73例非结核分枝杆菌肺病患者临床特点分析
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摘要
目的探讨非结核分枝杆菌肺病(NTM-PD)患者临床特点。方法回顾分析2016-2017年7月佛山市第四人民医院确诊73例NTM-PD患者临床资料。结果男性占47. 9%,女性52. 1%,平均年龄(62. 59±14. 28)岁; 73例患者平均体重指数(BMI)为(17. 50±2. 88) kg/m~2。肺部均有斑片、结节影伴纤维条索,以支气管扩张为多见(82. 2%),其次为空洞(52. 1%),实变影少见(12. 3%)。7类NTM亚种被分离,胞内分枝杆菌(43. 8%),与龟脓肿分枝杆菌(24. 7%)为多见。耐药率分别为异烟肼(100%)、利福平(82. 2%)、乙胺丁醇(97. 3%)、链霉素(98. 6%)、阿米卡星(100%)、氧氟沙星(87. 7%)、卷曲霉素(91. 8%);一二线药物全耐(41. 1%)。其中40例为初治,27例复治。10例患者行抗NTM治疗,2例完成2年疗程,平均治疗时间为(8. 10±8. 49)月,随访1年,其中1例有效,8例无效,1例恶化。结论 NTM-PD与营养不良相关,肺部影像学与肺结核类似,但以支气管扩张改变为主,耐药率极高;抗NTM治疗疗程长,药物不良反应多见,患者难以耐受,多数未能坚持疗程,疗效不确切。
Objective To explore the clinical features and drug resistance of patients with non-tuberculous mycobacterial pulmonary disease( NTM-PD). Methods The clinical data of 73 patients with NTM-PD whom were diagnosed by Foshan Fourth People's Hospital from 2016 to July 2017 were retrospective analysis. Results Male accounted for 47. 9% and female 52. 1%,and the average age was 62. 59 ± 14. 28 years old. The average body mass index of these 73 patients were 17. 50 ± 2. 88 kg/m~2. All of the patients had patchy shadows and nodules in their lungs,accompanied by fiber streaks. Most of them had bronchiectasis( 82. 2%),and secondly cavity( 52. 1%),but the consolidation accounted for only 12. 3%. 7 species of NTM were isolated,included Mycobacterium intercellulare( 43. 8%) and Mycobacterium chelonea-abcessus complex( 24. 7%). The rate of drug resistance was as follows:isoniazid( 100%), rifampin( 82. 2%), ethylamine butanol( 97. 3%), streptomycin( 98. 6%), amikacin( 100%),ofloxacin( 87. 7%),capreomycin( 91. 8%),and SHREACp O( 75. 3%),and the rate of drug resistance to all the above drugs was 41. 1%. Among them,40 cases were initial cases and 27 cases were retreated. 10 cases received anti-NTM treatment,and 2 of them completed 2 years period of treatment. The average period of treatment was( 8. 10 ± 8. 49) months. During 1-year follow-up,1 of them was effective,8 were invalid,and 1 turned worse. Conclusion NTM-PD is considered to be associated with malnutrition,and the lung image is similar to tuberculosis,mostly with bronchiectasis. The drug resistance of NTM is extremely high. The period of treatment is too long for patients to insist,not to mention the medicine untoward effects. Most patients fail to adhere to the course of treatment,and the curative effect is not accurate.
Objective To explore the clinical features and drug resistance of patients with non-tuberculous mycobacterial pulmonary disease( NTM-PD). Methods The clinical data of 73 patients with NTM-PD whom were diagnosed by Foshan Fourth People's Hospital from 2016 to July 2017 were retrospective analysis. Results Male accounted for 47. 9% and female 52. 1%,and the average age was 62. 59 ± 14. 28 years old. The average body mass index of these 73 patients were 17. 50 ± 2. 88 kg/m~2. All of the patients had patchy shadows and nodules in their lungs,accompanied by fiber streaks. Most of them had bronchiectasis( 82. 2%),and secondly cavity( 52. 1%),but the consolidation accounted for only 12. 3%. 7 species of NTM were isolated,included Mycobacterium intercellulare( 43. 8%) and Mycobacterium chelonea-abcessus complex( 24. 7%). The rate of drug resistance was as follows:isoniazid( 100%), rifampin( 82. 2%), ethylamine butanol( 97. 3%), streptomycin( 98. 6%), amikacin( 100%),ofloxacin( 87. 7%),capreomycin( 91. 8%),and SHREACp O( 75. 3%),and the rate of drug resistance to all the above drugs was 41. 1%. Among them,40 cases were initial cases and 27 cases were retreated. 10 cases received anti-NTM treatment,and 2 of them completed 2 years period of treatment. The average period of treatment was( 8. 10 ± 8. 49) months. During 1-year follow-up,1 of them was effective,8 were invalid,and 1 turned worse. Conclusion NTM-PD is considered to be associated with malnutrition,and the lung image is similar to tuberculosis,mostly with bronchiectasis. The drug resistance of NTM is extremely high. The period of treatment is too long for patients to insist,not to mention the medicine untoward effects. Most patients fail to adhere to the course of treatment,and the curative effect is not accurate.
引文
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[4]童莉,谭守勇,刘志辉,等.广州市越秀区及海珠区非结核分枝杆菌流行状况[J].实用医学杂志,2015,31(13):2211-2213.
[5]中华医学会结核病分会,《中华结核和呼吸杂志》编辑委员会.非结核分枝杆菌病诊断与治疗专家共识[S].中华结核和呼吸杂志,2012,35(8):572-580.
[6]中华医学会结核病分会,非结核分枝杆菌病实验室诊断专家共识编写组.非结核分枝杆菌病实验室诊断专家共识[S].中华结核和呼吸杂志,2016,39(6):438-443.
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[8]中华医学会.临床诊疗指南:结核病分册[M].北京:人民卫生出版社,2005:64-86.
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[10]邓国防,付亮,唐怡敏,等.277例非结核分枝杆菌肺病治疗状况分析[J].中国防痨杂志,2017,39(4):391-396.
[11]史祥,尹洪云.58例非结核分枝杆菌肺病住院患者的临床分析[J].临床肺科杂志,2013,18(2):311-312.
[12]黄葵.非结核分枝杆菌肺病诊治研究进展[J].内科,2017,12(2):192-194.
[13]HERNNDEZ-GARDUO E,ELWOOD R K,Elwood.Increasing incidence of nontuberculous mycobacteria,Taiwan,2000-2008[J].Emerg Infect Dis,2010,16(6):1047-1048.
[14]SIMONS S,VAN INGEN J,HSUEH P R,et al.Nontuberculous mycobacteria in respiratory tract infections,eastern Asia[J].Emerg Infect Dis,2011,17(3):343-349.
[15]CASSIDY P M,HEDBERG K,SAULSON A,et al.Nontuberculous mycobacterial disease prevalence and risk factors:a changing epidemiology[J].Clin Infect Dis,2009,49(12):e124-e129.
[16]曹仕鹏,傅满姣,罗丹.非结核分枝杆菌肺病54例临床特点分析及诊治体会[J].广西医学,2016,38(3):328-331.
[17]姚岚,郝晓晖,唐神结,等.非结核分枝杆菌肺病144例的影像学特点分析[J].中华结核和呼吸杂志,2012,35(8):615-616.
[18]陈晓丽.25例非结核分枝杆菌肺病诊治体会[J].临床肺科杂志,2015,20(11):2122-2123.
[19]方木通,苏优峰,刘厚明,等.93例非结核分枝杆菌肺病患者临床分析[J].北京医学,2013,35(9):777-779.
[20]ANDRJAK C,NIELSEN R,THOMSEN V,et al.Chronic respiratory disease,inhaled corticosteroids and risk of non-tuberculous mycobacteriosis[J].Thorax,2013,68(3):256-262.
[21]BRAUN E,SPRECHER H,DAVIDSON S,et al.Epidemiology and clinical significance of non-tuberculous mycobacteria isolated from pulmonary specimens[J].Int J Tuberc Lung Dis,2013,17(1):96-99.
[2]BRODE S K,DALEY C L,MARRAS T K.The epidemiologic relationship between tuberculosis and non-tuberculous mycobacterial disease:a systematic review[J].Int J Tuberc Lung Dis,2014,18(11):1370-1377.
[3]THOMSON R M.Changing epidemiology of pulmonary nontuberculous mycobacteria infections[J].Emerg Infect Dis,2010,16(10):1576-1583.
[4]童莉,谭守勇,刘志辉,等.广州市越秀区及海珠区非结核分枝杆菌流行状况[J].实用医学杂志,2015,31(13):2211-2213.
[5]中华医学会结核病分会,《中华结核和呼吸杂志》编辑委员会.非结核分枝杆菌病诊断与治疗专家共识[S].中华结核和呼吸杂志,2012,35(8):572-580.
[6]中华医学会结核病分会,非结核分枝杆菌病实验室诊断专家共识编写组.非结核分枝杆菌病实验室诊断专家共识[S].中华结核和呼吸杂志,2016,39(6):438-443.
[7]CEDERHOLM T,BOSAEUS I,BARAZZONI R,et al.Diagnostic criteria for malnutrition-An ESPEN Consensus Statement[J].Clin Nutr,2015,34(3):335-340.
[8]中华医学会.临床诊疗指南:结核病分册[M].北京:人民卫生出版社,2005:64-86.
[9]DALEY C L,GRIFFITH D E.Pulmonary non-tuberculous mycobacterial infections[J].Int J Tuberc Lung Dis,2010,14(6):665-671.
[10]邓国防,付亮,唐怡敏,等.277例非结核分枝杆菌肺病治疗状况分析[J].中国防痨杂志,2017,39(4):391-396.
[11]史祥,尹洪云.58例非结核分枝杆菌肺病住院患者的临床分析[J].临床肺科杂志,2013,18(2):311-312.
[12]黄葵.非结核分枝杆菌肺病诊治研究进展[J].内科,2017,12(2):192-194.
[13]HERNNDEZ-GARDUO E,ELWOOD R K,Elwood.Increasing incidence of nontuberculous mycobacteria,Taiwan,2000-2008[J].Emerg Infect Dis,2010,16(6):1047-1048.
[14]SIMONS S,VAN INGEN J,HSUEH P R,et al.Nontuberculous mycobacteria in respiratory tract infections,eastern Asia[J].Emerg Infect Dis,2011,17(3):343-349.
[15]CASSIDY P M,HEDBERG K,SAULSON A,et al.Nontuberculous mycobacterial disease prevalence and risk factors:a changing epidemiology[J].Clin Infect Dis,2009,49(12):e124-e129.
[16]曹仕鹏,傅满姣,罗丹.非结核分枝杆菌肺病54例临床特点分析及诊治体会[J].广西医学,2016,38(3):328-331.
[17]姚岚,郝晓晖,唐神结,等.非结核分枝杆菌肺病144例的影像学特点分析[J].中华结核和呼吸杂志,2012,35(8):615-616.
[18]陈晓丽.25例非结核分枝杆菌肺病诊治体会[J].临床肺科杂志,2015,20(11):2122-2123.
[19]方木通,苏优峰,刘厚明,等.93例非结核分枝杆菌肺病患者临床分析[J].北京医学,2013,35(9):777-779.
[20]ANDRJAK C,NIELSEN R,THOMSEN V,et al.Chronic respiratory disease,inhaled corticosteroids and risk of non-tuberculous mycobacteriosis[J].Thorax,2013,68(3):256-262.
[21]BRAUN E,SPRECHER H,DAVIDSON S,et al.Epidemiology and clinical significance of non-tuberculous mycobacteria isolated from pulmonary specimens[J].Int J Tuberc Lung Dis,2013,17(1):96-99.