonary disease and pulmonary tuberculosis are similar, which are easily misdiagnosed as pulmonary tuberculosis. The cure rate of NTM pulmonary disease is low, and the rate of treatment interruption and loss to follow-up is high.

Key words: Mycobacterium infections, Lung disease, Disease attributes

中图分类号:

R563

韩喜琴, 王敬, 谭秋清, 李晓华, 张立群, 邵玲玲, 段鸿飞. 93例非结核分枝杆菌肺病临床分析[J]. 中国防痨杂志, 2023, 45(4): 355-361. doi: 10.19982/j.issn.1000-6621.20220519

Han Xiqin, Wang Jing, Tan Qiuqing, Li Xiaohua, Zhang Liqun, Shao Lingling, Duan Hongfei. Clinical analysis of 93 cases of pulmonary disease caused by nontuberculous mycobacteria[J]. Chinese Journal of Antituberculosis, 2023, 45(4): 355-361. doi: 10.19982/j.issn.1000-6621.20220519

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基本特征	例数(构成比,%)
年龄组(岁)
16~44	20(21.50)
45~59	30(32.26)
≥60	43(46.24)
性别
男性	47(50.54)
女性	46(49.46)
地区分布
华北地区	67(72.04)
东北地区	13(13.98)
西北地区	5(5.38)
华中地区	4(4.30)
华东地区	4(4.30)

感染菌种	例数	构成比(%)
MAC	53	56.99
脓肿分枝杆菌	28	30.11
堪萨斯分枝杆菌	4	4.30
蟾蜍分枝杆菌	3	3.22
NTM混合感染	2	2.14
戈登分枝杆菌	1	1.08
偶发分枝杆菌	1	1.08
施氏分支杆菌	1	1.08
合计	93	100.00

治疗分类	鸟-胞内分枝杆菌复合群肺病(44例)		脓肿分枝杆菌肺病(27例)
治疗分类	例数	方案	例数	方案
初治	16	方案1:3~6Am-Azi(Clr)-R(B)-E/12~18Azi(Clr)-R(B)-E	16	方案4(含头孢西丁):Fox(1~2)3~6Am-Lzd-Azi(Clr)-Mfx(Lfx)/12~18Azi(Clr)-Mfx-Lzd±M
	13	方案2(含氟喹诺酮类):3~6Am-Azi(Clr)-R(B)-E-Lfx(Mfx)/12~18Azi(Clr)-R(B)-E	6	方案5:3~6Am-Lzd-Azi(Clr)-Mfx(Lfx)/12~18Azi(Clr)-Mfx-Lzd(M)
复治	15	方案3:3~6Am-Azi-Lzd-Cfz/12~18Azi-Lzd-Cfz	5	方案4(含头孢西丁):Fox(1~2)3~6Am-Lzd-Azi(Clr)-Mfx(Lfx)/12~18Azi(Clr)-Mfx-Lzd±M

症状	例数	可疑药物
骨髓抑制	16	Fox、Lzd、Lfx、Mfx
胃肠道症状	12	Azi、Clr、Lfx、Mfx
双下肢麻木	12	Lzd
皮肤色素沉着	11	Cfz
耳鸣、听力下降	8	Am
肝损害	3	Am、Clr、Mfx、Lzd、Azi
视力下降	3	EMB、Lzd

治疗方案	鸟-胞内分枝杆菌复合群肺病 (23例)		P值^a	治疗方案	脓肿分枝杆菌肺病 (13例)		P值^a
治疗方案	成功例数	失败例数	P值^a	治疗方案	成功例数	失败例数	P值^a
方案1	5	7	0.684	方案4	6	1	0.559
方案2	6	5		方案5	4	2