非结核分枝杆菌肺病54例临床特点分析及诊治体会  

Analysis on clinical characteristics and diagnosis-treatment experience of 54 cases of nontuberculous mycobacteria pulmonary disease

作　　者：曹仕鹏[1] 傅满姣[1] 罗丹[1] 

机构地区：[1]湖南省长沙市中心医院肺科医院结核病研究所,长沙市410004

出　　处：《广西医学》2016年第3期328-331,共4页Guangxi Medical Journal

基　　金：国家卫生和计委生育委员会科技重大专项课题(2013ZX10005004-002)

摘　　要：目的分析非结核分枝杆菌(NTM)肺病的临床特点,以提高对NTM肺病的诊疗水平。方法回顾性分析54例NTM肺病患者的临床资料。结果 NTM肺病≥40岁的中老年人多见(87.0%),病程较长,平均8.3年,多发于原有慢性肺部基础疾病或免疫力低下人群;临床症状无特异性,结核菌素试验皮试多为弱阳性(79.6%);胸部CT示病灶多位于双侧肺(81.5%)和全部肺叶(70.4%),薄壁空洞(14/18,77.8%)较厚壁空洞(4/18,22.2%)常见,均靠近胸膜,支气管扩张多位于右中叶或左舌叶(12/17,70.6%),钙化影少见(9.3%);支气管灌洗液NTM培养阳性率高(18/20,90.0%);菌种以鸟-胞内分枝杆菌(64.8%)和龟或脓肿分枝杆菌(25.9%)多见;对一线抗结核药耐药率高,耐药率均超过90%。极易误诊为肺结核(96.3%),治愈率低(34.8%)。结论 NTM肺病容易被误诊,治疗难度大,应分析其临床特点和诊疗上的难点,总结出提高NTM肺病诊疗成功率的策略。Objective To analyze the clinical characteristics of nontuberculous mycobacteria（NTM） pulmonary disease, and thus to improve the level of diagnosis and treatment of NTM pulmonary disease. Methods The clinical data of 54 patients with NTM pulmonary disease were retrospectively analyzed. Results NTM pulmonary disease was common in middle-elderly adults aged ≥40 years（87.0% ） ,had a long course（average course was 8.3 years）. It mainly occurred in the individuals with chronic lung diseases or hypoimmunity. No specific clinical symptoms were observed. Most of tuberculin skin test was weakly positive（79.6% ）. Chest CT showed the lesions were mainly located in bilateral lung（81.5% ） and the whole lungs（70. 4% ） ,the thin-walled cavity（ 14/18,77.8% ） was more than the thick-walled cavity（4/18,22.2% ）, and all of the cavities were located near the pleura. And the bronchiectasis were mainly located in the right middle lobe or left lingular lobe（ 12/17, 70.6% ）,but calcification was rare（9.3% ）. NTM culture positive rate of bronchoalveolar lavage fluid（BALF） was high（ 18/20,90.0% ）. Mycobacterium avium-intracellulare（64.8% ） and mycobacterium chelonae-abscessus （25.9%） were the majority, and the drug-resistance rate of the first-line anti-tuberculosis drugs was high and more than 90%. NTM lung disease was easy to be misdiagnosed as tuberculosis （96.3%） ,arid the cure rate was low （34.8%）. Conclusion NTM pulmonary disease is easy to be misdiagnosed, and the treatment is difficult. The clinical characteristics and the difficulties of diagnosis and treatment of NTM pulmonary disease should be analyzed, and then the strategies for improving the success rate of diagnosis and treatment of NTM pulmonary disease were summarized.

关 键 词：非结核分枝杆菌肺病 临床特点 诊治体会 

分 类 号：R517.9[医药卫生—内科学] R378.91[医药卫生—临床医学]