肺结核病与非结核分枝杆菌肺病互相继发4例报告并文献复习  

Four cases of pulmonary tuberculosis secondary to nontuberculous mycobacterium pulmonary disease or nontuberculous mycobacterium pulmonary disease secondary to pulmonary tuberculosis and literature review

作　　者：严舒俊[1] 黄景彬[1] 李永财[1] 李霞[1] 杨惠芳[1] 

机构地区：[1]广东省佛山市顺德区慢性病防治中心,广东佛山528300

出　　处：《医学信息（西安上半月）》2005年第6期629-632,共4页Medical Information

摘　　要：目的分析非结核分枝杆菌(Nontuberculous Mycobacteria,NTM)肺病及肺结核病与NTM肺病互相继发(或并发)的临床表现特点,提高认识,减少误诊。方法收集4例肺结核病与NTM肺病互相继发病例的有关资料,并文献资料一起分析。结果①NTM肺病的性别分布男多于女,发病年龄多见于40岁以上;②主要症状:咳嗽、咳痰、咯血(或血痰)、发热,③病程长,最长达50年,④多数患者有慢性病史,⑤X线胸片表现两侧达68%、单侧30%、空洞54%、胸膜累及40%,⑦对异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)的耐药性分别为:95%、73%、79%和74%。结论NTM肺病多见于有慢性病史,病程长,以咳嗽、咳痰、咯血(或血痰)、发热为主要症状,X线胸片,病灶分布两侧为多、多有空洞并累及胸膜,对常用的抗痨药物有高度耐药性;而患者病情较重与患肺结核或NTM肺病后容易互相继发(或并发)有一定关系。Objective To study the clinical characteristic of patients with pulm onary tuberculosis secondary to nontuberculous mycobacterium (NTM) pulmonary dis ease or NTM pulmonary disease secondary to pulmonary tuberculosis, and the aim t o improve cognition and reduce misdiagnose. Methods We collected 4 cases of pul monary tuberculosis secondary to NTM pulmonary disease or NTM pulmonary disease secondary to pulmonary tuberculosis, and the data of the cases together with the data of correlative literatures were analyzed. Results ① The sex distribution of NTM pulmonary disease: M>F, and the patients with NTM pulmonary disease were usually more than 40 years old. ② The main clinical symptoms of NTM pulmonary d isease included cough, expectoration, hemoptysis (bloody sputum) and fever. ③Ev ery patient with NTM pulmonary disease had a long progress, and the longest was 50 years. ④Most of the patients had medical histories of chronic diseases. ⑤Th oracic cavity with X-ray irradiation showed that 68% of the patients were damage d in the both sides, 30% in one side, 54% accompanied with cavities, and 40% inv olved in thoracic cavity membrane. ⑥The resistance rates of NTM strains were 95 %, 73%, 79% and 74% to isoniazid, rifampicine, streptomycin and ethambutol respe ctively. Conclusion NTM pulmonary disease is characterized by history of chroni c disease, long course of disease, with main symptoms of cough, expectoration, h emoptysis (bloody sputum) and fever, damages in both sides or thoracic cavity me mbrane and cavities in chest X-ray, high resistance to anti-tuberculosis drugs i n common use. Because of pulmonary tuberculosis secondary to NTM pulmonary disea se or NTM pulmonary disease secondary to pulmonary tuberculosis, the patients of NTM pulmonary disease are always seriously ill.

关 键 词：肺结核病 非结核分枝杆菌肺病 链霉素 乙胺丁醇 耐药性 

分 类 号：R521[医药卫生—内科学] R563[医药卫生—临床医学]