老年与非老年脓肿分枝杆菌肺病临床特点对比及预后影响因素分析

doi:10.19982/j.issn.1000-6621.20250411

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (1): 106-112.doi: 10.19982/j.issn.1000-6621.20250411

老年与非老年脓肿分枝杆菌肺病临床特点对比及预后影响因素分析

尚园园¹^,², 聂文娟²(), 初乃惠²()

¹首都医科大学附属北京友谊医院老年医学科,北京100050
²首都医科大学附属北京胸科医院结核一病区,北京101149

收稿日期:2025-10-22 出版日期:2026-01-10 发布日期:2025-12-31
通信作者: 聂文娟,初乃惠 E-mail:94642975@qq.com;dongchu1994@sina.com
基金资助:
北京市高层次公共卫生人才项目(G2022-3-020);北京重大呼吸道传染病研究中心课题(BJRID2025-013);北京市医管中心扬帆3.0项目(ZLRK202331);首都医科大学临床专科学院(系)培养基金开放课题(CCMU2024ZKYXY011)

Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease

Shang Yuanyuan¹^,², Nie Wenjuan²(), Chu Naihui²()

¹Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
²Department I of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China

Received:2025-10-22 Online:2026-01-10 Published:2025-12-31
Contact: Nie Wenjuan,Chu Naihui E-mail:94642975@qq.com;dongchu1994@sina.com
Supported by:
Beijing High-level Public Health Talent Program(G2022-3-020);Beijing Major Respiratory Infectious Diseases Research Center Project(BJRID2025-013);Beijing Hospital Management Center “Set Sail 3.0” Project(ZLRK202331);Open Project of Training Fund for Clinical Specialized College (Department) of Capital Medical University(CCMU2024ZKYXY011)

摘要/Abstract

摘要：

目的: 对老年与非老年脓肿分枝杆菌肺病(Mycobacterium abscessus pulmonary disease, MAB-PD)患者的临床特点、耐药情况进行比较,对MAB-PD患者预后进行影响因素分析。方法: 选择2021年1月1日至2023年5月31日期间就诊于首都医科大学附属北京胸科医院确诊的123例MAB-PD患者(老年组48例,非老年组75例),收集患者的临床资料、药物敏感性试验结果及治疗结局,对两组患者的临床特点进行比较,对患者预后影响因素进行分析。结果: 老年MAB-PD患者空洞发生率为41.7%(20/48),高于非老年MAB-PD患者[24.0%(18/75)];胸膜粘连比例为66.7%(32/48),也高于非老年MAB-PD患者[46.7%(35/75)],差异均有统计学意义(χ²=4.279,P=0.039;χ²=4.721,P=0.030)。多因素logistic分析显示:年龄≥65岁(OR=2.532,95%CI:1.048~6.120)、BMI<18.5kg/m²(OR=4.379,95%CI:1.758~10.905)、胸膜粘连(OR=3.566,95%CI:1.420~8.955)是患者治疗失败的危险因素。结论: 老年MAB-PD患者以空洞、胸膜粘连为主要特征。高龄、低BMI、胸膜粘连是MAB-PD患者治疗失败的危险因素,临床上需要针对高龄、营养不良及影像出现粘连患者制定个体化干预措施。

关键词: 老年, 分枝杆菌感染, 非典型性细菌, 抗药性, 治疗结局

Abstract:

Objective: To compare the clinical characteristics and drug resistance profiles between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease (MAB-PD), and to analyze the prognostic factors influencing treatment outcomes. Methods: A total of 123 patients diagnosed with MAB-PD at Beijing Chest Hospital, Capital Medical University, from January 1, 2021, to May 31, 2023, were enrolled and divided into an elderly group (48 patients, age ≥65 years) and a non-elderly group (75 patients, age <65 years). Clinical data, drug susceptibility testing results, and treatment outcomes were collected. The clinical features of the two groups were compared, and prognostic factors associated with treatment outcomes were analyzed. Results: The incidence of cavitary lesions was significantly higher in elderly MAB-PD patients (41.7% (20/48)) compared to non-elderly patients (24.0% (18/75)). The proportion of patients with pleural adhesion was also significantly greater in the elderly group (66.7% (32/48)) than in the non-elderly group (46.7% (35/75)) (χ²=4.279, P=0.039; χ²=4.721, P=0.030, respectively). Multivariate logistic analysis identified age ≥65 years (OR=2.532, 95%CI: 1.048-6.120), BMI<18.5 kg/m² (OR=4.379, 95%CI: 1.758-10.905), and the presence of pleural adhesion (OR=3.566, 95%CI: 1.420-8.955) as independent risk factors for treatment failure. Conclusion: Elderly patients with MAB-PD are more likely to present with pulmonary cavities and pleural adhesions. Advanced age, low BMI, and pleural adhesion are significant risk factors for treatment failure in MAB-PD patients. Individualized management strategies should be considered for elderly patients, those with malnutrition, and those exhibiting pleural adhesions on imaging.

Key words: Aged, Mycobacterium infections, Atypical bacterial forms, Drug resistance, Treatment outcomes

中图分类号:

R563

尚园园, 聂文娟, 初乃惠. 老年与非老年脓肿分枝杆菌肺病临床特点对比及预后影响因素分析[J]. 中国防痨杂志, 2026, 48(1): 106-112. doi: 10.19982/j.issn.1000-6621.20250411

Shang Yuanyuan, Nie Wenjuan, Chu Naihui. Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 106-112. doi: 10.19982/j.issn.1000-6621.20250411

图/表 3

表1

表2

表3

老年组与非老年组MAB-PD患者治疗结局影响因素多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
性别(女性)	―0.038	0.486	0.006	0.938	0.963	0.371~2.496
气促	―0.094	0.551	0.029	0.864	0.910	0.309~2.679
BMI<18.5kg/m²	1.477	0.466	10.064	0.002	4.379	1.758~10.905
空洞	0.145	0.475	0.094	0.760	1.156	0.456~2.936
年龄≥65岁	0.929	0.450	4.260	0.039	2.532	1.048~6.120
胸膜粘连	1.271	0.470	7.325	0.007	3.566	1.420~8.955

表3

参考文献 39

[1]	Kumar K, Loebinger MR. Nontuberculous Mycobacterial Pulmonary Disease: Clinical Epidemiologic Features, Risk Factors, and Diagnosis: The Nontuberculous Mycobacterial Series. Chest, 2022, 161(3): 637-646. doi:10.1016/j.chest.2021.10.003.
[2]	Mencarini J, Cresci C, Simonetti MT, et al. Non-tuberculous mycobacteria: epidemiological pattern in a reference laboratory and risk factors associated with pulmonary disease. Epidemiol Infect, 2017, 145(3): 515-522. doi:10.1017/S0950268816002521. pmid: 27804902
[3]	Kim JY, Kim NY, Jung HW, et al. Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease. BMC Pulm Med, 2022, 22(1): 269. doi:10.1186/s12890-022-02063-2.
[4]	Lake MA, Ambrose LR, Lipman MC, et al. “Why me, why now?” Using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection. BMC Med, 2016, 14: 54. doi:10.1186/s12916-016-0606-6.
[5]	Mirsaeidi M, Farshidpour M, Ebrahimi G, et al. Management of nontuberculous mycobacterial infection in the elderly. Eur J Intern Med, 2014, 25(4): 356-363. doi:10.1016/j.ejim.2014.03.008. pmid: 24685313
[6]	Guo W, Shangguan Y, Ji Z, et al. Clinical characteristics and antimicrobial susceptibility profiles of Mycobacterium abscessus and Mycobacterium massiliense pulmonary infection. J Glob Antimicrob Resist, 2024, 38: 83-89. doi:10.1016/j.jgar.2024.04.004.
[7]	Li YM, Tong XL, Xu HT, et al. Prevalence and Antimicrobial Susceptibility of Mycobacterium abscessus in a General Hospital, China. Biomed Environ Sci, 2016, 29(2): 85-90. doi:10.3967/bes2016.009.
[8]	中国防痨协会. T/CHATA 001—2020 非结核分枝杆菌病诊断. 2020-07-07.
[9]	中华医学会结核病学分会. 非结核分枝杆菌病诊断与治疗指南(2020年版). 中华结核和呼吸杂志, 2020, 43(11): 918-946. doi:10.3760/cma.j.cn112147-20200508-00570.
[10]	中华医学会急诊医学分会, 中国老年社区获得性肺炎急诊诊疗专家共识组. 中国老年社区获得性肺炎急诊诊疗专家共识. 中华急诊医学杂志, 2023, 32(10): 1319-1327. doi:10.3760/cma.j.issn.1671-0282.2023.10.005.
[11]	张振伟, 赵玉明, 陈泓洲, 等. 中国18个长寿地区65岁及以上老年人肌肉重量和力量的分布特征. 中华流行病学杂志, 2024, 45(5): 656-665. doi:10.3760/cma.j.cn112338-20240227-00083.
[12]	Woods GL, Brown-Elliott BA, Conville PS, et al. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes. 2nd ed. Wayne (PA): Clinical and Laboratory Standards Institute, 2011.
[13]	Fujiwara K, Furuuchi K, Aono A, et al. Clinical risk factors related to treatment failure in Mycobacterium abscessus lung disease. Eur J Clin Microbiol Infect Dis, 2021, 40(2):247-254. doi:10.1007/s10096-020-04026-z.
[14]	Conradie F, Diacon AH, Ngubane N, et al. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. N Engl J Med, 2020, 382(10):893-902. doi:10.1056/NEJMoa1901814.
[15]	de Visser MA, Kululanga D, Chikumbanje SS, et al. Outcome in Children Admitted to the First PICU in Malawi. Pediatr Crit Care Med, 2023, 24(6):473-483. doi:10.1097/PCC.0000000000003210.
[16]	Liu Z, He M, Wang X. nomogram for predicting the overall survival in rectal cancer patients after total neoadjuvant therapy. Tech Coloproctol, 2024, 28(1):107. Published 2024 Aug 14. doi:10.1007/s10151-024-02986-4. pmid: 39141173
[17]	Zhang D, Wu M, Yi X, et al. Correlation analysis of myopia and dietary factors among primary and secondary school students in Shenyang, China. Sci Rep, 2024, 14(1):20619. doi:10.1038/s41598-024-71254-0. pmid: 39232029
[18]	Verma AK, Arora VK. Non-tuberculous mycobacterial infections in geriatric patients-A neglected and emerging problem. Indian J Tuberc, 2022, 69 Suppl 2: S235-S240. doi:10.1016/j.ijtb.2022.10.010.
[19]	Franceschi C, Garagnani P, Morsiani C, et al. The Continuum of Aging and Age-Related Diseases: Common Mechanisms but Different Rates. Front Med (Lausanne), 2018, 5: 61. doi:10.3389/fmed.2018.00061.
[20]	Morimoto K, Nakagawa T, Asami T, et al. Clinico-microbiological analysis of 121 patients with pulmonary Mycobacteroides abscessus complex disease in Japan-An NTM-JRC study with RIT. Respir Med, 2018, 145: 14-20. doi:10.1016/j.rmed.2018.10.012. pmid: 30509703
[21]	Park J, Yoon SH, Kim JY, et al. Radiographic severity and treatment outcome of Mycobacterium abscessus complex pulmonary disease. Respir Med, 2021, 187: 106549. doi:10.1016/j.rmed.2021.106549.
[22]	Park S, Jo KW, Lee SD, et al. Clinical characteristics and treatment outcomes of pleural effusions in patients with nontuberculous mycobacterial disease. Respir Med, 2017, 133: 36-41. doi:10.1016/j.rmed.2017.11.005. pmid: 29173447
[23]	Bachar K, Shulimzon T, Segel MJ. Nontuberculous mycobacteria infections of the pleura: A systematic review. Respir Med, 2022, 205: 107036. doi:10.1016/j.rmed.2022.107036.
[24]	Yagi K, Ito A, Fujiwara K, et al. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis: A Multicenter Retrospective Study. Ann Am Thorac Soc, 2021, 18(9): 1490-1497. doi:10.1513/AnnalsATS.202008-938OC. pmid: 33832404
[25]	Tunesi S, Zelazny A, Awad Z, et al. Antimicrobial susceptibility of Mycobacterium abscessus and treatment of pulmonary and extra-pulmonary infections. Clin Microbiol Infect, 2024, 30(6): 718-725. doi:10.1016/j.cmi.2023.09.019.
[26]	Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J, 2020, 56(1): 2000535. doi:10.1183/13993003.00535-2020.
[27]	Kwak N, Dalcolmo MP, Daley CL, et al. Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis. Eur Respir J, 2019, 54(1): 1801991. doi:10.1183/13993003.01991-2018.
[28]	Mougari F, Bouziane F, Crockett F, et al. Selection of Resis-tance to Clarithromycin in Mycobacterium abscessus Subspecies. Antimicrob Agents Chemother, 2016, 61(1): e00943-16. doi:10.1128/AAC.00943-16.
[29]	Mougari F, Amarsy R, Veziris N, et al. Standardized interpretation of antibiotic susceptibility testing and resistance genotyping for Mycobacterium abscessus with regard to subspecies and erm 41 sequevar. J Antimicrob Chemother, 2016, 71(8): 2208-2212. doi:10.1093/jac/dkw130. pmid: 27147307
[30]	Flight WG, Hough NE, Chapman SJ. Outcomes of pulmonary Mycobacterium abscessus infection. Int J Mycobacteriol, 2020, 9(1): 48-52. doi:10.4103/ijmy.ijmy_3_20.
[31]	He G, Wu L, Zheng Q, et al. Antimicrobial susceptibility and minimum inhibitory concentration distribution of common clinically relevant non-tuberculous mycobacterial isolates from the respiratory tract. Ann Med, 2022, 54(1): 2500-2510. doi:10.1080/07853890.2022.2121984. pmid: 36120867
[32]	Guo Q, Wei J, Zou W, et al. Antimicrobial susceptibility profiles of Mycobacterium abscessus complex isolates from respiratory specimens in Shanghai, China. J Glob Antimicrob Resist, 2021, 25: 72-76. doi:10.1016/j.jgar.2021.02.024.
[33]	Fujiwara K, Uesugi F, Furuuchi K, et al. Minimum Inhibitory Concentrations before and after Antibacterial Treatment in Patients with Mycobacterium abscessus Pulmonary Disease. Microbiol Spectr, 2021, 9(3): e0192821. doi:10.1128/Spectrum.01928-21.
[34]	Lee MC, Sun PL, Wu TL, et al. Antimicrobial resistance in Mycobacterium abscessus complex isolated from patients with skin and soft tissue infections at a tertiary teaching hospital in Taiwan. J Antimicrob Chemother, 2017, 72(10): 2782-2786. doi:10.1093/jac/dkx212.
[35]	Sfeir M, Walsh M, Rosa R, et al. Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study. Open Forum Infect Dis, 2018, 5(2): ofy022. doi:10.1093/ofid/ofy022.
[36]	Griffith DE, Daley CL. Treatment of Mycobacterium abscessus Pulmonary Disease. Chest, 2022, 161(1): 64-75. doi:10.1016/j.chest.2021.07.035.
[37]	Koons B, Greenland JR, Diamond JM, et al. Pathobiology of frailty in lung disease. Transl Res, 2020, 221: 1-22. doi:10.1016/j.trsl.2020.04.001. pmid: 32376405
[38]	Wyrostkiewicz D, Opoka L, Filipczak D, et al. Nontuberculous Mycobacterial Lung Disease in the Patients with Cystic Fibrosis-A Challenging Diagnostic Problem. Diagnostics (Basel), 2022, 12(7): 1514. doi:10.3390/diagnostics12071514.
[39]	Zhao Z, Hu H, Wang M, et al. Risk Factors and Mental Health Status in Patients With Non-Tuberculous Mycobacterial Lung Disease: A Single Center Retrospective Study. Front Public Health, 2022, 10: 912651. doi:10.3389/fpubh.2022.912651.

特征	老年MAB-PD患者(48例)				非老年MAB-PD患者(75例)				χ²值		P值
特征	例数		发生率(%)		例数		发生率(%)		χ²值		P值
性别^a									0.396		0.529
男性	16		33.3		21		28.0
女性	32		66.7		54		72.0
临床表现
咳嗽	39		81.3		61		81.3		0.000		0.991
气促	13		27.1		10		13.3		3.640		0.056
咳痰	37		77.1		56		74.7		0.093		0.761
咯血	10		20.8		20		26.7		0.540		0.462
发热	10		20.8		20		26.7		0.540		0.462
吸烟	8		16.7		9		12.0		0.535		0.464
饮酒	3		6.2		5		6.7		0.008		0.927
体质量指数(kg/m²)^a										0.096	0.757
<18.5		16		33.3		23		30.7
≥18.5		32		66.7		52		69.3
合并恶性肿瘤		9		18.8		7		9.3		2.293	0.130
既往抗结核治疗		24		50.0		42		56.0		0.424	0.515
糖皮质激素/免疫抑制剂治疗		5		10.4		6		8.0		-^b	0.749^b
既往药物治疗史
克林霉素		8		16.7		14		18.7		0.080	0.778
阿奇霉素		5		10.4		2		2.7		-^b	0.109^b
阿米卡星		9		18.8		13		17.3		0.040	0.841
亚胺培南		0		0.0		2		2.7		-^b	0.520^b
头孢西丁		3		6.2		3		4.0		-^b	0.677^b
利奈唑胺		6		12.5		5		6.7		-^b	0.336^b
左氧氟沙星		10		20.8		16		21.3		0.004	0.947
莫西沙星		4		8.3		9		12.0		0.416	0.519
支气管扩张病史		19		39.6		38		50.7		1.446	0.229
胸部CT影像
结节		38		79.2		54		72.0		0.797	0.372
空洞		20		41.7		18		24.0		4.279	0.039
树芽征		17		35.4		34		45.3		1.186	0.276
囊状支气管扩张		32		66.7		50		66.7		0.000	1.000
胸膜粘连		32		66.7		35		46.7		4.721	0.030

药物名称	老年MAB-PD患者(17例)		非老年MAB-PD患者(31例)		χ²值	P值
药物名称	耐药例数	耐药率(%)	耐药例数	耐药率(%)	χ²值	P值
阿米卡星	3	17.6	1	3.2	-^a	0.121^a
头孢西丁	11	64.7	20	64.5	0.000	0.990
环丙沙星	12	70.6	28	90.3	-^a	0.112^a
克拉霉素	8	47.1	8	25.8	2.231	0.135
亚胺培南	15	88.2	30	96.8	-^a	0.283^a
利奈唑胺	7	41.2	17	54.8	0.82	0.365
米诺环素	16	94.1	29	93.5	-^a	1.000^a
莫西沙星	13	76.5	26	83.9	-^a	0.701^a
妥布霉素	15	88.2	28	90.3	-^a	1.000^a
甲氧苄啶/磺胺甲噁唑	13	76.5	25	80.6	-^a	0.727^a
多西环素	17	100.0	30	96.8	-^a	1.000^a

老年与非老年脓肿分枝杆菌肺病临床特点对比及预后影响因素分析

Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 39

相关文章 15

编辑推荐

Metrics

本文评价

[1]	谭霄, 李芳萍, 张谦, 张美家. 肠道菌群与非结核分枝杆菌肺感染的因果效应:一项双向两样本孟德尔随机化分析[J]. 中国防痨杂志, 2026, 48(1): 121-130.
[2]	朱庆东, 赵春艳, 黄爱春, 曾春梅, 龚春明, 许超艳, 简莎莎, 李维文, 宋畅. 1990—2021年中国60岁及以上老年人HIV/AIDS合并药物敏感结核病的疾病负担及变化趋势[J]. 中国防痨杂志, 2026, 48(1): 34-40.
[3]	唐顺定, 许琳, 李玲, 寸得娇, 杨蕊. 云南省民族地区≥65岁老年人接受肺结核主动筛查的意愿及影响因素分析[J]. 中国防痨杂志, 2026, 48(1): 49-56.
[4]	陈丽, 秦雪玲, 张念伦, 于桂芹. 2020—2023年65岁及以上老年人肺结核患者耐药情况及影响因素分析[J]. 中国防痨杂志, 2025, 47(S2): 23-26.
[5]	曾霞波, 李丹, 李汝霞, 黄学勇, 尹进, 张挣瑜, 苏倩. 重庆市老年2型糖尿病患者结核病核心知识知晓率调查研究[J]. 中国防痨杂志, 2025, 47(S2): 32-36.
[6]	张鑫, 邢惟俊, 杨志伟, 姚文, 徐芳, 杨增伟, 李东辉, 同重湘. 血清γ-干扰素和白细胞介素2水平对老年肺结核的诊断价值[J]. 中国防痨杂志, 2025, 47(S2): 63-65.
[7]	曹群香, 陈思阳, 王朝晖. 肺康复治疗用于老年间质性肺炎治疗的效果研究[J]. 中国防痨杂志, 2025, 47(S2): 137-139.
[8]	王伟. 噻托溴铵粉雾剂联合沙美特罗替卡松治疗老年支气管哮喘-慢阻肺病重叠综合征的疗效探究[J]. 中国防痨杂志, 2025, 47(S2): 155-157.
[9]	李静, 张慧敬, 苗元庆. 系统化护理在老年糖尿病并发重症呼吸衰竭患者中的应用效果[J]. 中国防痨杂志, 2025, 47(S2): 194-196.
[10]	王学青, 朱卉, 顾丹红, 邱莺. 基于循证理念的标准化护理模式用于急诊老年肺炎患者高流量湿化氧疗中的效果分析[J]. 中国防痨杂志, 2025, 47(S2): 197-199.
[11]	吴艳艳, 范萍, 张凌娟. 循证护理对老年患者吸入性肺炎的预防效果[J]. 中国防痨杂志, 2025, 47(S2): 229-231.
[12]	张英, 胡梦蝶, 刘文红. 老年肺炎患者多维度综合护理干预的效果评价[J]. 中国防痨杂志, 2025, 47(S2): 244-246.
[13]	宋飞飞, 杜春涛. 老年社区获得性肺炎患者病原菌分布、影像学特点及并发呼吸衰竭的相关因素[J]. 中国防痨杂志, 2025, 47(S1): 78-80.
[14]	郭召东. 老年腹股沟疝患者术后肺部感染的危险因素分析[J]. 中国防痨杂志, 2025, 47(S1): 110-112.
[15]	陈少芬, 金安岳, 陈思思, 蓝爱春, 张晓晓, 吴甜莺. 多元运动联合音乐疗法在老年患者肺炎护理中的作用[J]. 中国防痨杂志, 2025, 47(S1): 164-167.