Clinical analysis of 93 cases of pulmonary disease caused by nontuberculous mycobacteria

doi:10.19982/j.issn.1000-6621.20220519

Abstract

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

CLC Number:

R563

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

Figures/Tables 5

References 36

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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