间质性肺疾病合并结核分枝杆菌感染的研究进展

doi:10.19982/j.issn.1000-6621.20240171

摘要/Abstract

摘要：

在呼吸系统疾病中,间质性肺疾病和肺结核为两种常见且可对健康造成不同程度危害的疾病。肺结核是一种由结核分枝杆菌引起的传染性疾病,在全球范围内造成严重的疾病负担。间质性肺疾病是一组以慢性炎症和肺泡间质纤维化为特征的非传染性肺部疾病,同样对患者的生活质量和预后产生深远影响。肺部间质性及纤维化改变可能会掩盖感染的征象,而结核分枝杆菌感染会进一步加重间质性肺疾病病情。因此,当肺结核与间质性肺疾病合并发生时,它们的相互作用及共存使得及时诊治存在挑战性,同时也影响疾病的预后和转归。本文对间质性肺疾病合并结核分枝杆菌感染的流行病学、发生机制、诊断方法、高危因素,以及治疗等方面的研究进展进行综述,以期为临床诊治提供参考。

关键词: 肺疾病,间质性, 分枝杆菌,结核, 感染, 共病现象, 总结性报告(主题)

Abstract:

Interstitial lung disease (ILD) and pulmonary tuberculosis (TB) are two prevalent respiratory diseases that can significantly impact health. TB, caused by Mycobacterium tuberculosis, is an infectious disease imposing a severe disease burden globally. In contrast, ILD is a group of non-communicable lung diseases characterized by chronic inflammation and alveolar interstitial fibrosis, profoundly affecting patients’ quality of life and prognosis. The interstitial and fibrotic changes in the lungs can mask signs of infection, while Mycobacterium tuberculosis infection can further worsen the condition of ILD. Therefore, when TB and ILD coexist, their interaction complicates timely diagnosis and treatment, adversely affecting the disease prognosis and outcome. This review summarizes the research progress in the epidemiology, pathogenesis, diagnostic methods, high-risk factors, and treatment of ILD combined with Mycobacterium tuberculosis infection, aiming to provide references for clinical diagnosis and treatment.

Key words: Interstitial lung disease, Mycobacterium tuberculosis, Infection, Comorbidity, Consensus development conferences as topic

中图分类号:

R563
R52

傅可言, 朱邦政, 叶健. 间质性肺疾病合并结核分枝杆菌感染的研究进展[J]. 中国防痨杂志, 2024, 46(7): 823-829. doi: 10.19982/j.issn.1000-6621.20240171

Fu Keyan, Zhu Bangzheng, Ye Jian. Research progress on interstitial lung disease combined with Mycobacterium tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2024, 46(7): 823-829. doi: 10.19982/j.issn.1000-6621.20240171

参考文献 49

[1]	Shah Gupta R, Koteci A, Morgan A, et al. Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review. BMJ Open Respir Res, 2023, 10(1): e001291. doi:10.1136/bmjresp-2022-001291.
[2]	Chioma OS, Hesse LE, Chapman A, et al. Role of the Microbiome in Interstitial Lung Diseases. Front Med (Lausanne), 2021, 8: 595522. doi:10.3389/fmed.2021.595522.
[3]	Odashima K, Kagiyama N, Kanauchi T, et al. Incidence and etiology of chronic pulmonary infections in patients with idiopathic pulmonary fibrosis. PLoS One, 2020, 15(4): e0230746. doi:10.1371/journal.pone.0230746.
[4]	Ogawa K, Kurosaki A, Miyamoto A, et al. Clinicoradiological Features of Pulmonary Tuberculosis with Interstitial Pneumonia. Intern Med, 2019, 58(17): 2443-2449. doi:10.2169/internalmedicine.2341-18.
[5]	Chung MJ, Goo JM, Im JG. Pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis. Eur J Radiol, 2004, 52(2): 175-179. doi:10.1016/j.ejrad.2003.11.017. pmid: 15489076
[6]	Shachor Y, Schindler D, Siegal A, et al. Increased incidence of pulmonary tuberculosis in chronic interstitial lung disease. Thorax, 1989, 44(2): 151-153. doi:10.1136/thx.44.2.151. pmid: 2929001
[7]	Park SW, Song JW, Shim TS, et al. Mycobacterial pulmonary infections in patients with idiopathic pulmonary fibrosis. J Korean Med Sci, 2012, 27(8): 896-900. doi:10.3346/jkms.2012.27.8.896.
[8]	Dias VL, Storrer KM. Prevalence of latent tuberculosis infection among patients with interstitial lung disease requiring immunosuppression. J Bras Pneumol, 2022, 48(2): e20210382. doi:10.36416/1806-3756/e20210382.
[9]	Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med, 2022, 205(9): e18-e47. doi:10.1164/rccm.202202-0399ST.
[10]	赵东, 查世乾, 王易轩, 等. 巨噬细胞向肌成纤维细胞转化促进LPS诱导的急性肺损伤模型小鼠肺纤维化. 基础医学与临床, 2024, 44(3): 281-287. doi:10.16352/j.issn.1001-6325.2024.03.0281.
[11]	Mutsaers SE, Miles T, Prêle CM, et al. Emerging role of immune cells as drivers of pulmonary fibrosis. Pharmacol Ther, 2023, 252: 108562. doi:10.1016/j.pharmthera.2023.108562.
[12]	Sun Y, Xu H, Lu T, et al. Progress in Understanding the Role and Therapeutic Targets of Polarized Subtypes of Macrophages in Pulmonary Fibrosis. Cell Biochem Biophys, 2023, 81(4): 673-682. doi:10.1007/s12013-023-01182-9. pmid: 37749443
[13]	吴显劲, 黄海勇, 萧乐瑶, 等. 巨噬细胞极化与结核分枝杆菌感染的研究进展. 中国防痨杂志, 2023, 45(12): 1198-1204. doi:10.19982/j.issn.1000-6621.20230265.
[14]	Harari A, Rozot V, Bellutti Enders F, et al. Dominant TNF-α⁺ Mycobacterium tuberculosis-specific CD4⁺ T cell responses discriminate between latent infection and active disease. Nat Med, 2011, 17(3): 372-376. doi:10.1038/nm.2299.
[15]	陈洁, 叶海明, 张菊芳. 血清单核细胞趋化蛋白-1、γ干扰素、白细胞介素-18表达情况及其在肺结核患者诊断和治疗评估中的价值. 新发传染病电子杂志, 2023, 8(6): 52-57. doi:10.19871/j.cnki.xfcrbzz.2023.06.010.
[16]	Sharan R, Singh DK, Rengarajan J, et al. Characterizing Early T Cell Responses in Nonhuman Primate Model of Tuberculosis. Front Immunol, 2021, 12: 706723. doi:10.3389/fimmu.2021.706723.
[17]	Kim JY, Kang YA, Park JH, et al. An IFN-γ and TNF-α dual release fluorospot assay for diagnosing active tuberculosis. Clin Microbiol Infect, 2020, 26(7): 928-934. doi:10.1016/j.cmi.2019.11.003.
[18]	Vu TN, Chen X, Foda HD, et al. Interferon-γ enhances the antifibrotic effects of pirfenidone by attenuating IPF lung fibroblast activation and differentiation. Respir Res, 2019, 20(1): 206. doi:10.1186/s12931-019-1171-2.
[19]	Miyazaki Y, Araki K, Vesin C, et al. Expression of a tumor necrosis factor-alpha transgene in murine lung causes lymphocytic and fibrosing alveolitis. A mouse model of progressive pulmonary fibrosis. J Clin Invest, 1995, 96(1): 250-259. doi:10.1172/JCI118029. pmid: 7542280
[20]	Gono T, Kaneko H, Kawaguchi Y, et al. Cytokine profiles in polymyositis and dermatomyositis complicated by rapidly progressive or chronic interstitial lung disease. Rheumatology (Oxford), 2014, 53(12): 2196-2203. doi:10.1093/rheumatology/keu258. pmid: 24970922
[21]	刘昌伟, 马玲娣, 魏振华, 等. γ-干扰素释放试验在基层门诊肺结核筛查中的应用及评价. 新发传染病电子杂志, 2023, 8(6): 63-68. doi:10.19871/j.cnki.xfcrbzz.2023.06.012.
[22]	陈水平. Gene X-pert MTB/RIF检测对肺结核病的诊断价值研究. 智慧健康, 2023, 9(28): 87-90. doi:10.19335/j.cnki.2096-1219.2023.28.022.
[23]	中华医学会呼吸病学分会间质性肺疾病学组. 特发性肺纤维化诊断和治疗中国专家共识. 中华结核和呼吸杂志, 2016, 39(6): 427-432. doi:10.3760/cma.j.issn.1001-0939.2016.06.005.
[24]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 肺结核基层诊疗指南(2018年). 中华全科医师杂志, 2019, 18(8): 709-717. doi:10.3760/cma.j.issn.1671-7368.2019.08.002.
[25]	Lee YH, Cha SI, Lim JK, et al. Clinical and radiological features of pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis. Respir Investig, 2019, 57(6): 544-551. doi:10.1016/j.resinv.2019.08.001.
[26]	刘劭华. 肺间质改变为主的肺结核CT诊断. 中外医学研究, 2016, 14(10): 41-43. doi:10.14033/j.cnki.cfmr.2016.10.020.
[27]	Wong C, Sahni S, Cheema MAI, et al. Mycobacterium tuberculosis Infection in the Setting of Interstitial Lung Disease: Coincidence or Bad Luck?. Cureus, 2018, 10(10): e3391. doi:10.7759/cureus.3391.
[28]	张静静, 李青, 王丹阳, 等. 血清KL-6水平检测在临床间质性肺病诊断中的研究进展. 现代检验医学杂志, 2022, 37(4): 198-204. doi:10.3969/j.issn.1671-7414.2022.04.039.
[29]	Kishaba T. Evaluation and management of Idiopathic Pulmonary Fibrosis. Respir Investig, 2019, 57(4): 300-311. doi:10.1016/j.resinv.2019.02.003. pmid: 30853366
[30]	Miwa S, Suzuki Y, Shirai M, et al. Assessment of serum KL-6 as a prognostic marker in pulmonary tuberculosis patients. Int J Tuberc Lung Dis, 2013, 17(2): 240-242. doi:10.5588/ijtld.12.0498. pmid: 23228506
[31]	Lynch DA, Sverzellati N, Travis WD, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med, 2018, 6(2): 138-153. doi:10.1016/S2213-2600(17)30433-2. pmid: 29154106
[32]	Kashkash F, Khorri A. Observational findings of transbronchial lung biopsy in patients with interstitial lung disease: a retrospective study in Aleppo University Hospital. Ann Med Surg (Lond), 2023, 85(2): 146-152. doi:10.1097/MS9.0000000000000180. pmid: 36845790
[33]	国家呼吸内科医疗质量控制中心, 中华医学会结核病学分会, 中国防痨协会结核病控制专业分会, 等. 综合医疗机构肺结核早期发现临床实践指南. 中国防痨杂志, 2024, 46(2): 127-140. doi:10.19982/j.issn.1000-6621.20230428.
[34]	Kumar R, Gupta N. Role of bronchoscopy in evaluation of cases with sputum smear negative pulmonary tuberculosis, interstitial lung disease and lung malignancy: A retrospective study of 712 cases. Indian J Tuberc, 2015, 62(1): 36-42. doi:10.1016/j.ijtb.2015.02.006. pmid: 25857564
[35]	Freund O, Hadad Y, Lagziel T, et al. The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples. Adv Respir Med, 2023, 92(1): 15-24. doi:10.3390/arm92010003.
[36]	Kim YW, Kwon BS, Lim SY, et al. Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study. Clin Microbiol Infect, 2020, 26(7): 911-916. doi:10.1016/j.cmi.2019.11.013.
[37]	Vega V, Cabrera-Sanchez J, Rodríguez S, et al. Risk factors for pulmonary tuberculosis recurrence, relapse and reinfection: a systematic review and meta-analysis. BMJ Open Respir Res, 2024, 11(1): e002281. doi:10.1136/bmjresp-2023-002281.
[38]	李雅欣, 孙奇颉, 胡一平, 等. 间质性肺疾病合并分枝杆菌感染19例临床分析. 中华实用诊断与治疗杂志, 2023, 37(11): 1093-1096. doi:10.13507/j.issn.1674-3474.2023.11.003.
[39]	Kim R, Meyer KC. Therapies for interstitial lung disease: past, present and future. Ther Adv Respir Dis, 2008, 2(5): 319-338. doi:10.1177/1753465808096948. pmid: 19124380
[40]	D’Agnano V, Mariniello DF, Ruotolo M, et al. Targeting Progression in Pulmonary Fibrosis: An Overview of Underlying Mechanisms, Molecular Biomarkers, and Therapeutic Intervention. Life (Basel), 2024, 14(2): 229. doi:10.3390/life14020229.
[41]	Khan M, Alghamdi M, Al-Jahdali H. Reactivation pulmonary tuberculosis in two patients treated with pirfenidone. Int J Mycobacteriol, 2017, 6(2): 193-195. doi:10.4103/ijmy.ijmy_64_17. pmid: 28559525
[42]	Hande MH, Acharya KV, Shreenivasa A, et al. Perils with Pirfenidone and “the tuberculosis link”. Int J Mycobacteriol, 2019, 8(3): 298-301. doi:10.4103/ijmy.ijmy_96_19.
[43]	Krachunov II, Ivanov YY. Reactivation of tuberculosis in patient treated with the antifibrotic drug nintedanib. Int J Mycobacteriol, 2022, 11(4): 454-456. doi:10.4103/ijmy.ijmy_194_22. pmid: 36510934
[44]	Piotrowski W, Bestry I, Białas AJ, et al. Guidelines of the Polish Respiratory Society for diagnosis and treatment of idiopathic pulmonary fibrosis. Adv Respir Med, 2020, 88(1): 41-93. doi:10.5603/ARM.2020.0081. pmid: 32153010
[45]	Macías-Barragán J, Sandoval-Rodríguez A, Navarro-Partida J, et al. The multifaceted role of pirfenidone and its novel targets. Fibrogenesis Tissue Repair, 2010, 3: 16. doi:10.1186/1755-1536-3-16.
[46]	Ahidjo BA, Maiga MC, Ihms EA, et al. The antifibrotic drug pirfenidone promotes pulmonary cavitation and drug resistance in a mouse model of chronic tuberculosis. JCI Insight, 2016, 1(14): e86017. doi:10.1172/jci.insight.86017.
[47]	Richeldi L, du Bois RM, Raghu G, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med, 2014, 370(22): 2071-2082. doi:10.1056/NEJMoa1402584.
[48]	Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J, 2015, 46(6): 1563-1576. doi:10.1183/13993003.01245-2015.
[49]	国家感染性疾病临床医学研究中心/深圳市第三人民医院, 北京大学深圳医院, 中国医学科学院北京协和医院, 等. 风湿性疾病患者合并结核分枝杆菌潜伏感染诊治的专家共识. 中国防痨杂志, 2022, 44(9): 869-879. doi:10.19982/j.issn.1000-6621.20220225.