支气管扩张合并非结核分枝杆菌感染临床分析  

Clinical analysis of nontuberculous mycobacterial infection in patients with bronchiectasis

作　　者：郑艳[1] 周华[1] 周建英[1] ZHENG Yan;ZHOU Hua;ZHOU Jianying(Department of Respiratory Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院呼吸内科,杭州310003

出　　处：《中国感染与化疗杂志》2019年第3期253-258,共6页Chinese Journal of Infection and Chemotherapy

基　　金：浙江省自然科学基金项目(LY16H190004);浙江省医药卫生科技项目(2015RCA009;2016KYA075)

摘　　要：目的探讨支气管扩张(支扩)合并非结核分枝杆菌(nontuberculosis mycobacteria,NTM)感染患者的临床特点和肺部影像表现。方法回顾性分析浙江大学医学院附属第一医院2016年6月-2018年6月确诊为支扩合并NTM感染的患者,收集患者临床、微生物学、影像等资料。结果共有40例患者诊断为支扩合并NTM感染,其中27例感染Ⅲ组分枝杆菌,均为鸟-胞内分枝杆菌复合群(Mycobacterium avium complex,MAC),占67.5%(27/40);11例感染Ⅳ组分枝杆菌,均为龟-脓肿分枝杆菌复合群,占27.5%(11/40);2例感染Ⅱ组分枝杆菌,均为堪萨斯分枝杆菌,占5.0%(2/40)。龟-脓肿分枝杆菌复合群的患者出现咯血症状的比例明显高于MAC感染的患者(χ2=8.212,P=0.004),MAC则以胸闷气促、发热常见。NTM感染的支扩患者痰抗酸杆菌涂片阳性率高达86.8%,痰液NTM-DNA检测阳性率较高(89.4%),而血结核感染T细胞检测(T-SPOT)常阴性(94.1%)。支扩合并NTM感染的肺部影像中空洞、小结节、树芽征、斑片状渗出影常见,MAC组的支扩则常侵犯双上叶、中叶或舌叶。结论支扩合并NTM感染以MAC和龟-脓肿分枝杆菌复合群为常见;两者临床表现有差异,其中龟-脓肿分枝杆菌复合群组咯血发生率更高;影像表现多样,MAC组支扩以右肺中叶支气管最好发。Objective To investigate the clinical and chest imaging features of nontuberculous mycobacteria(NTM)infection in bronchiectasis.Methods A retrospective analysis was conducted with the clinical and microbiological data of 40 patients diagnosed with bronchiectasis and NTM infection in the First Affiliated Hospital of Zhejiang University School of Medicine.Results A total of 40 patients were identified with bronchiectasis and NTM infection,including 27 cases caused by Mycobacterium avium complex(MAC)(groupⅢNTM,67.5%),11 cases due to Mycobacterium chelonae-abscessus complex(groupⅣNTM,27.5%),and 2 cases caused by Mycobacterium kansas(groupⅡNTM,5.0%).Hemoptysis was found in significantly more patients infected with Mycobacterium chelonae-abscessus complex than those with MAC infection(P=0.004).Chest tightness and shortness of breath were common in the patients with MAC infection.Acid-fast bacillus sputum smear was positive in 86.8%of the bronchiectasis patients complicated with NTM infection.Blood T-SPOT was generally negative(94.1%).Sputum NTM-DNA was positive in 89.4%of the patients.Cavities,small nodules,tree-in-bud sign,and patchy exudate were usually seen in the pulmonary images of bronchiectasis combined with NTM infection.The bronchiectasis in MAC group usually invaded bilateral upper and middle lobes,or lingula of left lung.Conclusions The NTM infection in bronchiectasis is mainly caused by MAC and Mycobacterium chelonae-abscessus complex.The clinical manifestation varies with specific pathogen.Hemoptysis is more prevalent in the bronchiectasis patients complicated with Mycobacterium chelonae-abscessus complex infection than those with MAC infection.The pulmonary images are diverse in bronchiectasis complicated with NTM infection.MAC infection is frequently observed in the bronchus of right middle lobe.

关 键 词：支气管扩张 非结核分枝杆菌 结核感染T细胞检测 非结核分枝杆菌-DNA 

分 类 号：R562.22[医药卫生—呼吸系统] R378.91[医药卫生—内科学]