34例非结核分枝杆菌病的临床病理特征分析

doi:10.19982/j.issn.1000-6621.20240151

摘要/Abstract

摘要：

目的: 探讨非结核分枝杆菌(non-tuberculous mycobacteria,NTM)病的临床病理学特征。方法: 回顾性收集北京协和医院2015年3月1日至2023年12月31日诊治且有病理送检记录的34例NTM病患者的临床资料及病理资料。将所有患者分为播散性NTM病组(14例)和非播散性NTM病组(20例),分析并比较两组患者的临床病理特征。结果: 22例(64.71%, 22/34)患者的致病菌为鸟-胞内分枝杆菌,6例(17.65%,6/34)患者的致病菌为龟-脓肿分枝杆菌,4例(11.76%,4/34)患者为堪萨斯分枝杆菌。病理组织学检查发现23例(67.65%,23/34) 可见肉芽肿病变,其中,19例(82.61%,19/23)样本中的上皮样组织细胞排列均松散,7例(30.43%,7/23)样本中可见化脓性肉芽肿。5例(14.71%,5/34)可见富于核碎片的嗜碱性坏死,4例(11.76%,4/34)出现粉染的干酪样坏死,18例 (52.94%,18/34)观察到多核巨细胞反应。5例(23.81%,5/21)抗酸染色阳性。结论: NTM病的病理组织学表现多样,以松散的上皮样肉芽肿为主要病理改变,常伴多核巨细胞反应,且化脓性肉芽肿较常见。

关键词: 分枝杆菌,非典型性, 病理学,临床, 诊断,鉴别

Abstract:

Objective: To explore the clinicopathological characteristics of non-tuberculous mycobacterial (NTM) disease. Methods: Clinical and pathological data from 34 NTM patients who were diagnosed and treated in Peking Union Medical College Hospital between March 1, 2015 and December 31, 2023 were retrospectively collected. All patients were divided into disseminated NTM disease group (14 cases) and non-disseminated NTM disease group (20 cases). The clinicopathological characteristics of these groups were analyzed and compared. Results: Twenty-two patients (64.71%, 22/34) were infected with Mycobacterium avium/intracellular; 6 patients (17.65%, 6/34) were caused by Turtle/Mycobacterium abscessus infection, and 4 patients (11.76%, 4/34) were infected with Mycobacterium kansasii. Histopathological examination revealed granulomatous lesions in 23 cases (67.65%, 23/34). Of these, 19 cases (82.61%, 19/23) exhibited loosely arranged granuloma, 7 cases (30.43%, 7/23) showed suppurative granulomas, and basophilic necrosis was found in 5 cases (14.71%, 5/34). Pink-stained caseous necrosis was reviewed in 4 cases (11.76%, 4/34), and multinucleated giant cell reaction was observed in 18 cases (52.94%, 18/34). Positive acid-fast staining was identified in 5 out of 21 cases examined (23.81%, 5/21). Conclusion: The pathological features of NTM disease are diverse, with loosely arranged epithelioid granulomas being the most common finding. These granulomas are often accompanied by multinucleated giant cell reactions and suppurative granuloma.

Key words: Mycobacteria, atypical, Pathology, clinical, Diagnosis, differential

中图分类号:

R52
R365

张卉, 葛莉, 张煜涵, 冯瑞娥. 34例非结核分枝杆菌病的临床病理特征分析[J]. 中国防痨杂志, 2024, 46(7): 756-762. doi: 10.19982/j.issn.1000-6621.20240151

Zhang Hui, Ge Li, Zhang Yuhan, Feng Ruie. Clinicopathologic characteristics of 34 cases non-tuberculous mycobacterial disease[J]. Chinese Journal of Antituberculosis, 2024, 46(7): 756-762. doi: 10.19982/j.issn.1000-6621.20240151

图/表 2

表1

图1

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特征	播散性NTM病组 (14例)	非播散性NTM病组 (20例)	统计检验值	P值
性别			-^e	1.000
男性	7(50.00)	9(45.00)
女性	7(50.00)	11(55.00)
年龄(岁)	49.8(41,58)	51.5(39,62)	Z=-0.263^f	0.796^e
临床症状
发热	12(85.71)	12(60.00)	-^e	0.141
咳嗽	7(50.00)	13(65.00)	-^e	0.487
自身免疫性疾病	10(71.43)	8(40.00)	-^e	0.296
抗IFN-γ抗体相关免疫缺陷病	2(14.29)	0(0.00)
系统性红斑狼疮	3(21.43)	2(10.00)
高IgE综合征	1(7.14)	0(0.00)
干燥综合征	0(0.00)	2(10.00)
类风湿关节炎	0(0.00)	2(10.00)
其他^a	4(28.57)	2(10.00)
结核病史	2(14.29)	2(10.00)	-^e	1.000
吸烟史	4(28.57)	4(20.00)	-^e	1.000
粉尘接触史	2(14.29)	4(20.00)	-^e	1.000
致病菌
鸟-胞内分枝杆菌复合群	9(64.29)	13(65.00)	-^e	1.000
龟-脓肿分枝杆菌	2(14.29)	4(20.00)	-^e	1.000
堪萨斯分枝杆菌	2(14.29)	2(10.00)	-^e	1.000
其他^b	1(7.14)	1(5.00)
病理学表现
肉芽肿	12(85.71)	11(55.00)	-^e	0.076
松散的肉芽肿	12(85.71)	6(30.00)	-^e	0.002
结核病样肉芽肿	0(0.00)	4(20.00)	-^e	0.126
化脓性肉芽肿	4(28.57)	3(15.00)	-^e	0.410
多核巨细胞	9(64.29)	9(45.00)	-^e	0.315
坏死	6(42.86)	4(20.00)	-^e	0.252
干酪样坏死	2(14.29)	2(10.00)	-^e	1.000
嗜碱性坏死	4(28.57)	1(5.00)	-^e	0.135
化脓性坏死	4(28.57)	1(5.00)	-^e	0.135
抗酸染色阳性	2(18.18)^c	3(30.00)^d	-^e	0.361